Strengthening the Employee Holistically

Employees have lives and needs outside the workplace—needs beyond a paycheck and benefits. The needs were always there – what is trending is the conviction that if their current employer isn’t fulfilling their needs, they’ll leave their jobs to work for an employer that will.

Employers can see increased talent retention and performance by understanding the importance of employees’ holistic wellbeing and learning how to design a positive employee experience.

Think holistically and strengthen the employee experience

Employers need a deeper understanding of what employee needs look like and how they can help their employees outside the workplace. Supporting employees’ holistic wellbeing includes providing support in these key areas:

  • Physical health:  Level of illness, injury, preventative care, and general lifestyle.
  • Financial health: State of personal and family financial security.
  • Mental health:  Condition of psychological and emotional wellbeing.
  • Social health: The ability to form satisfying interpersonal relationships with others.

If you want to support your employees’ physical, mental, financial, and social health, you’ll need a compelling employee experience. According to Met Life’s recent study, there are five key areas that will contribute to a good experience:

Purposeful work

Purposeful work is a top driver for employee mental, social, and physical health. Employees are interested in their employers having a clear purpose and a positive impact, which significantly influences retention. People also want to feel valued at their organization, so it is not only about contributing to purposeful work but also being valuable.

Flexibility and work-life balance

Flexibility and work-life balance have become a priority. Seven in ten employees rank work-life management benefits and programs like flexible hours and financial allowance for their home office as their top needs. It’s essential to recognize that flexibility means different things to different people. The key factors include:

  • Where they work (remote, hybrid, in-person)
  • When they work (setting working hours and “protecting” pockets of time)
  • What they wear
  • How Paid Time Off (PTO) can be used

Employees who are satisfied with the flexibility their employers provide are twice as likely to stay with their current organization for as long as possible or until retirement, and 82 percent of employees feel mentally healthy. 

Social and supportive cultures

Strong cultures bring people together and increase social health, resilience, and loyalty. People thrive off their connections with others, but it takes strong leadership and managerial support to bring that culture to life. For instance, 77 percent of employees with supportive managers say they feel mentally healthy versus only 47 percent of workers who do not feel supported.

Career development and training

Employees are serious about growing and advancing their careers and are not afraid to seek employers that will support their careers. Job seekers look for roles that offer development, training, and advancement opportunities and see them as a must-have. The number of job seekers looking for jobs with those coveted benefits has grown by 8 percent since 2020; employers that offer these opportunities are more likely to have successful employees.

Wellness programs and benefits

Regarding mental health, wellness programs and benefits are the best route. This may include fertility benefits, parental leave policies, pet insurance, and employee-assisted programs (i.e., mental health counseling, legal support, and credit counseling). These benefits support the inner workings of employees’ personal lives, produce resilience, and improve overall mental health.

Why it matters

Employers face a tight labor market marked by declining job satisfaction and loyalty. Only 66 percent of employees say they are satisfied at their place of work (a 20-year low). If you’re thinking, “Well, I know my employees are loyal and satisfied,” be cautious. There is a significant gap in employer and employee perceptions. While 86 percent of employers believe their employees are loyal and satisfied: 

  • 55 percent of employees say their employer has their best interests in mind
  • 39 percent of employees would recommend their employer as a place to work
  • More employees are quitting their jobs to work for an employer that meets their needs

The same study found that holistically healthy employees are more likely to be satisfied with their current job, feel engaged and productive, and intend to stay with the company for at least 12 months. Understanding the value of supporting your people can make a huge difference.

Pursuing wellbeing is good business

It is safe to say that employees expect more support from their employers in many areas, at work and beyond. The good news? Positive wellbeing is good business.

Organizations that care for their employees’ wellbeing, offer compelling benefits, and provide an attractive employee experience will seize the win-win opportunity. They will attract talent that will enable the organization to perform at its highest level. After all, employees are more engaged, loyal, and productive when their needs are met.

 

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What is Health Insurance? Why is It Important?

As an employer, if you’re shopping around for the best health insurance plan for your employees and wondering, “what exactly is insurance? And why is it important?” you are not alone. Insurance can be confusing—you may wonder how it works, the benefits of insurance, and how you can find the best plan and benefits for your employees.

Let’s dive in.

What is health insurance?

Simply put, health insurance is a safety net that helps your employees and their loved ones stay healthy with preventative care and medications, as well as help them recover after something like an illness or an accident. When your employees experience something covered by their insurance, and they file a claim, the insurance pays the provider based on the terms of the policy.

You want employees to feel protected and to be proactive about their health. Not doing so can lead to greater health risks long-term and cost them financial security. Insurance protects them from this risk. You hope your employees spend more time using their insurance for preventative care than catastrophic care, but if they have no insurance, either scenario will put them in a difficult financial situation.

How does insurance work?

Insurance is, essentially, a “rainy day fund” that is shared by your employees and managed by what is called an insurance carrier. The insurance carrier uses the money collected, called a premium, to help fulfill its promise to your employees when a claim is filed. Insurance also has a policy limit, the maximum amount the carrier will pay under the policy, and a deductible, the amount your employees must pay themselves, out of pocket, before the carrier pays a claim.

What are the benefits of insurance?

Having insurance allows your employees to manage life events that inevitably come up. Insurance helps keep your employees’ lives on track as much as possible after something happens. Insurance also:

  • Helps your employees live their lives with fewer worries. Employees know they’ll receive financial assistance after an accident and have support to recover, and it provides protection for when the worst happens.
  • Increases employee retention rates. When you offer health insurance to your current employees, it shows that you care about their wellbeing—and when you offer it to potential employees, you widen your pool of candidates.
  • Helps maintain your employees’ current standard of living. If they become disabled or have a critical illness, insurance can cover their day-to-day costs and other expenses while they focus on their health and recovery.
  • Helps give your employees peace of mind. A study shows that when needed health care, such as medications, increased in price by ten dollars, people stopped buying those medications. Life happens, and your employees cannot anticipate what might come up.

How do I choose an insurance advisor?

Consider the following when choosing an insurance agency and advisor to help secure coverage for your employees:

  • Type of coverage. What kind of insurance does the agency offer? Can they advise and educate on a spectrum of policies such as fully insured, level-funded, or self-funded? Do they offer additional insurance options such as life insurance or ancillary benefits? The more you know, the better position you’ll be in to make educated decisions for your business and your employees.
  • Education and resources. What resources does the agency offer to help you manage your insurance and benefits program? Do they proactively share information and materials? Do they make resources readily available?
  • Customer service. Do others recommend this agency? What do others say about them? Look them up online to see Google reviews, explore testimonials and case studies on their website, and review their LinkedIn profiles.

Taking the time to research a company before engaging in a sales conversation is common for buyers today. But be sure you are also making time in your process to spend quality time getting to know your future advisor.

Great insurance agencies and advisors will take the time to educate you about different options. Get a sense of how capable they are at informing and educating, so you can feel confident and informed about a potentially unfamiliar topic. Make your advisor selection based on building a relationship with someone who will work collaboratively to help you make the best decisions for your business.

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Why (and How) You Should Care About Employee Health

The month of May, deemed Global Employee Health and Fitness Month (GEHFM), is a time to observe how the benefits of health and a healthy workplace make a difference in employers’ and employees’ lives. Employees in good health, both physically and mentally, are more likely to give their all to their organization. When employees have health-related issues, and nothing is done to help them, it affects their lives and costs businesses money. An estimated $530 billion a year, in fact.

The good news is that improving employee health is not an impossible feat. It’s quite possible! Show your employees you care about their health and wellbeing with these tips you can implement in your workplace.

Give employees autonomy

Research done by McKinsey Quarterly shows that the higher someone’s rank is in a company, the lower the instances of health issues such as stress and cardiovascular disease.

Why? The higher the rank, the lower the stress and chances for illness.

But why?

Even though these high-ranked employees faced many demands in their job, they enjoyed more control over their tasks, how they did them, and when.

This kind of autonomy needs to apply to all your employees. Instead of looking over their shoulders and being a helicopter, give your employees control over their tasks. You can still provide priorities and task deadlines but let them choose what tasks to work on during their day—and how they do them.

Encourage physical activity

A sedentary lifestyle at home and work can lead to health-related issues such as back pain, which 8 out of 10 people experience at some point in their life. Encourage your employees to get up and move during the day—taking a walk, stretching at their desks, and doing yoga are all good options. If your office is onsite, provide workstations with ergonomic chairs and standing desks. If your employees work remotely, consider giving them a stipend that they can use to make their at-home workstation ergonomic.

Help avoid digital eyestrain

Thirteen hours. That is how much time the average person spends daily in front of a digital screen (computer, phone, television), including both personal and work screen time, according to the Screen Time Report. In the same report, 71% of employers estimate their employees spend three or more hours staring at a screen—and 10% estimate their employees spend ten or more hours staring at a screen.

Your employees are locked in to some kind of screen during most of their day, so encourage them to give their eyes a rest by following the 20-20-20 rule: Every 20 minutes, take a break and stare at something 20 feet away for 20 seconds.

Give a shoulder to cry on

Having social support—family and friends you can count on—directly affects health. The same is true for workplace support. Having a competitive culture that pits people against one another weakens social support. Also, having a transactional culture, where people feel like they’re just a number instead of a valued employee, further weakens that support.

Let your employees know that you and their fellow employees have their back and make your company culture one of support and empathy. This lets them know they can trust one another and leads to happier employees.

Don’t make people choose

Life is a trade-off between work and family commitments. Parents have school and sports commitments for their children; people have aging relatives they might need to take to doctor’s appointments. But for many people, these are stress-inducing events because they feel forced to choose between one or the other—work or family.

Make sure your employees know that family and other personal commitments are a part of life. Give them flexible schedules so they don’t miss out on important moments or appointments—because when people feel happy and fulfilled at home, it will reflect in their work.

Encourage employees to actually end the day

 

Multiple studies show that the number of hours worked does not necessarily equate to productivity. Once the workday is done, encourage your employees to clock out and enjoy their evenings and weekends with their friends and family. If your employees work remotely, encourage them to do the same and to log off their computers when the workday is done.

Invest in your employees’ health

When you show that you care about the health and wellbeing of your employees, they will notice. Give them access to health insurance, health and wellness programs, annual health screenings, and health education with practical, straightforward advice that your employees can put into practice. By providing these, you give employees the chance to take charge of their health.

Try “office recess”

Remember recess as a kid? It was a time to play, recharge, and have fun. Office recess is the same concept, where you encourage employees to “take a recess”—to pause and do something for themselves. This gives employees a mid-day energy boost and gets them started on the path to relaxation.

Be healthy, be happy

Employee health is a good investment. When you take the time to make sure they are healthy and happy—both physically and mentally—they will remember it and give their all for you. Use this month to spend time considering how you can make positive, forward-thinking changes to your company that promotes the health and wellbeing of your employees. Even small changes can make a difference. As you work to make these improvements, empowering employees to make healthy decisions for themselves, your culture, productivity, and internal relationships will improve—along with employee health.

 

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Why Employee Benefits Are Important

Employees are the backbone of your organization, the people that keep things running smoothly and keep your clients happy—and a generous benefits package goes a long way toward keeping employees happy. But long gone are the days when only employee compensation, free lunches, foosball tables, and nap rooms met people’s needs.

The pandemic happened. And with it came the Great Resignation, where 4.5 million US workers left their jobs voluntarily in 2021. Wanting a different lifestyle, high healthcare costs, rising inflation, the financial challenges posed by the pandemic, and needing to feel rewarded and appreciated for their work are a few reasons people left their previous positions.

People want and expect more from their position and employee benefits and believe they can get more, so they are. It’s time to start paying attention to the current feelings behind employee benefits—and why you should offer not just good but great benefits.

Employee attraction and retention

Let’s throw some percentages up in the air: 49%, 78%, and 40%.

  • 49% of your employees will start looking for new work in the next 12 months if they aren’t happy with their job or benefits.
  • 78% of them will stay with your company if your benefits package is attractive.
  • 40% of potential new employees will seriously consider your company if your benefits package addresses their wants and needs.

Employees want to work in a caring company culture where they get more from their job than a place to work and a paycheck. With excellent benefits, you show you value people, and you will not only attract new employees but also retain your current ones.

Work/life balance

Blending the demands of work and life can leave employees feeling frazzled at the end of the day. There are projects to finish, deadlines to meet, dinner to make, sick kids to take to the doctor —all these demands can feel like balancing a wobbly stack of plates ready to crash.

With the rise in remote work, people are spending more time working than ever; nearly 70% say they are spending more time working on the weekends because of the pandemic and the transition to remote work. Also, 45% of people now spend more time at work than ever before because of remote work. Providing substantial employee benefits like flexible schedules and paid time off gives them the support needed to help build the bridge between work and life.

Overall mental health and wellness

One in five adults will have mental health issues, but only one in three who need help will get it. And when employees don’t get the help they need, their work suffers: The World Health Organization estimates that mental health issues cost companies $1 trillion a year in lost productivity, but prioritizing employees’ mental health gives a return of $4 per person in improved health and productivity.

Despite money lost or money gained, people want a more open culture surrounding mental health and training on where to find assistance or resources. Focusing on overall mental health and wellbeing helps with overall morale.

Increased productivity

When employees wake up and come to work each day, you want them to feel fulfilled and ready to tackle any projects and challenges that come their way. When there is a robust benefits package to take care of employees, they will feel that they’re taken care of and will give back to you by being productive in their roles, providing excellent customer service, and being more engaged.

Improved financial security

Whether your employees are just starting their career or thinking about retirement, they want to have their immediate, short-term, and long-term financial security assured.

  • Immediate: Vital parts of immediate financial security are an employee’s paycheck, tuition reimbursement for their learning and education, monthly stipend reimbursements, and quality health insurance. Providing these immediate financial needs pushes worries to the back of your employees’ minds and gives them comfort and focus.
  • Short-term: This kind of security comes with offering a disability and life insurance plan. If your employees have family and the unexpected happens, the ability to earn income will be stalled or lost entirely. A disability and life insurance plan is important for when life, well…happens.
  • Long-term: Employees will, in the years ahead, want to fully retire or work part-time, which naturally leads to a reduction in income. Offering a good retirement plan (either a 401(k) or an IRA) builds up an employee’s net worth and gives them a solid nest egg to fall back on.

Giving employees assurance that these three forms of security will be taken care of is important—employees bring their home life with them to work, along with their worries. Alleviating those worries goes a long way.

Show them you care

Actions speak louder than words. A company should have values written down and also put those values into practice to show employees they care about them and their wellbeing. Giving employees a robust benefits package complements those values, leading to a positive culture and a pleasant workplace for all.

 

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Photo by fizkes

 

Three Employee Benefits to Help Your Employees Achieve Their Dreams

When employees feel supported by their organization, they’re much likelier to want to stick around. They’ll also feel more comfortable being themselves at work, which will help your company’s culture and sense of belonging. People who feel like they belong will work harder to protect and uplift their community than those who feel uncomfortable and unseen.

One great way to build trust and reliance that leads to long-lasting employee/employer relationships is enabling employees to pursue their personal goals outside of work. Employee benefits can play a vital role in helping you achieve this. Here are three benefits to consider that will make a lasting positive impact on the lives of your employees.  

Family planning benefits

Choosing to start a family is one of the biggest decisions a person can make during their life. Starting a family is expensive and scary—to build a healthy family, you need time and money. And without support from your job, it can be stressful to maintain a career. Making it easier for your employees to start a family can reduce stress, give peace of mind, and create stability. Offering these benefits to all your employees, regardless of relationship status or sexual orientation, is a great way to improve Diversity, Equity, and Inclusion (DEI) within your company.

Whether it’s paid parental leave, adoption aid, or fertility treatments, benefits that make it easier for your employees to start a family send a clear message: You care about the personal goals of your employees and want to make it easier for them to get what they want out of life.

Student loan support

Last year, a study found that the likelihood of high school students going to a four-year college plummeted by almost 20%, from 71% – 53%. People are worried about the cost and want to avoid debt. Since 1980, the cost of going to college has risen by 169%, yet the average pay for workers between the ages of 22 and 27 has only increased by 19%. It’s harder than ever for people to justify going to college, considering the debt they can expect to accrue.

Student loan or tuition support can make or break someone’s dream to go back to school. This benefit will not only empower your employees to educate themselves without the burden of debt, but also education will make a lasting impact on the rest of their lives, opening doors that would otherwise be shut.

Community engagement

 

When people volunteer and engage with their community, it can have positive effects on their health and mental wellbeing. It also gives them a sense of purpose that can be hard to get otherwise.

Consider offering benefits such as paid time off for community engagement. This will make it easier for your employees to set aside volunteer time. Finding the time to volunteer at their local voting office, old folks’ home, animal shelter, or community garden can be difficult with only two days off a week.

Offering paid time off specifically set aside for community engagement will give your employees that extra room to go do something they’re passionate about, whether it’s protesting, cleaning up their local nature reserve, or helping out a neighbor in need.

Their happiness is your success

 

The more fulfilled your employees feel, the happier they’ll be, and the stronger their relationship with your company will become. Creating an organization that empowers people to build their dreams isn’t just a fantastic way to leave a positive legacy in the world— it’s how powerful businesses are made. Talk to your benefits advisor to learn about other employee benefits that will help your employees achieve their goals.

 

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Just the Facts: Employee Healthcare Literacy

As mentioned in the previous week’s blog—only 4 to 14% of adults in the United States have a basic understanding of health insurance.

What does this mean? It means out of the current US population of 329.5 million, only 13.2 to 46.1 million people have the knowledge to understand their health insurance fully!

Instead of leaving your employees out in the cold and leaving their decisions about health insurance and healthcare to chance, help your employees understand why healthcare literacy is so important, so it can empower them to make good decisions.

The first step? Understanding what healthcare literacy is.

What is healthcare literacy?

It is how people interpret or act on health information and services. For example, receiving medication from a doctor and knowing how to read the label to decipher how much medicine to take or understanding and interpreting a medical invoice is considered a form of healthcare literacy.

There are two different types:

  • Personal healthcare literacy, or how well someone can find and understand health information/services needed.
  • Organizational healthcare literacy, or how well businesses/organizations help their employees find health information/services required.

Both types are about using health information and services to make the best health decisions possible.

What can affect healthcare literacy?

Many factors can affect someone’s healthcare literacy. For instance, if someone does not understand medical terms, they may not be able to understand or interpret a doctor’s diagnosis. Other factors that could potentially affect healthcare literacy are lacking an understanding of the healthcare system and how it works and other personal factors such as age, income, education, culture, language abilities, reading skills, writing skills, and math skills.

What happens if someone has poor healthcare literacy?

A person with poor healthcare literacy will often delay or avoid care, will not understand the costs associated with out-of-network care, will not ask their employer questions about their health insurance plan, and will be less likely to use preventive services and care, such as getting a flu shot.

Why is employee healthcare literacy important?

At some point, your employees will need to use their health insurance to access and understand health information and services like prescription services.

Their level of healthcare literacy affects:

  • The ability to navigate their health insurance plan and the healthcare system to find needed doctors and services.
  • Knowing when to share personal information with healthcare providers.
  • Practicing self-care and at-home procedures, as well as using preventative health services.
  • Understanding concepts such as cost-benefit ratios (weighing the risks and benefits of receiving medical treatment).

Having strong healthcare literacy lets your employees find the information and services they need, effectively communicate with their healthcare providers about needs/preferences, and understand their health condition and choices they have about treatments and doctors so they can decide what services and options are the best for them.

How can you, as an employer, help improve healthcare literacy?

A good step on the path to improving literacy is to ask your employees about their understanding of health insurance terms and concepts. You can use their answers and thoughts to specifically address areas where knowledge might be lacking.

Also, be sure to lean on and use your broker or advisor as a resource. Look at what they offer in terms of support to members in understanding their benefits and being healthcare literate. This can include resources, online portals, and mobile apps.

Understanding is one of many steps

Understanding healthcare literacy and what it is will help your employees understand what it is as well. Increasing healthcare literacy in your organization will, in turn, create well-informed and knowledgeable employees who feel confident and take charge of their healthcare decisions. And, as they say, knowledge is power.

 

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Why Healthcare Literacy Should Be a Top Concern for Employers (And What to Do About It)

These days, offering a group health plan for your employees is crucial for reducing turnover, keeping employees engaged, and attracting talent. But offering benefits is a huge investment for employers, making it an often stressful piece of running a business. Like any significant investment, group health plans become easier to implement when you can bring in a solid return on investment.

One major factor contributing to your ROI is the percentage of employees who actually use the benefits you offer. A chief component of whether they use their benefits relies on their ability to understand their plan. Unfortunately, people often struggle to understand their benefits—in fact, only 4-14% of adults have a basic grasp of health insurance. In the US, a whopping nine out of ten adults have difficulty using health information. Imagine the ratio of your employees who feel comfortable navigating their benefits plan and understanding the benefits available. Statistically, it reflects these numbers.

Lack of healthcare literacy is an epidemic that affects the health and wellbeing of employees. Lack of understanding leads employees to miss out on accessing and using their benefits, which has a direct correlation on their health outcomes.

For the sake of your employees’ wellbeing and for the value of your investment, it’s crucial you take steps to help improve your employees’ ability to understand, navigate, and use their health plans.

Use plain language

When communicating with your employees about their health plan, make sure you avoid healthcare jargon and confusing terms. Offer explanations for terms they might come across so they can better navigate unfamiliar language. Healthcare.gov offers an excellent glossary of terms and definitions you can share with your employees. Also, read through any documents your provider will offer your employees and familiarize yourself with them. If you find yourself having questions, chances are your employees will have those same questions.

Be proactive in helping employees find clear answers, for the easier it is for them to understand what they’re reading, the more likely they will use their benefits.

Communicate often

If you want your employees to take full advantage of their health plan, it’s important that it’s kept top of mind for them—this means making sure you’re not only communicating about benefits around open enrollment/renewal season.

Talking about benefits just once a year isn’t going to help your employees stay engaged with their health plan. Consider adding communications about their benefits in internal newsletters, employee reviews, and quarterly meetings. Keep the conversation going year-round, so health benefits always stay at the top of their mind.

Tailor your message

When talking about your benefits plan, create conversations and messages that center on the differing wants and needs of your employee population.

  • Have employees who are of the age where they may be considering starting a family? Make sure to remind them of your family planning benefits.
  • Is there an emotionally challenging situation your employees might be facing? (Say, a pandemic?) Remind them of their mental health benefits.
  • Have employees who are traveling? Don’t forget to highlight their access to your telehealth benefits.

Whatever your health plan offers, it’s crucial to understand how it addresses your employees’ needs so that you can create meaningful and engaging conversations based on specific concerns.

Get the message out

You won’t be able to overturn healthcare illiteracy overnight. Still, with a tailored, clear, and thoughtful communication year-round, you’ll be able to affect your employees’ engagement with their health benefits. And through that effort, you’ll empower them to preserve their health and wellbeing. When in doubt, talk to your benefits advisor for suggestions on how to increase healthcare literacy within your company and in turn, increase ROI on your investment.

 

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Agencies Issue FAQs Regarding Coverage of Over the Counter COVID-19 Diagnostic Tests

Agencies Issue FAQs Regarding Coverage of Over the Counter COVID-19 Diagnostic Tests

On December 2, 2021, President Biden announced that federal agencies would soon issue guidance regarding the availability of coverage/reimbursement from group health plans and health insurance carriers for individuals who purchase over the counter, at-home COVID-19 diagnostic tests (“OTC COVID-19 tests”).  Accordingly, on January 10, 2022, the agencies released “FAQs About Affordable Care Act Implementation Part 51, Families First Coronavirus Response Act (FFCRA) and Coronavirus Aid, Relief, and Economic Security Act (CARES Act) Implementation” which, among other things, requires group health plans and health insurance carriers to reimburse participants, beneficiaries, or enrollees (“Individuals”) for no less than eight (8) OTC COVID-19 tests per calendar month beginning on January 15, 2022 (i.e., for tests purchased on or after January 15, 2022).

Background

During the COVID-19 public health emergency, the FFCRA requires group health plans (self-funded, fully-insured, grandfathered, and non-grandfathered plans, but not excepted benefits such as dental or vision) and health insurance issuers (“Plans and Carriers”) to cover testing or certain other items or services intended to diagnose COVID-19 without cost sharing (deductibles, copays, or coinsurance), prior authorization, or other medical management requirements.  It also permits the agencies to implement the FFCRA through sub-regulatory guidance, program instruction, or otherwise.  The CARES Act expanded the FFCRA to, among other things, include a broader range of reimbursable COVID-19 diagnostic items and services that must be covered without cost-sharing, prior authorization, or medical management during the public health emergency.

In 2020, the agencies implemented several FAQs intended to serve as statements of policy to implement the above-referenced requirements under the FFCRA and CARES Act.  Since that time, the FDA has authorized at-home OTC COVID-19 diagnostic tests that individuals can self-administer and self-read to diagnose COVID-19.  Accordingly, per the agencies, the FAQs issued on January 10, 2022 are intended to address both the FDAs approval of at-home OTC COVID-19 tests and the President’s request for additional guidance on group health plan coverage for these tests to address the ongoing COVID-19 public health emergency.

 

FAQ Guidance

Pursuant to the FAQs, Plans and Carriers must cover OTC COVID-19 tests that meet the criteria specified under the FFCRA even if they are not ordered by a health care professional, and must cover such tests without imposing cost-sharing, prior authorization, or medical management requirements.  This is so even if there is no order from a health professional for an Individual.

Coverage by the plan may be accomplished by directly reimbursing Individuals for their purchase upon submission of a claim by the Individual, or by reimbursing the entity who sold the OTC COVID-19 test directly, though the agencies strongly encourage plans to adopt the latter approach.

Note, however, there is no requirement for Plans or Carriers to provide coverage of OTC COVID-19 tests that are intended for employment testing, such as weekly testing an unvaccinated Individual is required to undergo pursuant to the OSHA Emergency Temporary Standard (“ETS”) or an employer’s own mandated testing program.

Plans and Carriers are required to reimburse OTC COVID-19 tests purchased from any retailer or pharmacy if the test meets the FFCRA statutory criteria, but if the test is administered without a health care provider’s assessment or order for testing and purchased from out-of-network pharmacies or retailers, then the Plan or Carrier may limit reimbursement to the lower of the actual price or $12 per test if the Plan or Carrier arranges for direct coverage (meaning the Individual who purchases the OTC COVID-19 test is not required to seek reimbursement post-purchase or make any up-front out-of-pocket expenditures) of OTC COVID-19 tests that meet the FFCRA criteria through both its pharmacy network and a direct-to-consumer shipping program.  Per the agencies, the direct-to-consumer shipping program may be provided through one or more in-network provider(s) or another entity designated by the Plan or Carrier.

In order to limit reimbursements for tests purchased from non-preferred providers, Plans and Carriers must ensure there are an adequate number of retail locations (in-person and online) with access to OTC COVID-19 tests and communicate necessary information about the direct coverage program, including when it is available and which retail pharmacies are available.

Per the agencies, whether access is adequate is determined based on all relevant facts and circumstances, including where Individuals are located and current utilization of the Plans’ or Carrier’s pharmacy network by Individuals.  Further, if there are significant delays for individuals to receive the OTC COVID-19 tests, such as through the shipping program, the Plan or Carrier must allow Individuals to purchase (and be reimbursed for) their OTC COVID-19 tests from any retailer.

The agencies also recognize the important need for adequate testing to be available to health care providers who are diagnosing and treating COVID-19, and that everyone has reasonable access to OTC COVID-19 tests.  Thus, to prevent stockpiling and provide adequate safeguards, the agencies permit Plans and Carriers to limit OTC COVID-19 tests purchased by Individuals without a health care provider’s involvement or assessment, the agency provides a safe harbor from agency enforcement action for Plans or Carriers that limit the number of OTC COVID-19 tests eligible for reimbursement per Individual to no less than eight (8) tests per 30-day period or per calendar month.  Plans and Carriers are not permitted to limit Individuals to a smaller number of tests over a short period of time (such as limiting Individuals to four (4) tests per 15-day period).  Plans can choose to be more generous by reimbursing a larger number of OTC COVID-19 tests (i.e., more than 8) per calendar month if they prefer.

Testing for Employment Purposes

Plans and Carriers are permitted to address suspected fraud and abuse, such as taking reasonable steps to ensure OTC COVID-19 tests are purchased for an Individual’s (or their covered family member’s) own personal use as long as the steps do not create significant access barriers.  This may include requiring attestations that the OTC COVID-19 test was purchased by the Individual for personal, non-employment related use, will not be reimbursed by another source, and will not be made available for resale as long as the attestation process is reasonable and does not result in undue delay of reimbursement.  Plans and Carriers may also require reasonable documentation as proof of purchase, such as the UPC code from the OTC COVID-19 test, when claims are submitted.

Finally, Plans and Carriers may assist Individuals by providing education and information resources to support Individuals seeking OTC COVID-19 testing as long as the materials clearly indicate the Plan or Carrier is required to cover all OTC COVID-19 tests that meet FFCRA criteria (subject to the safe harbors referenced previously).  The FAQs provide some examples of potential education and information resources Plans and Carriers may use.

What Does This Mean for Employers?

Employers are encouraged to work with their carriers or third-party administrators and stop-loss carriers to ensure these new requirements are implemented and to determine whether the plan will implement any of the permitted safe harbors so that this can be effectively communicated to employees and their family members.

The agencies clarified that they will not take enforcement action against Plans or Carriers for modifying health insurance coverage mid-year to meet these requirements or for failing to meet the 60-day advance notice requirements (for changes made to information required to be included in SBCs) if notice of these changes is provided as soon as reasonably practicable.

Finally, employers should clearly articulate to employees that the employer’s testing policy adopted pursuant to the OSHA ETS, if any, is not subject to this requirement and, employees are expected to pay out of pocket for weekly COVID-19 tests without seeking reimbursement from the employer’s group health plan if the employer does not pay for the applicable testing.  Further, pursuant to the OSHA ETS, while the employer may allow an OTC COVID-19 test to be used for purposes of applicable employment testing, the test may not be both self-administered and self-read unless observed by the employer or an authorized telehealth proctor.

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About the Author.  This alert was prepared for Employee Benefit Consultants, Inc. by Marathas Barrow Weatherhead Lent LLP, a national law firm with recognized experts on the Affordable Care Act.  Contact Stacy Barrow or Nicole Quinn-Gato at sbarrow@marbarlaw.com or nquinngato@marbarlaw.com.

 

The information provided in this alert is not, is not intended to be, and shall not be construed to be, either the provision of legal advice or an offer to provide legal services, nor does it necessarily reflect the opinions of the agency, our lawyers or our clients.  This is not legal advice.  No client-lawyer relationship between you and our lawyers is or may be created by your use of this information.  Rather, the content is intended as a general overview of the subject matter covered.  This agency and Marathas Barrow Weatherhead Lent LLP are not obligated to provide updates on the information presented herein.  Those reading this alert are encouraged to seek direct counsel on legal questions.

© 2022 Marathas Barrow Weatherhead Lent LLP.  All Rights Reserved.

Breaking Down Full-Coverage Health Insurance

When it comes to attracting and retaining employees with various employee benefits, health insurance is at the top of their minds. A survey shows that “56% of U.S. adults with employer-sponsored health benefits said that whether or not they like their health coverage is a key factor in deciding to stay at their current job.” The same survey shows that “46% said health insurance was either the deciding factor or a positive influence in choosing their current job.”

With health insurance, the type of coverage is important. You may have heard the terms full-coverage health insurance or comprehensive coverage. Learn more about what this type of health insurance is, and why you should consider offering it to your employees.

What is full-coverage health insurance?  

Full-coverage health insurance, also known as major medical health insurance or comprehensive coverage, is a health insurance plan that provides overarching, broad coverage of a variety of healthcare services such as doctor visits, hospital visits, and emergency room visits.

In contrast to full coverage, limited-benefit plans (or supplemental policies) may cover only specific conditions (e.g., cancer) or specific types of services (e.g., hospitalization), or have a dollar cap on coverage. These plans are not considered comprehensive, nor are they considered minimum essential coverage, and are not regulated by the Affordable Care Act. However, they can be a good supplement to a full-coverage health insurance plan.

What should be included in a full-coverage health insurance plan?

At the minimum, a full-coverage health insurance policy, which includes all new individual/family and small-group major medical health insurance policies sold after January 1, 2014, must cover the ten essential health benefits outlined in the Affordable Care Act (ACA) with no annual or lifetime benefit caps:

  • Hospitalization
  • Ambulatory services (visits to doctors and other healthcare professionals and outpatient hospital care)
  • Emergency services
  • Maternity and newborn care
  • Mental health and substance abuse treatment
  • Prescription drugs
  • Lab tests
  • Chronic disease management, “well” services, and preventive services
  • Pediatric dental and vision care
  • Rehabilitative and “habilitative” services

What is considered a full-coverage health insurance plan?

  • Most group health insurance plans
  • ACA-compliant policies purchased in a state’s health insurance exchange/marketplace
  • ACA-compliant plans purchased off-exchange (purchased directly from an insurance company or through an agent or broker, outside of the ACA-created health insurance exchange)
  • Medicaid and Child’s Health Insurance Program (CHIP) plans (Medicaid has some exceptions. Some people qualify for limited-benefit Medicaid coverage; this is not considered comprehensive coverage.)
  • Medicare (either Original Medicare or Medicare Advantage, although Original Medicare is typically combined with a Medigap plan and Part D plan to provide comprehensive coverage)

Be aware that the term “comprehensive” regarding health insurance plans is like the term “natural” regarding groceries. It’s not an officially defined term and has no official marketing rules associated with its use.

A variety of full-coverage plans

Employers can offer different types of full-coverage plans to cover specific needs. Here are some examples, as given by the official government healthcare website:

  • Exclusive Provider Organization (EPO):  A managed care plan where services are covered only if you use doctors, specialists, or hospitals in the plan’s network.
  • Health Maintenance Organization (HMO): Usually limits coverage to care from doctors who work for or contract with the HMO, and it generally won’t cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage.
  • Point of Service (POS):  A health plan where you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. POS plans require you to get a referral from your primary care doctor to see a specialist.
  • Preferred Provider Organization (PPO):  A type of health plan where you pay less if you use providers in the plan’s network. You can use doctors, hospitals, and providers outside of the network without a referral for an additional cost.

Be well-informed and do your research

Buying health insurance means you should always do your research. It’s important to work with your advisor and legal counsel to help you understand the fine print and terminology (such as essential health benefits and minimum essential coverage) before offering plans to your employees. Full-coverage health insurance is what employees want from their employers, and implementing such a plan will lead to employee attraction, retention, and satisfaction.

 

Content provided by Q4iNetwork and partners

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6 Employee Benefits to Consider for 2022

Employee priorities have changed because of the pandemic, which has led employers to examine their employee benefits offerings for 2022. Key concerns brought up by employees include physical wellbeing, peace of mind, and financial health—huge issues challenging employers to consider benefits they might have ignored in the past.

Here are six employee benefits trends to consider for 2022.

Paid Time Off (PTO)

The balance of work and personal life is an essential consideration for employees in today’s workplace. SHRM states that US workers rank Paid Time Off (PTO) as the second most important benefit after healthcare. Also, according to Project: Time Off, employees who work for companies that encourage PTO are happier with their jobs. If PTO is something you want to consider for your employees, decide what works best for them and your organization.

Flexible work hours and location

When a whopping 40% of workers would consider quitting if their jobs offered no flexible hours or the opportunity to work from home at least a few days a week, it shows how vital remote work has become. Remote work benefits, such as time saved commuting, more personal time, better sleep, and better overall health can be attractive options to employees. Employers who want to attract and retain the best talent might offer flexible hours and remote work locations as an employee benefit.

Financial wellness

Financial stress skyrocketed during the pandemic, as 32% of people said the pandemic still affects their finances. Stressed employees are more distracted and less productive, making it a lose/lose situation for both employees and employers.

However, 80% of people who feel employers are committed to helping strengthen their financial resiliency are more likely to stay with their company. If, as an employer, you want to show your company is people-centered, a financial wellness benefit is something to think about.

Family planning

Currently, 10% of employers with 50 employees or less offer family planning and fertility benefits, and more than 30% of employers with 500 or more employees provide these benefits. Considering millennials are the largest generation in the US workforce today, and many are at the age where family planning plays an important role in their lives, offering family-focused benefits could be a smart move for employers. Employers who create strategic benefits plans that meet the current needs of their workforce will have an easier time attracting and retaining talent.

Student loan repayment

The number of people in the United who currently have an outstanding student loan debt is 44.7 million. A student loan repayment benefit aims to reduce the burden this debt has on employees and could attract millennial employees, as 28.9 million people in this age group are indebted borrowers.

Such a benefit would help with loyalty and retention, as 4 in 5 young people would commit to employers for 5 years if the employer helped pay their student loans. 

Mental health and wellbeing

During the pandemic, mental health issues such as anxiety and depression rose when the United States first went into lockdown. This is not an issue to ignore, both for the sake of employees’ mental health and an employer’s bottom line—depression, for instance, costs employers about $17 million to $44 million in lost productivity. With this in mind, think about expanding your employee health and wellness benefits to go beyond offering employee assistance programs (EAPs). An EAP is a type of employee benefits program that helps employees with personal and/or work-related problems that may impact their job performance and overall physical/mental wellbeing. For example, Joey Price, CEO of JumpstartHR, explained how companies are investing in mindfulness apps “to help employees balance the tension of work from home and life from home.”

Let your employees be the driver of your decisions

Now, more than ever, benefits that help with overall wellbeing and wellness are key trends to consider in 2022. But the best way to know what benefits your employees want? Ask them.

 

Content provided by Q4iNetwork and partners

Photo by imagehitevo