Don’t Get Bit by Mini-COBRA. Understanding Your Obligations as a Health Insurance Plan Sponsor.

The Consolidated Omnibus Budget Reconciliation Act, known as COBRA, is a federal law that requires certain employers to allow former employees to continue health insurance coverage for a specified length of time. While the coverage is at the former employee’s expense (plus up to an additional 2% admin fee), employers have certain obligations to remain in compliance.

COBRA applies to private employers that offer group health insurance plans and employ 20+ employees, but this definition gets tricky in states that have mini-COBRA laws such as Georgia.

If you don’t offer a group health insurance plan at all, you’re not subject to COBRA. But if you do provide a plan and, even if you only have a few employees, read on please.

After an employee walks out the door, the clock starts ticking on your COBRA obligations.

First, you have 30 days from an employee’s last day on the job (or upon qualifying for Medicare) to notify your health insurance plan administrator of the employee’s COBRA eligibility.

Second, the plan administrator then has just 14 days to notify the employee of the right to elect COBRA coverage.

Failure to comply could cause your company to be fined $110 for every day that a COBRA notice is late by the Department of Labor. The IRS can also assess penalties.

Additionally, you must offer the same coverage the employee elected while employed, and any dependents must be offered an opportunity to elect coverage even if the former employee opts out. Sixty days is the election period for both ex-employees and covered dependents, and coverage can be maintained for 18 months (in some cases for three years by spouses and dependents) so long as premiums are paid in full.

What is mini-COBRA?

Georgia, like some other states, has passed mini-COBRA laws to cover businesses that offer group health insurance but employ fewer than 20 employees. As such, in Georgia, if you employ at least two employees, you’re obligated to offer COBRA to former employees. However, the former employee must have had at least six months of continuous coverage immediately prior to termination. And, the employee can only extend coverage to the end of the term plus three additional months. If the employee was terminated for gross misconduct, you needn’t offer COBRA at all.

Several states have mini-COBRA laws, and they vary from state to state. Find your state here.

Keeping up with COBRA can be an administrative burden. Contact your PBG representative for guidance.

Think Twice Before Going Straight to the Emergency Room. Why Telemedicine, Convenience Clinics and Urgent Care Are Financial Lifesavers.

Going to the emergency department for healthcare services is expensive, and health insurance carriers are clamping down on what they will and will not reimburse. Depending on a patient’s symptoms, illness or injury, it’s the right place to go for care in many instances. But it’s still overused, and it’s costing health plan members, employers and hospitals.

BlueCross BlueShield of Georgia announced more than a year ago that it would no longer reimburse emergency room visits it deemed unnecessary. Instead, the insurance company encourages its health plan members to use telemedicine, convenience clinics or urgent care centers to receive non-emergency but urgent healthcare services.

Why exactly is emergency room healthcare so expensive?

According to data released late in 2018 by the Health Care Cost Institute (HCCI), emergency room spending per person grew 99 percent between 2009 and 2016 despite utilization remaining steady. Why?

There are many reasons for this increase, including more patients presenting at emergency rooms with high severity illness and injuries. Another reason is that according to federal law, hospitals and healthcare systems are required to provide emergency care to all patients even if they have no health insurance or ability to pay. Hospitals are left with billions of dollars of uncompensated care, and those costs are passed on to government and private health insurance companies through higher charges.

Of course, patients experiencing an emergency health condition or injury should go directly to the emergency room. But for those cases where you have time to seek lower levels of care, it would be financially prudent to do so. Let’s look at the options.

Sore throats, earaches, low-grade fevers, flu-like symptoms and mild injuries can often be addressed by your regular physician’s nurse line. Try calling the after hours care line first. As an established patient, some doctors will provide healthcare advice via phone.

If that isn’t an option, many insurance carriers now sponsor telemedicine healthcare. While patients have been slow to adopt this super accessible form of care, it’s wise to understand your benefits. Using your smartphone, tablet or computer, you can log in and virtually see a physician in minutes. They’re capable of assessing and diagnosing conditions and even prescribing medications in some cases, all for a similar fee to your office co-pay. Plus, you don’t have to leave the comfort of home.

In the event you need to be seen, seek out convenience care clinics covered by your health insurance plan. You often won’t wait long to be seen by a nurse practitioner or other licensed healthcare provider. They can diagnose conditions and prescribe medication. The fees may be slightly higher than office co-pays, but far less than a visit to urgent care or the emergency room.

While these are great options for minor illnesses and injuries, there are times when you need access to higher-level care. In these situations, urgent care centers are a great alternative to emergency rooms. Many have labs, x-ray machines and other diagnostic equipment to diagnose. The costs are going to be lower, generally less than half that of an emergency room.

When you or a loved one is ill or injured, it’s tempting to seek out the best care possible. Use sound judgment when determining if emergency care is necessary. Difficulty breathing, chest pain, open wound fractures, significant changes in mental status are just a few issues that would justify an immediate trip to the ER, but when possible, use right-level care. And as always, research your health insurance network each year so you’re aware of in-network providers at all care levels. It can save you thousands in out-of-network and unreimbursed costs.

Have additional questions about your health plan benefits? Please talk with your human resources department or your PBG representative.

Why Voluntary Benefits Aren’t Really So Voluntary for Today’s Employers.

Attracting and retaining top-notch talent is the number one reason employers provide competitive benefit packages. Interestingly, Mercer found that 89 percent of employers are now including voluntary benefits as part of their comprehensive benefits offering. Simply put, employees are used to seeing these options in their new-hire paperwork, and the trend isn’t likely to change for good reason.

Voluntary insurance benefits were originally added to benefit packages as a way to fill gaps in health insurance plans. While provided by employers, they’re paid for entirely (or near entirely) by employees through payroll deduction.

Typically, life insurance, disability, dental and vision are the most common options. But competitive employers are getting creative with their suite of benefits. In fact, we’re starting to see employers offer financial planning, online education, pet insurance and other employee-requested plans. Before we talk about the benefits most requested by employees, let’s review the three reasons voluntary benefits aren’t so voluntary anymore.

  • Employees are demanding them. With the workforce changing and employees leaving companies more frequently, your best talent is likely to choose an employer who offers the benefits they want.
  • Employees are worried about their financial future more than ever. Voluntary benefits like life and disability provide financial security. By offering these plans, employees are more focused on their work, and less so on the day-to-day financial demands during stressful times.
  • They’re inexpensive. Buying voluntary benefits under a group plan is more cost-effective than it is for employees to purchase them on their own. 

What are the newest trends and most requested voluntary benefits?

  • Identity theft protection
  • Pet insurance
  • Long-term care insurance, including cancer care
  • Discounts on things like everyday purchases at retail outlets and travel benefits
  • Wellness, nutrition and fitness discounts

Not surprisingly, employees are asking for benefits that help them better balance competitive, demanding careers with healthy, enjoyable personal lives. The best employees appreciate employers that ease that burden. But education is key for employees to really understand (and respond positively) to the value of the total benefits package. If your goal is to attract and retain the best staff, then start by asking what benefits they value most. Then consider deploying the following methods to communicate their worth:

  • Use financial benefit statements during the new hire process, as well as annually during open enrollment.
  • Provide hypothetical cost modeling for employees so they understand the potential financial implications of a short/long-term disability or illness compared to the modest cost of the insurance.
  • Offer monthly education via email about the financial risks of being uninsured
  • Encourage employees to use voluntary benefits such as financial planning and lifestyle enrichment.

Turnover will always be part of running a business. Fortunately, a thoughtfully designed voluntary benefits package can mitigate the loss of great employees.

Interested in adjusting your voluntary benefits package? Please talk with your PBG representative.

Everyone Wins When Employees Use Preventive Healthcare Services.

All Affordable Care Act health plans include 21 preventive care services that are covered 100 percent by health insurance as long as you go to an in-network provider. That means no copay, no deductible and no coinsurance. Examples include cancer screenings, annual physicals and other screenings that help minimize long-term health risks and/or focus on early detection when treatment protocols work best. Yet, according to the Centers for Disease Control and Prevention (CDC), Americans use these preventive services at only half the rate available.

Forgoing preventive health care is one reason why Americans spend so much on health care services. The CDC reported recently that treating chronic diseases that are often preventable such as type-2 diabetes accounts for 86 percent of the nation’s health costs. More importantly, these statistics mean we’re sicker than we need to be, which impacts our quality of life, as well as contributes to higher health insurance premiums. 

What can employers do?

Start by educating employees of the health insurance plan’s preventive benefits and provide time away from work to complete the assessments. The scheduled time away will pay for itself in spades with lower health plan utilization and unexpected absenteeism. Help them understand how prevalent chronic health conditions are among Americans. As of 2012, half of all adults had one or more chronic health conditions according to the CDC, and it’s only getting worse. It’s vital that employees get screened for heart disease, arthritis, cancers, diabetes, etc.

The reality, however, is most employees don’t know all the preventive health screenings available to them through the employer-sponsored health insurance plan. Let’s review them and then look at effective ways you can communicate them to your employees.

  1. Abdominal Aortic Aneurysm screening (for men who have smoked)
  2. Alcohol abuse screening and counseling
  3. Aspirin use
  4. Blood pressure screening
  5. Cholesterol screening
  6. Colorectal cancer screening
  7. Depression screening
  8. Type 2 Diabetes screening
  9. Diet counseling
  10. Falls prevention
  11. Hepatitis B screening
  12. Hepatitis C screening
  13. HIV screening
  14. A variety of immunization vaccines
  15. Lung cancer screening
  16. Obesity screening and counseling
  17. Sexually transmitted infection prevention
  18. Statin preventive medication
  19. Syphilis screening
  20. Tobacco use screening
  21. Tuberculosis screening

Knowing that chronic diseases lead to 7 out of every 10 deaths and account for 75 percent of the nation’s health care costs is reason enough to encourage employees to maximize their preventive health benefits. You can do this by asking employees to comply with the health insurance company’s annual health assessment. It’s often just a simple online questionnaire that helps the insurance company identify early risk factors.

Other ideas to increase use of preventive health care benefits include:

  • Offering additional paid-time-off for annual physicals
  • Hosting a flu clinic or time off to get a flu shot
  • Emailing wellness education every month
  • Providing access to healthful snacks in the workplace
  • Organizing lunchtime walking groups and sponsoring employees who take part in charity 5k run/walks

At Partners Benefit Group, our goal is to help employers manage the costs of their health insurance plans. While we can’t predict the health care needs of employees, we can encourage them to best care for themselves. Have additional questions? Please talk with your PBG representative.

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