Category: Blog

To meet federal requirements, large health plans must obtain a national health plan identifier number (HPID) by November 5, 2014. For this requirement, a large health plan is one with more than $5 million in annual receipts. The Department of Health and Human Services (HHS) has said that since health plans do not have receipts, insured plans should look at premiums for the prior plan year and self-funded plans should look at claims paid for the prior plan year. Small health plans (those with less than $5 million in claims during the prior plan year) have until November 5, 2015, to obtain an HPID.

Although this requirement applies to all health plans, the insurer will obtain the identifier number for fully insured plans. Self-funded plans will need to obtain the number, even if they use a third party administrator (TPA) to pay claims. Plans will be required to use HPIDs in specified HIPAA standard transactions by November 7, 2016.

“Controlling Health Plans” (CHPs) are required to obtain an HPID. “Subhealth Plans” (SHPs) may obtain an HPID. A CHP is defined as a health plan that either:

• Controls its own business activities, actions, or policies; or
• Is not controlled by an entity that is not a health plan, and if it has one or more subhealth plans, exercises sufficient control over the subhealth plan to direct its business activities, actions, or policies.

An SHP is defined as a health plan whose business activities, actions, or policies are directed by a controlling health plan.

These definitions were written with insurance companies in mind, since they will be the ones obtaining and using most of the HPIDs. Applying them to self-funded plans can be a bit confusing and HHS has not released any guidance specifically explaining how to handle multiple plans offered by a single employer. In the absence of specific instructions, a reasonable approach would seem to be to use the same approach as the employer uses with its Form 5500 filing. If an employer bundles all of its group health benefits into a single “wrap” plan and files a Form 5500 under a single plan number, the employer should probably apply for a single HPID for all self-funded benefits under the wrap plan.

Although health reimbursement arrangements (HRAs) and health flexible spending accounts (HFSAs) generally are considered group health plans, HHS has said that these plans usually will not need an HPID. An HPID is not needed for a benefit that is not considered a group health plan, such as life, disability, or a health savings account (although the related high deductible health plan will need an HPID).

An employer will apply for its HPID through the Centers for Medicare and Medicaid Services (CMS) website. Many employers will first need to register and set up a health insurance oversight system (HIOS) account at https://portal.cms.gov/wps/portal/unauthportal/home/. Note that an individual must have a login before they can register a new user account. To obtain a login, the individual must provide personally identifiable information (name, Social Security number, birthdate, home address, and primary phone number).

For more information on the HPID, download UBA’s free publication, “Deadline Approaching for Larger Self-Funded Health Plans to Obtain a Health Plan Identifier”.

CMS has prepared – and recently updated – step-by-step instructions in both graphic and text formats in its Quick Guide and it also has prepared a short YouTube video – Learn how a Controlling Health Plan can obtain a Health Plan Identifier! – that will also walk the submitter through the process. There are several steps to this process, so it cannot be completed in one session.

Detailed information is available at: http://www.cms.gov/Regulations-and-Guidance/HIPAA-Administrative-Simplification/Affordable-Care-Act/Health-Plan-Identifier.html and at http://www.cms.gov/Regulations-and-Guidance/HIPAA-Administrative-Simplification/Affordable-Care-Act/Downloads/HPOESTrainingSlidesMarchSlideDeck.pdf. Questions may be directed to HHS at HPIDquestions@noblis.org.

By Linda Rowings
Chief Compliance Officer, UBA 

The U.S. Department of Health and Human Services (HHS), the Internal Revenue Service (IRS), and the Department of Labor (DOL) released final regulations that explain when dental and vision plans and employee assistance plans (EAPs) will be considered “excepted benefits.” Excepted benefits are health benefits that are limited enough in scope to be exempt from many of the requirements of the Patient Protection and Affordable Care Act (PPACA), such as annual dollar limits, reporting on W-2s and various fees.

Excepted benefits are not considered “minimum essential” coverage. This means that a large employer will not avoid the employer-shared responsibility (play or pay) penalty if it simply offers coverage that is considered an excepted benefit. It also means that an individual who is covered by an excepted benefit remains eligible for a premium tax credit, as long as the person meets the income and other requirements to receive the credit.

The regulatory agencies issued proposed regulations in December 2013 and the final regulations generally follow the proposed regulations, although in a few instances the final rule is less restrictive than the proposed rule. The proposed regulations also addressed a new type of benefit called a “limited wraparound” plan; the agencies will issue a final regulation on this benefit later.

Dental and vision benefit plans are considered excepted benefits if the benefits offered are limited to care of the mouth or eyes and the benefits either are provided under a separate policy or they are not an “integral” part of the medical plan. Under the final rules, benefits are not considered an integral part of a plan if participants have the right to opt out of coverage, or if claims are administered under a separate contract from other benefits administration. To qualify as a non-integrated benefit, employees do not have to pay a separate premium or contribution for the excepted coverage.

Particularly for self-funded plans, the new rules will make it much simpler for a stand-alone dental or vision plan to qualify as an excepted benefit. A benefit will be considered an “excepted benefit” if it meets any of these criteria:

• It is provided through a separate policy or contract.
• The employee may decline coverage for the stand-alone dental or vision coverage.
• Claims for the dental or vision benefits are administered under a contract separate from claims 
administration for any other benefits administration under the plan.

For more information on excepted benefits, including how to determine the status of EAPs, download UBA’s PPACA Advisor, “Excepted Benefits – ‘Limited Scope’ Dental and Vision Plans and EAPs.”

By Elizabeth Kay
Compliance and Retention Analyst
AEIS, a UBA Partner Firm

Health care reform has brought about many changes and growing pains. One of the changes we have seen recently in 2014 is the increased use of focused or ”narrow” provider networks. While these were implemented by the insurance carriers in the individual Marketplace to help control premium costs, we have seen the subscribers of employer sponsored or group plans affected as well, but it’s not in the way you might think.

Just before 2014, we talked with our clients, who are also providers, and informed them about the smaller networks ahead of time. This is so they could check with their carriers to confirm if they were going to be considered participating providers in the smaller networks to help avoid confusion, as many of them were not even aware that carriers had more than one HMO or PPO network that they offered. 

Later in 2014, we started receiving phone calls from some of our other clients and their employees complaining that they were unable to get in to see their doctors. They were being denied access to the same providers that they had been seeing for years, with their same insurance coverage, due to the provider citing that they no longer accepted their insurance carrier. 

Now, according to the insurance carrier, their providers were still contracted in-network providers, so why would they decline to accept their insurance?

Well, it turns out that the provider had seen some patients that had coverage with a carrier with whom they were contracted. However, upon submitting the claims to the carrier, the claims were not paid by the carrier because the insured had been issued coverage through our state Marketplace exchange with access to a narrow network, not the full carrier network.

To make matters more complicated, this particular carrier had used the same prefix and numbering system for the subscriber numbers of enrollees from the individual state Marketplace plans and enrollees in employer sponsored or group plans. 

Therefore, when the provider submitted claims for those enrolled through their employer, those claims were being declined by the carrier, even though they should have been accepted and paid.  But, because the subscriber numbers looked the same as those of individual enrollees, the claims system rejected them as it was coded to process claims based on the subscriber number, and not by another factor such as a group number.

As a result, the provider began denying any patients that had coverage through this carrier because they were not getting paid, and thought that their contract had been suspended or terminated.

After we had gone back and forth between the provider and the carrier, we finally discovered what the problem was, and they fixed the problem.

Once they were able to correct it, those provider’s claims that should be paid because they had coverage through an employer sponsored plan would be covered, as they had access to the full provider network. But providers were not really educated about any of this, so they were still denying patients.

We contacted the providers on behalf of our clients that had reached out to us with this problem and were able to educate them. We asked that they re-submit the claims for our clients. One billing specialist was in some disbelief, but we told her that we had confirmed with the carrier that the claims for our client would be paid, explained why the claims were declined in the first place, and finally convinced her to complete the re-submission process not only for our client, but for others that had been declined as well. We then took an additional step and told them the proper questions to ask their patients about what kind of coverage they have so that they can avoid having claims declined in the future.

So, I suppose the moral of the story is to educate, be informed, and be aware that even if you don’t have a plan with a narrow or skinny provider network, you can still be impacted. But as long as we keep calm, stick together, and have knowledgeable advisors to rely on, then we will be able to overcome these growing pains together.

Bring it on, 2015, we are ready for you!

To benchmark your plan design and costs with other employers of your size, geography and industry, request a custom benchmarking report from your local UBA Partner firm.

By Carol Taylor, Employee Benefit Advisor
D&S Agency, A UBA Partner Firm

There is a lot of buzz in the market right now as employers are implementing their plans for the upcoming year. Many employers are looking at ways to keep their costs for medical coverage low, but still meet the requirements of the Patient Protection and Affordable Care Act (PPACA). These plans, often referred to as ”skinny plans,” may only cover preventive services or may cover everything but inpatient or outpatient hospital services.

Since these plans will meet the minimum essential coverage requirement, as long as they are employer sponsored plans, they will allow employers to not be penalized under the “A” fine of $2,000 per employee less the first 30.

However, the lingering question remains about whether they meet minimum value. The plan that only covers preventive services definitely does not meet minimum value, even based on the calculator released by the Department of Health and Human Services (HHS). It returns a minimum value calculation of less than 12%, far below the required 60%.

There seems to be much confusion though, with plans that do not cover inpatient hospitalization services. If you are only basing their value on the HHS minimum value calculator, they barely pass with a 60.6% value, as seen below in Picture 1.  However, the Internal Revenue Service (IRS), who is tasked with enforcing the employer fines, has stated in IRS Notice 2012-31 that plans that do not cover the four core categories of coverage “would not satisfy any of the design-based safe harbors.” The four core categories they reference include physician and mid-level practitioner care, hospital and emergency room services, pharmacy benefits, and laboratory and imaging services.

Is it possible that there are technical issues with the HHS minimum value calculator? Quite likely. The first version of the calculator that was released did not calculate properly unless you ran the plan through a second time.

Actuaries believe that the skinny plans don’t pass the minimum value test. Using ClearPATH, a commercial grade actuarial value calculator developed by actuary Richard Burd, the same plan that passes the HHS calculator, fails the minimum value score with a mere 25.6% value. Pictures 2 and 3 show the details, using the same benefit design as shown in the HHS calculator. The ClearPATH input screen follows the benefits as outlined in a summary of benefits and coverages (SBC), with total transparency on cost assumptions, and is available from Contribution Health, in Lancaster, PA, or their software partner, Total Compensation Systems. It is interesting to note that other actuary models also place the value of these plans in the same range as ClearPATH.

Employers should approach these plans with extreme caution. Since the IRS is the agency that will levy the fines for those employers with more than 50 full-time equivalent employees that do not offer affordable, minimum value coverage, their own regulatory guidance should bear more weight.

Employers also should keep in mind they could be opening up potential liability for lawsuits under the Employee Retirement Income Security Act (ERISA). If HHS were to change, or in some views correct, their system, the employees would have made decisions based on not having all the correct information. They would have relied on their employer to supply them with that. If the employer did not perform their due diligence, not only would they be opening the door for potential lawsuits from employees, but IRS fines would also be levied. Unless the IRS also released transitional relief, these changes could occur in the middle of a plan year. With mandatory 60-day advance notice requirements of off-renewal changes, this could prove quite costly for an employer.

If faced with making that decision now, employers should always err on the side of caution. 

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Below are some to-dos for sponsors of self-funded group health plans.  The information is limited generally to the “what” and the “when.”  For more details on each of the items, request UBA’s PPACA Decision Guide for Self-funded Plans.   

1. HIPAA Risk Assessment & Training

A self-funded group health plan is a covered entity under the Health Insurance Portability and Accountability Act (HIPAA).  The HIPAA Privacy and Security Rules provide a baseline of protections for use and disclosure of individually identifiable health information held by covered entities and their business associates.  The Privacy Rule gives individuals rights regarding that information; the Security Rule specifies administrative, technical, and physical safeguards for covered entities and their business associates.  Employers sponsoring self-funded group health plans should, at a minimum, conduct and document a HIPAA Risk Assessment and train employees on the procedures and protocols that the company has in place to address the findings of the HIPAA assessment.

Employers should also review their state laws.  Some states have more stringent requirements.  For example, Texas law requires employees of covered entities to have HIPAA training within 30 days of employment and then ongoing training every two years. 

2. Update the Plan’s BAAs

Plan sponsors of self-funded group health plans need to be sure their business associate agreements (BAAs) have been amended to meet the requirements of the Health Information Technology for Economic and Clinical Health (HITECH) Act by September 22, 2014.   A “business associate” is a person or entity who performs functions or activities on behalf of, or provides certain services to, a covered entity that involve access by the business associate to protected health information and includes subcontractors that create, receive, maintain, or transmit protected health information on behalf of another business associate.

Sponsors should verify that a compliant BAA is in place between the plan and the plan’s TPA, broker, and other vendors which meet the definition of business associate. 

For more information, go to HHS Guidance for BAAs.

3. Apply for the Plan’s HPID

The Patient Protection and Affordable Care Act (PPACA) and HIPAA require that self-funded health plans obtain and use a 10-digit health plan identifier (HPID) in certain transactions.  The purposes of requiring HPIDs include:

• reducing administrative costs by adopting a uniform set of operating rules for each covered transaction;
• simplification of routing, reviewing, and payment of electronic transactions; and
• reduction in manual errors and manual intervention

The HPID must be used by health plans, or their business associates, when conducting electronic “standard transactions” beginning November 7, 2016.  Large health plans [GM1] must obtain an HPID by November 5, 2014.  For this requirement, a large health plan is one with more than $5 million in claims paid for the prior plan year.  Small health plans [GM2] have until November 5, 2015, to obtain an HPID.  A small health plan is one with less than $5 million in claims paid for the prior plan year.

Please Note:  The plan’s TPA may not obtain the HPID for the plan.

4. Filing and Payment of Transitional Reinsurance Fee

PPACA established the transitional reinsurance fee (TRF).  The funds generated by the TRF will help stabilize premiums in the individual insurance market.  The TRF applies to self-funded major medical plans for 2014, 2015, and 2016.  (Insurers pay the fee on fully insured medical plans.)

Plan sponsors of self-funded plans must report the number of covered lives and pay the fee to the federal government at www.pay.gov.  The filing of the number of covered lives is due by November 15, 2014.  While the form is not yet available, sponsors should [GM3] decide which is the most beneficial method for determining the number of covered lives.  The plan’s TPA may assist with the calculation and pay the applicable fee on behalf of the plan sponsor.

Plan sponsors may pay the fee in one installment, by January 15, 2015, January 15, 2016, and January 15, 2017, or in two installments each year.  If paid in installments, the larger installment will be due January 15 and the smaller installment will be due November 15.  For example, if the 2014 fee is paid in installments, $52.50 per person will be due January 15, 2015, and $10.50 per person will be due November 15, 2015.

5. 6055 & 6056 Reporting

Beginning in 2016, carriers, self-funded employers, ALEs, and individuals will be responsible for reporting coverage information based on the 2015 plan year.  In order for the IRS to verify that individuals and employers are meeting their shared responsibility obligations, and that individuals who request premium tax credits are entitled to them, employers and insurers will be required to provide reporting on the health coverage they offer. 

All applicable large employers will complete Part I and Part II of IRS Form 1095-C for each employee, regardless of whether the employee was eligible for coverage during the reported year.  Self-funded ALEs will complete Part III – covered individuals.  Part III requires the employer to report for each covered individual the covered individual’s name, social security number (SSN), and date of birth if the SSN is unavailable.

The reporting will occur with the same timing and process as W-2 and W-3 reporting. Even though these forms are not final, employers may want to study them as they begin to determine whether they are currently collecting, and will be able to retrieve, the information needed to complete the forms.

By Peter Freska, MPH, CEBS
Benefits Advisor, The LBL Group
A United Benefit Advisors Partner Firm

The Patient Protection and Affordable Care Act (PPACA) is driving companies to look at many aspects of their organization more strategically. With an estimated 2.5 million people in Professional Employer Group (PEO) arrangements totaling $92 billion in annual revenue, the spotlight was cast on them (source: https://www.napeo.org/about/annualreport.pdf). The questions related to the implications of PPACA on PEOs are many, and the law is still out for interpretation.

Focused provider networks (aka skinny or narrow) are nothing new to the health insurance marketplace.  Insurance carriers have been using different sized provider networks in their HMO and PPO portfolios for many years now.

The concept is familiar to most of us.  If you offer a smaller provider network, you can offer the same plan at lower premiums than the plan offered with a carrier’s full HMO or PPO network.

The question is, how effective are they in reducing, or maintaining lower premiums?

In order for the insurance concept to work so that people pay as little in premiums as they can, you have to get as many people as possible to participate.  That way, when there are claims, the more people who are paying premiums translates into lower premiums for everyone who is participating.  It’s simple division; right?  A $10,000 claim divided among 100 people is $100/person vs. $50/person when the same claim is averaged among 200 people.

So, with insurance premiums on the rise up to 182% from 1999 to 2013 compared to inflation at 40% over that same time period*, how are the insurance carriers going to get people to participate in the marketplace exchanges so that health care reform can be successful?

Well, they have to start by making it affordable.  How did they do that?  Well, they increased the maximum out of pocket to the maximum allowed under the Patient Protection and Affordable Care Act (PPACA), reduced the network sizes, and gave the participating providers in the smaller networks a pay cut.

In February of this year, I watched a panel of experts discuss the state of the marketplace exchanges at an industry conference in Orlando, Florida.  One panelist made a comment stating that he felt the marketplace plans with the focused networks were going to essentially “blow up.”  He felt the narrow network strategy to keep lower premiums was going to backfire.

He cited that the participating providers were potentially of lower caliber than those that chose not to participate because they knew that they could not provide their standard quality of care for the lower rate of pay.  He believed that we were going to see more re-admissions to hospitals for patients who were either sent home too soon, or who suffered a relapse, secondary infection, etc. Doctors may be more inclined to see as many patients as possible, so they may not spend the time needed with each patient, and misdiagnose, or miss things altogether that could otherwise have been caught early, or even prevented entirely.

If we see a rise in claims due to re-admissions, and other factors cited above, the insurance carriers will have to increase the premiums for the next year in order to cover their losses if they did not collect enough premiums the previous year, and adjust the rates to cover the cost of projected claims for the next year based on the new data they have collected from 2014.  What do we think those increases will be – 5%, 10%, 25%? 

In May, I had the opportunity to ask an executive at Blue Shield of California what he thought about this statement made by the panelist.  I asked him if he felt they would see higher utilization than expected on these ‘focused’ networks due to the quality of the participating providers.  He got a little uncomfortable in his chair (whether because he did not like the question, or because he had not been asked it previously, I’m not sure), paused and then said that he did not know.  He said they did not have enough claims data at that time to really be able to give an answer.

A major insurance carrier mentioned at the UBA 2014 Fall Meeting & Expo in Rosemont, Illinois, that they had to submit rates to governing bodies for January 1, 2015, before the end of the second quarter of 2014, before they had most of their new enrollments from the first open enrollment period under PPACA and the marketplace exchanges processed.  This means that they had to submit rates based on projections and not actual claims data from 2014.  Therefore, they may not know if the narrow network strategy will indeed backfire for at least another year or more.

Some carriers have stated they have seen a higher utilization in the smaller networks this year, mostly due to the newly insured population.  One of those carriers reported that the population using the smaller networks  also require more administrative time for carriers to educate insureds about the plans and how to use to use the plans.

This makes me wonder how long the providers in the narrow networks will be able to keep up with the demand and the cost of seeing numerous patients for lower payments from the insurance carriers.  It costs the provider time/money for their staff to submit claims to the carrier for payment.  If they have a higher volume of patients, that means a higher administrative burden on the provider.  Will they be able to keep their costs under control with the current pay rates from the carriers?  Will they be able to maintain the current contract, or will they have to re-negotiate, or pull their contract altogether?

Another issue that we have been facing with the ‘focused’ provider networks is that most of the carriers did not have a handle on accurate provider network listings when the marketplaces opened.  In fact, Covered California had to take down their provider search tool from their site completely because it was not accurate and people were enrolling in plans in which their current providers could not accept. 

There were many cases where individuals have been going to see their providers, only to be turned away saying that they do not accept that plan.  Once this has been discovered, some individuals have been able to change plans under the “qualifying life events” outside of the open enrollment period, according to Tracy Seipel, a reporter at the San Jose Mercury News. 

While this is great for those who have discovered their current providers are not in-network due to a routine office visit, it might not be so easy for those who have to seek services due to an emergency.  While a claim in the emergency room due to a possible loss of life or limb will be covered as an in-network benefit at any provider, thanks to PPACA legislation, it does not mean that a subsequent in-patient hospital stay at the same facility will be covered.

Now that we are in September, and are coming up to the open enrollment period, I find myself wondering; did it work?  Are we going to see more people leave the marketplace exchanges in January when their renewal premiums skyrocket?  Or will they be able to maintain close to the current rates?

I guess we may have to wait another few weeks, or until open enrollment in 2016, to find out how the “focused” provider networks will impact premiums.

To benchmark your plan design and costs with other employers of your size, geography and industry, request a custom benchmarking report from your local UBA Partner firm.

*Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999-2013.  Bureau of Labor Statistics, Consumer Price Index, U.S. City Average of Annual Inflation (April to April), 1999-2013; Bureau of Labor Statistics, Seasonally Adjusted Data from the Current Employment Statistics Survey, 1999-2013 (April to April).

It is back to school time!  Universities and colleges across the nation have dedicated time and resources to course planning and curriculum evaluation, but have they prepared for the Patient Protection and Affordable Care Act (PPACA)?  Have they run the numbers, solved for unknown variables, and double-checked their answers?

PPACA requires applicable large employers – employers that employ fifty or more full-time and full-time equivalent employees during business days of the preceding calendar year – to offer full-time employees and their dependents affordable, minimum value coverage or pay penalties (Play or Pay) beginning in 2015 or 2016.  In general, a full-time employee means, with respect to a calendar month, an employee who is employed an average of at least thirty (30) hours of service per week, or one hundred thirty (130) hours of service per calendar month, with an employer.  An hour of service is each hour for which an employee is paid, or entitled to payment, for the performance of duties for the employer; and each hour for which an employee is paid, or entitled to payment by the employer for a period of time during which no duties are performed due to vacation, holiday, illness, incapacity (including disability), layoff, jury duty, military duty or leave of absence.  Excluded from the hours of service calculation include those hours which are performed by a bona fide volunteer, hours performed by students as part of a federal work-study program or a substantially similar state program, or any hour for services to the extent the compensation for those services constitutes income from sources outside the United States. 

Universities employ students in various capacities – tutors, bookstore and recreation center workers, graduate assistants, resident hall advisors, and recruitment team members.  Beginning with benefit year 2015, universities will have to offer student workers health insurance if they qualify as full-time employees, pursuant to Play or Pay.  With Play or Pay drawing nearer, universities should be well into the preparatory phase.  Preparation includes reviewing policies which should limit the number of hours students can work per week for each semester.  Universities should also ensure an enforcement mechanism is in place for such policies.  Educating supervisors and student workers about the maximum number of hours a student can work is integral.  For tutors, bookstore and recreation center workers, and graduate assistants, this all is pretty straight forward.  The formula is simple.  Students who “punch-in” for fewer than 30 hours per week are not full-time employees and do not have to be offered university group health insurance.   However, there are some student worker positions that present a more difficult set of circumstances, with latent variables, that must be addressed.  Answering incorrectly could result in penalties under Play or Pay and penalties under federal wage and hour laws.

Tracking hours of service for resident hall advisors and students part of recruitment teams, for example, involves more than “punching a time clock.”  On some campuses, resident hall advisors are students that live in on-campus dormitories and have a myriad of duties – attend mandatory employer-called meetings, resolve roommate disputes, organize dormitory and/or floor social gatherings, and offer general advice based on past experience.  Some universities give resident hall advisors stipends or pay them for a fixed amount of hours and may include housing as part of compensation.  Resident hall student employees could be “on-call” 24/7. 

Another group of student workers are students who are part of university recruitment teams whereby students travel to high schools or summer camps and recruit for the university.  A typical week of work would look something like: On Monday, student recruitment team members get in a university van and travel to a different location.  They spend the week with high school students in a camp-like environment, dining and sleeping in dormitories, hosting and participating in fellowship events.  On Friday, they get back in the university van and return home.  They could be paid for X number of hours per week plus meals and lodging during the time they are away.

How do universities track the hours of service for different student worker categories like the student recruitment team members or the resident hall advisors?  The preamble to the Play or Pay final regulations states that the definition of hour of service for purposes of crediting hours of service tracks the Department of Labor’s regulations under a qualified retirement plan, with certain modifications.  For employees paid on an hourly basis, an employer is required to calculate actual hours of service from records of hours worked and hours for which payment is made or due.  It would be prudent for universities to consult a wage and hour attorney for guidance, especially when addressing the intricacies of non-exempt employees, on-call employees, and situations that involve traveling away from home.  Leaving these variables unknown can result in penalties under both Play or Pay and wage and hour laws.

As a side note, the student worker issue does have the attention of some congressmen.  The Student Worker Exemption Act provides a blanket exemption for student workers who would be entitled to university-sponsored health insurance, thereby relieving universities of their obligation to offer student workers coverage as is required per PPACA.  Regardless of the traction, the wage and hour issues should still be examined – a problem that has costly consequences if it is answered incorrectly.

For more help in determining how many employees you have for various purposes under the Patient Protection and Affordable Care Act, request UBA’s guide, “Counting Employees Under PPACA”.

Communicating the value of benefits is an age-old dilemma further complicated now that many employers are making big plan changes to comply with the Patient Protection and Affordable Care Act (PPACA). As more and more employers move to high deductible health plans, making employees aware of how to use their benefits and take control of their health care consumption will be the key to cost savings. UBA’s white paper, “A Business Case For Benefits Communications,” addresses how best to reach employees, what they need to know, and how they prefer to receive the information. However, once you have educated your workforce, how do you enroll them efficiently and effectively in your plan options? UBA Partner Mike Humphrey, Senior Benefits Advisor at The Wilson Agency, has been guiding employers through the daunting task of enrolling hundreds or thousands of employees and their dependents for years. To keep open enrollment hassle and panic-free, he offers four basic tips for employers:

1.      Enrollment should be automated.

Going through thousands of sheets of paper to get the process done is part of what makes open enrollment a daunting process. Instead, think about your organization’s culture and environment (and your precious time); most likely it will make sense to automate the program. There is an additional expense, but it’s easily justified for larger employers. It will be easier for you, more accurate, and the majority of employees will prefer an online process to filling out paperwork.

2.      Make sure it has a user-friendly interface.

While setting up an online open enrollment system, take the extra time to ensure that it is easy for employees to use. For example:

• Is everything easy to understand?
• Does entry of information flow nicely?
• Can the user save their progress and go back to make modifications at a later time?
• Does it automatically send the employee a confirmation statement after they have finished enrolling?

3.      Consider multi-learning tools.

The choice of an online open enrollment system also depends on how educated your employees are about their benefit programs. However, even for a well-educated group of employees, we suggest a dictionary of applicable terminology (possibly have a definition pop up as you hover over words like deductible, co-pay, co-insurance, etc.). Video tutorials are also a popular way to show employees how to use the online system and to further guide them in their selection of health plan options.

4.      Make the business case.

If you have multiple HR offices and/or sub-companies, make sure that you have their buy-in before implementing the online system. Explain the cost and what you receive in return. If people see how it will benefit them, they’ll be more likely to support the initiative. And once they’re on board, be sure to have plenty of opportunities for training HR staff.