How employers can help

A majority of Americans have received a surprise medical bill in the last year, and a new study provides some insight into how consumers feel about medical billing — and where they place the blame for unexpected costs.

According to the study, published by research organization NORC at the University of Chicago, the majority of respondents named insurance companies as very responsible for surprise billing, followed next by hospitals. Most of the surprise charges were for a physician’s service, followed by lab tests.

The study illustrates that despite years of conversations around price transparency and consumer-directed healthcare, the industry is still struggling to effectively educate employees about their benefits and care costs.

What employers can do

A new study by Mercer found employers’ turnover rate dropped by a third when comparing companies doing the most to help employees thrive, versus those doing the least.

Employees stay longer when the culture of health is stronger, the study found. Further, employers engaging in more “wellbeing practices,” also bend the cost curve more substantially.

What are the well-being practices? The study broke them down into three categories, “basic,” “culture of health,” and “quality and value.” Here are a few of these solutions for cost containment and employee well-being.

What employers should know

Congress is working on a solution for paid parental leave, with options currently under consideration on both sides of the aisle.

Most recently, Sen. Marco Rubio released the “Economic Security Act for New Parents,” which would allow parents to withdraw early Social Security benefits to use after the birth or adoption of a child. Parents who took advantage of this bill would then delay the collection of those benefits in retirement

New rules could create more options for employees

New rules from the Trump administration will expand the reach of short-term insurance plans, which could result in additional options for consumers, including employees.

The new rules extend the duration of short-term health plans from three months to 364 days, and would also allow the plans to be renewed. These regulations make short-term plans more like other types of insurance.

While these plans are generally cheaper than other types of coverage, they do not cover as many services as traditional health plans, such as preventive care or prescriptions.

Still, many anticipate that consumers looking for lower-cost alternatives may forgo comprehensive coverage and elect these plans, especially as the individual mandate penalty no longer applies next year.

Why does this matter to employers? In a few circumstances, employees could choose these new options instead of workplace options. Here are a few scenarios where this could apply.

What to do when FMLA doesn't apply

When it comes to personal or medical employee absences, the Family and Medical Leave Act provides a standard set of requirements for employers with over 50 employees.

But there are cases where FMLA does not apply. If you have less than 50 employees, or the employee has not worked for the company the required amount of time for FMLA eligibility—1,250 work hours or 12 months of active employment—how do you handle employee leave?

The process will vary based on the specific circumstances at your organization, as there isn’t a “one-size-fits-all” approach when FMLA doesn’t apply. But in general, here are two scenarios—one where the employee has Short-Term Disability coverage, and one without Short-Term Disability coverage.

Five things to consider

Are you considering using a Professional Employer Organization (PEO) at your business? Businesses can partner with a PEO to outsource a variety of administrative tasks, including HR, payroll, health insurance and more.

When partnering with a PEO, the organization effectively becomes the employer of record of your employees. There are some pros and cons associated with this arrangement. Here are five things to consider about PEOs.

Getting a big rate increase? 

If you are receiving a big rate increase on next year’s group health plan, it may be time to consider a different funding strategy. With healthcare costs continuing to rise, there are only so many solutions for reducing the financial pressure on employers and employees through a fully-insured insurance plan.

If you’ve raised deductibles, helped employees with HSAs, implemented wellness programs – and are still seeing double digit premium increases, you may want to pursue a self-funded health plan.

First, what is self-funding, or self-insuring?

New plans could save employers money, but might not be right for every group

New regulations released by the Trump administration means more employers can form Association Health Plans (AHPs) to offer health coverage to employees. By allowing employers to band together to offer health coverage, AHPs allow smaller employers to take advantage of economies of scale.

The new rules mean any employers in the same industry or region, as well as sole proprietors, can now form or join an association and offer an AHP. Because these plans don’t have to offer the same set of benefits as other health plans, this can represent cost-savings for many employers.

However, this strategy isn’t necessarily right for every small business. How do you know if an AHP is right for your organization? Here are a few questions to ask.

How auto-adjudication can lead to premium increases

Auto-adjudication isn’t a term most employers are familiar with, but it can be a factor in rising group benefits costs. What is it, and how can it result in premium rate increases?

The term refers to how insurance companies approve claims sent by the hospital. In other words, when an employee visits a hospital, and the hospital files a claim with the insurer, the insurer then has to “adjudicate” the claim, either resulting in a denial or a payment.

Through the negotiation process between insurers and hospitals, insurers often agree to “auto-adjudicate” a portion of hospital claims. This means the claims are subject to less scrutiny and are typically paid automatically. Why would insurers agree to do this, and why would hospitals want them to?

How self-funded employers cover high claims

Are you an employer or business leader considering self-insuring your company’s health plan? Some employers believe that because they wouldn’t be able to sustain very high medical claims, self-insurance isn’t for them. However, stop loss coverage protects self-insured groups against these high costs, and can make this a good option for groups that might otherwise not consider it.

Here’s what you should know about stop-loss coverage when considering a self-funded health plan.