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8 Tips for Handling Tough Employee Conversations | North Carolina Employee Benefits

We all get cold feet when it comes to addressing difficult issues with colleagues in the workplace. It’s stressful, and you just can’t help but think of all of the ways that a well-meaning conversation could go sideways. You worry about the longer-lasting effects of a damaged work relationship but know that you must correct problematic work performance or behaviors before they get out of control.

Uncomfortable conversations about personal behaviors and poor performance are tough, and putting them off just allows the problems to worsen. Use your knowledge of the situation and put together the right combination of management skills to tackle the talk now.

Imagine these all-too-familiar employee situations that you know you need to address but don’t think you have the wisdom (or can’t muster up the courage) to handle:

  • The “No Good Deed Goes Unpunished” situation. For the past several months, one of your team members has been underperforming, and it has dragged down your business unit’s productivity. The underperforming employee has shared that she has a number of family and financial issues and is trying her hardest to stay ocused on work because she needs this job and loves the company. She lives your company values and is well-liked by her co-workers. Everyone feels bad for her situation and has been picking up the slack, but they are growing resentful of the extra work with no end in sight. You’ve been trying to be kind by avoiding the issues as her performance has slid from bad to worse. It is now impacting your company’s overall performance and degrading the employee relations climate.

  • The “Bad Behavior, Great Performer” situation. One of your employees consistently exceeds his production goals at the expense of the company culture. He is highly critical of others, issues demands from other work teams without regard for their other priorities, and employees grudgingly drop everything to deliver on impossible deadlines because they believe that they cannot push back. It’s all about him and his performance. He is regularly recognized by the company leadership for being the top producer, and employee complaints to management about his behavior have not been addressed. While production goals are good, your company culture is sinking and you’re starting to see increased absenteeism and turnover among your staff.

Don’t Overlook the Signals

In addition to employee resentment and lost productivity, there’s a bottom-line impact for not tackling these tough talks at the right time and in the right manner. The key is to pay attention to the signals and not feed the problem with neglect.

In the first scenario, trying to be a kind and sensitive boss worked in the beginning but is now backfiring. At first the team worked together to help their struggling colleague, but without a plan to fix the problem in the longer term, it created three serious issues for you to fix: employee morale, lack of confidence in your leadership for missing the signals of “team fatigue,” and not having a plan to keep the team on track — all resulting in lost productivity.

The best thing you can do in situations like these is to work with the struggling employee to develop a plan that puts her back on track or helps her consider alternatives if necessary. This type of conversation requires sensitivity along with some firmness because you need to steer the conversation from the personal issues back to actionable work deliverables.

In my experience dealing with circumstances like the second scenario, typically management allows the top performer’s behavior to go unchecked for fear that if the employee is corrected his performance will suffer or he will quit the company. While there may be an element of truth to those concerns if the individual is unwilling to accept constructive feedback, the bigger fear should be for the company’s culture, employee erosion of trust and confidence in the leadership team, and the motivation, performance, and retention of the other company employees if the behavior is not changed.

Often the top performer continues to use the same work patterns that have been successful and isn’t even aware of the impact on others. Addressing the issues sensitively so that he can make personal changes has the potential to create even higher levels of team unity and performance.

What Signals are You Looking For?

For starters, watch your team’s interactions with each other, be sure that each team member understands their key performance objectives, and take the time to “check in” regularly and solicit feedback about the job, work team, and overall company with each employee.

Having direct conversations on a regular basis helps you nip problems in the bud and shows your employees that you care about their concerns. You also learn each other’s communication patterns so that when it comes time to have that awkward or difficult conversation, you both are less uncomfortable.

Groups where team members work remotely increase the chances that signals can be missed. When telecommuting is coupled with the use of instant messaging and other forms of communications in place of direct face-to-face or voice communications, the sender’s well-intentioned messages may get lost in translation. Be sure to follow up any electronic communications with a direct phone call or meeting.

Eight Tips for Tackling These Conversations

Strategies to manage conflicts with subordinates are not fully taught in business classes. More common are courses addressing project conflicts, where the focus is on fixing the “what” of the problem, such as resetting priorities, changing business plans, or repairing broken systems or processes. There are fewer tools focusing on how teams communicate and repairing broken business relationships. Preparation and planning are critical to get what you need from these hard conversations while keeping your relationship with the employee intact.

  1. Focus your own viewpoint first. If you start out thinking the conversation will be really hard, you’re going to be more anxious. Chances are the conversation will be harder. Instead, position this discussion as a means to enhance your relationship while helping your employee develop better skills, understand company priorities better, or work more positively on the team. Think about how you can deliver the difficult talking points with honesty, courage and fairness.

  2. Recognize the emotions you will be feeling. Are you disappointed in this employee? Angry about the problems they’ve caused? Scared that your conversation will damage your work relationship? Put your negative feelings aside and consider how you will frame the problem you need to discuss and how your employee may feel. Try to come at the discussion with consideration and compassion for their feelings and frame the conversation with a desire for the employee’s success. “John, we need to have a hard conversation today, and I’m feeling anxious because I want you to win. Please know that I am invested in your success and will work with you to make that happen.”

  3. Be intentional in planning the conversation, but don’t script it out so that your delivery sounds mechanical. Some business consultants suggest drafting a script and considering alternatives based on the employee’s reactions. In my experience, these conversations never go completely according to plan, and scripted conversations feel artificial. Instead, write down key points and plan as if you are just having a simple conversation with a colleague. Be prepared to provide specifics and pace your conversation so that you take time to gauge your employee’s reactions to your comments. Your employee may react defensively if you provide vague statements. Instead of saying, “Sue, people in the company are telling me that you are difficult to work with and have a bad attitude,” frame the issue with examples, such as, “Sue, I am concerned because I’ve noticed in the last four team meetings you arrived late and weren’t prepared with project updates. As a result, both Joe and Sam missed their deliverables, and you didn’t let any of us know in advance that the timeline was slipping.”

  4. Recognize that you own part of the problem, too. Your goal is to have a conversation between adults where each owns some responsibility for the issue and solving the problem. This takes the conversation from finding fault to finding solutions. “Rob, I realize now that you have too many priorities and I didn’t provide you with the resources to deliver on the project. I also realize that I avoided addressing the problem at the beginning of the project and let it go too long without discussing it with you.”

  5. Outline what you want changed. Don’t just discuss the problem; describe the end result you envision. Discuss realistic and achievable outcomes and be willing to offer resources and assistance as appropriate.

  6. Ask the employee for his or her viewpoints. The last thing you want is a one-sided conversation. Slow the pace of the conversation, observe the employee’s reactions to your comments, and ask for feedback and suggestions for solving the problem. You may learn new information about what may have caused the problem, and the employee could offer even better solutions than you thought possible. Throughout the conversation, look for areas of consensus and acknowledge the employee’s feelings and concerns. That shows respect.

  7. End the conversation on a positive note with an action plan. Thank the employee for working with you through the difficult discussion. Acknowledge that it was a tough conversation and express appreciation for the employee’s professionalism as you both work towards a better outcome. Develop a going-forward action plan to solve the problem. “Tom, this was a hard talk, and I know it wasn’t easy for you. You provided some good ideas for fixing the issue, and I appreciate your professionalism. You can do this, and I am here to help you win.”

  8. Close the loop and follow up. Give the employee a little time to reflect on the discussion, but no more than a day or two. Follow up and ask the employee if they would like to have another discussion to cover any additional information or clarification. Put the agreed-upon action plan in writing, schedule regular status meetings, and recognize progress and improved performance. Taking these steps demonstrates your respect for the employee and desire for them to succeed.

Keep the Conversation Going

Great managers keep the conversation going to ensure team members are aligned and supporting each other to create a healthy corporate culture and successful company. When problems arise, they have the tough conversations to get things back on track. Handling these discussions well takes courage as well as empathetic listening and communications skills. Pay attention to the signals, develop your communications plan, and you’ll be more confident in tackling your next tough employee communications challenge.

Originally published by www.thinkhr.com

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Look Backward to Plan Forward | North Carolina Employee Benefits

We have entered Open Enrollment season and that means you and everyone in your office are probably reading through enrollment guides and trying to decipher it all. As you begin your research into which plan to choose or even how much to contribute to your Health Savings Account (HSA), consider evaluating how you used your health plan last year. Looking backward can actually help you plan forward and make the most of your health care dollars for the coming year.

Forbes magazine gives the advice, “Think of Open Enrollment as your time to revisit your benefits to make sure you are taking full advantage of them.” First, look at how often you used health care services this year. Did you go to the doctor a lot? Did you begin a new prescription drug regimen? What procedures did you have done and what are their likelihood of needing to be done again this year? As you evaluate how you used your dollars last year, you can predict how your dollars may be spent next year and choose a plan that accommodates your spending.

Second, don’t assume your insurance coverage will be the same year after year. Your company may change providers or even what services they will cover with the same provider. You may also have better coverage on services and procedures that were previously not eligible for you. If you have choices on which plan to enroll in, make sure you are comparing each plan’s costs for premiums, deductibles, copays, and coinsurance for next year. Don’t make the mistake of choosing a plan based on how it was written in years prior.

Third, make sure you are taking full advantage of your company’s services. For instance, their preventative health benefits. Do they offer discounted gym memberships? What about weight-loss counseling services or surgery? How frequently can you visit the dentist for cleanings or the optometrist? Make sure you know what is covered and that you are using the services provided for you. Check to see if your company gives discounts on health insurance premiums for completing health surveys or wellness programs—even for wearing fitness trackers! Don’t leave money on the table by not being educated on what is offer

Finally, look at your company’s policy choices for life insurance. Taking out a personal life insurance policy can be very costly but ones offered through your office are much more reasonable. Why? You reap the cost benefit of being a part of a group life policy. Again, look at how your family is expected to change this year—are you getting married or having a baby, or even going through a divorce? Consider changing your life insurance coverage to account for these life changes. Forbes says that “people entering or exiting your life is typically a good indicator that you may want to revisit your existing benefits.”

As you make choices for yourself and/or your family this Open Enrollment season, be sure to look at ALL the options available to you. Do your research. Take the time to understand your options—your HR department may even have a tool available to help you estimate the best health care plan for you and your dependents. And remember, looking backward on your past habits and expenses can be an important tool to help you plan forward for next year.

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Gupton on the Role of an Employee Benefits Broker in the Opioid Crisis

Gupton’s work on the opioid crisis continues to get attention. October 9th, Employee Benefit Advisor Magazine published an article on Gupton’s motivators, statistics, current pushes, and ideas on how an employee benefit consultant can impact the opioid crisis.

Ask the Experts: Distributing ERISA Notices Electronically | North Carolina Employee Benefits

Question: Our company is getting ready for open enrollment. Can we distribute ERISA notices electronically instead of printing and delivering hard copies?

Answer: Yes, electronic delivery complies with ERISA’s disclosure rules – but certain conditions must be met.

First, whether delivered in hard copy or electronic media, ERISA requires preparing and furnishing materials “in a manner consistent with applicable style, format, and content requirements.” It is a good idea to test electronic documents to make sure the formatting and style are correct.

Secondly, materials must be furnished using “measures reasonably calculated to ensure actual receipt.” For instance, if using a traditional delivery method, such as first-class mail, be sure to follow up on any undelivered/returned mail.

For electronic delivery, the compliance rules work differently depending on whether the recipients have regular access to the employer’s electronic information system:

  • Regular access means the recipients use the system, such as the employer’s email system or intranet, as an integral part of their regular job duties. This may include employees who work from home or who are traveling. However, simply having access to a kiosk in a workplace common area does not qualify as having regular access.

  • Without regular access means all other recipients. This may include employees on leave as well as non-employees such as COBRA participants, retirees, and alternate payees. For this group, electronic delivery does not comply with ERISA unless the recipient first affirmatively consents to receive the material electronically, provides an electronic address, and reasonably demonstrates their ability to access the material in electronic form. Since the process to secure consent is fairly cumbersome, most employers choose to distribute materials to this group using traditional hard-copy methods instead of electronic delivery.

Both groups of recipients must be notified of their rights to receive paper copies of the documents (at no charge), and reasonable and appropriate steps must be taken to safeguard confidentiality of personal information related to benefits. A best practice is for employers to ensure return-receipt or notice of undelivered mail features are enabled. Employers may conduct periodic reviews or surveys to confirm receipt as well.

Just emailing documents or posting them on the company’s intranet or benefit administration portal is not enough. Each time an electronic document is furnished, a notice (electronic or paper) must be provided to each recipient describing the significance of the document.

Originally published by www.thinkhr.com

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Ask the Experts: FSA Limits | North Carolina Employee Benefits

Question: Our company offers flexible spending accounts (FSAs) for health care and dependent daycare. Our plan limits are the maximum amounts allowed by federal law. Will the IRS increase the limits for 2019? We hold open enrollment in November for employees to make their FSA elections for the following year.

Answer: The maximum annual limits for Dependent Care FSAs and Health Care FSAs are set forth under § 129 and § 125, respectively, of the Internal Revenue Code.

The § 129 (Dependent Care) limits do not change from year to year. They are currently $5,000, or $2,500 if married and filing separately, and they apply on a calendar-year basis. To change them would require a change in law, which is unlikely in the current Congress.

On the other hand, the maximum limit for elective contributions to a Health Care FSA (HFSA) may change from year to year depending on inflation. The limit applies on a plan-year basis and the HFSA limit for a 12-month plan year beginning in 2018 is $2,650. The limit is one of over 50 different tax provisions that is subject to annual cost-of-living or inflation adjustments. Each fall, the IRS announces any changes for the following year. The announcement usually is released in mid-October, which should give employers time to prepare 2019 enrollment materials.

Based on estimated inflation, it appears the HFSA limit will increase from $2,650 for plan years beginning in 2018 to $2,700 for plan years beginning in 2019. The increase will not be official, however, until the IRS announcement is released.

Originally published by www.thinkhr.com

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Look Backward to Plan Forward | North Carolina Employee Benefits

We have entered Open Enrollment season and that means you and everyone in your office are probably reading through enrollment guides and trying to decipher it all. As you begin your research into which plan to choose or even how much to contribute to your Health Savings Account (HSA), consider evaluating how you used your health plan last year. Looking backward can actually help you plan forward and make the most of your health care dollars for the coming year.

Check out these four things to look at as you go into Open Enrollment season!

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Is Your Health Plan Affordable for 2019? | North Carolina Benefit Advisors

The Affordable Care Act’s employer shared responsibility provision — often called the employer mandate or “play or pay” — requires large employers to offer health coverage to their full-time employees or face a potential penalty. (Employers with fewer than 50 full-time and full-time-equivalent employees are exempt.) Large employers can avoid the risk of any play or pay penalties by offering all full-time employees at least one group health plan option that meets two standards: It provides minimum value and it is affordable.

Minimum value means the plan’s share of total allowed costs is at least 60 percent and the plan provides substantial coverage of physician services and inpatient hospital services.

Affordable means the employee’s required contribution (payroll deduction) for self-only coverage, if elected, does not exceed a certain percentage of the employee’s household income. The affordability percentage changes slightly each year based on the law’s indexing rule. For 2018, the percentage is 9.56 percent. For 2019, however, the percentage increases to 9.86 percent.

Although the change is minor, it means that employers may increase their plan’s employee-only contribution rate and still meet the affordability standard next year.

Determining Affordability

The first step in determining whether a group health plan option is affordable is to define the employee’s “income.” Employers do not know their workers’ total household income, so the play or pay rules offer employers three optional safe harbor methods to define income using information known to the employer. Employers may use any of the safe harbor methods. They also may use different methods for different classes (such as one method for hourly employees and another method for salaried employees), provided that the chosen method is applied uniformly to all employees in the class.

The three IRS safe harbor methods are:

1. Federal Poverty Line (FPL)

The FPL method is the easiest of the three methods. Multiply the mainland FPL amount for a single-member household by the affordability percentage, then divide by 12. As long as the self-only contribution rate does not exceed the resulting amount, the plan’s coverage is deemed affordable. For instance:

  • 2018: ($12,060 x 9.56%)/12 = $96.08 per month

  • 2019: ($12,140 x 9.86%)/12 = $99.75 per month

The FPL chart is updated every year in late January. For 2019 calendar-year health plans, the employer needs to refer to the current FPL amount ($12,140) since the new FPL amount will not be available until after the plan year starts. If the health plan year starts February 1, 2018 or later, however, the employer may refer to the new FPL amount which likely will be a little higher.

2. Rate of Pay

This is the most convenient method to define income when applied to hourly employees. Multiply the employee’s hourly rate of pay times 130 hours per month (regardless of how many hours he or she actually works), then multiply by the affordability percentage. As long as the self-only contribution rate does not exceed the resulting amount, the plan’s coverage is deemed affordable. For instance:

  • 2018: ($11* x 130) x 9.56% = $136.70 per month

  • 2019: ($11* x 130) x 9.86% = $140.99 per month

* Replace $11 with the hourly employee’s rate of pay.

For salaried employees, the rate of pay method is somewhat complicated so employers generally avoid using this method for non-hourly employees.

3. W-2

The W-2 method requires using current W-2 wages instead of looking back at the prior year. W-2 wages means the amount that will be reported in Box 1 of Form W-2. Pretax contributions, such as § 125 plan contributions and 401(k) or 403(b) plan deferrals, are not included in Box 1, so using the W-2 safe harbor method may understate the employee’s actual income. Coverage will be deemed affordable if, for each month of the plan year, the self-only contribution does not exceed the Box 1 amount multiplied by the affordability percentage.

Summary

Large employers can avoid the risk of potential penalties under the ACA’s play or pay rules by ensuring that they offer full-time employees at least one minimum value plan option that also is affordable. Affordable means the employee’s contribution to elect self-only coverage would not exceed a certain percentage of the employee’s income.

The percentage used to determine affordability changes from year to year is based on the law’s indexing formula. For 2018 plan years, the affordability percentage is 9.56 percent, but it increases to 9.86 percent for 2019 plan years. Employers and their advisors will want to keep this information in mind as they finalize their group health plan offerings and employee contribution rates for 2019.

Originally published www.thinkhr.com

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Short-Term Limited-Duration Insurance – In a Nutshell | North Carolina Benefit Advisors

On August 3, 2018, the Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury (the Departments) published a Final Rule to expand the availability of short-term medical policies. Called short-term, limited-duration insurance (STLDI), the policies are marketed to individuals as an alternative to ACA-compliant plans. Currently a short-term policy is limited to less than three months, but the new rule will allow carriers to issue the policies for longer periods.

What is short-term limited-duration insurance (STLDI)?

Short-term, limited-duration insurance is a specific type of health coverage that is exempt from the ACA’s market reform rules. STLDI policies may exclude entire categories of benefits, such as prescription drugs, maternity, or mental health care, may impose coverage caps, and may reject applicants with pre-existing conditions. STLDI policies offer lower premiums than ACA-compliant plans because they provide less coverage and typically only accept healthy applicants.

Note that STLDI is not minimum essential coverage and does not satisfy the ACA’s individual mandate. The individual mandate (i.e., the requirement for individuals to have some form of minimum essential coverage) expires at the end of 2018, after which persons without adequate health coverage will no longer be exposed to potential IRS tax penalties.

What is the purpose of the new federal rule?

The existing rule defines “short term” as less than three months and limits the policy’s duration by prohibiting renewals that would go beyond the three-month period. The new rule, on the other hand, will allow carriers to issue STLDI policies for an initial term of up to 364 days, and allows extensions or renewals for up a total of 36 months. This is a significant change that is intended to expand access to low-cost limited-coverage options for individuals.

The new federal rule takes effect for STLDI policies issued October 2, 2018, or later. There is a catch, however. Insurance is subject to state insurance laws, and many states appear reluctant to adopt the new rule for policies issued in their state. Some states even prohibit short-term policies under the current federal rule. At last weekend’s National Association of Insurance Commissioners (NAIC) meeting, several state regulators expressed concerns about “junk insurance” or deceptive marketing practices that may lure consumers into purchasing substandard coverage.

Are employers affected by STLDI policies or the new rule?

No.

Employers are not directly affected by STLDI policies. The policies are marketed to individuals, where permitted by state insurance law; they are not group plans.

Some workers may consider STLDI options, or ACA-compliant individual insurance options, as an alternative to their employer’s group plan. In most cases, though, persons who buy individual insurance do so because they do not have access to an employer’s plan. Workers whose employment ends may also consider individual options as an alternative to COBRA.

What’s Next?

Over the coming weeks and months, state insurance regulators and state legislatures are expected to review their existing laws and regulations on short-term, limited-duration insurance and consider whether to adopt changes. Some states likely will choose to implement rules to support the new federal rule, while other states certainly will impose restrictions or continue to prohibit the sale of insurance products they consider to be substandard.

Originally published by www.thinkhr.com

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DOL Updates the Employer CHIP Notice | North Carolina Employee Benefits

The U.S. Department of Labor (DOL) has updated the model notice for employers to use to inform employees about the Children’s Health Insurance Program (CHIP). All employers with group health plans are required to distribute a CHIP notice at least once a year to employees living in certain states. There is no need to send another notice to workers who received the prior version in the past year, but employers should use the updated notice going forward. This also is a good time for employers to review their procedures for distributing CHIP notices.

The following are the most frequently asked questions we receive from employers about CHIP notices.

Frequently Asked Questions

What is the purpose of the CHIP notice?
The CHIP notice informs benefits-eligible employees that their state’s CHIP or Medicaid program may offer premium assistance to help them pay for group health coverage at work. Many states offer some form of premium assistance to residents based on their family income. The updated notice includes contact information for each participating state (currently 37 states) and explains that persons approved for premium assistance have a special 60-day enrollment period to join their employer’s group plan without having to wait for the employer’s next annual enrollment period.

Does the CHIP notice requirement affect all employers?
All employers that offer a group health plan providing medical benefits, whether insured or self-funded, must consider the CHIP notice requirement. Each employer then will determine if it must distribute the notice depending on whether any of its employees live in one of the states listed in the notice.

Further, all group health (medical) plans must offer a special 60-day enrollment period when an employee becomes eligible for premium assistance (for the employee or a family member) from a state’s CHIP or Medicaid program.

Is the notice required for all employees or just for those enrolled in our group health plan?
The notice must be given to all employees living in any one of the listed states and eligible for the employer’s group health plan, whether or not currently enrolled. That is the minimum requirement. Many employers, however, choose to distribute the notice to all employees, regardless of benefits eligibility or location, to avoid the need for separate distributions when an employee’s status or location changes.

How do we prepare and distribute the notice? How often?
The DOL provides a model notice that employers can copy and distribute. Although employers have the option of creating their own notice to list only the states where their employees are located, most employers simply use the DOL model notice as it is. The model notice also is available in Spanish.

The notice must be distributed when employees initially become eligible for the employer’s health plan and then at least once a year thereafter. For convenience, most employers provide the notice at the same time as they distribute new hire materials and annual enrollment materials.

When combined with other materials, the CHIP notice must appear “separately and in a manner which ensures that an employee who may be eligible for premium assistance could reasonably be expected to appreciate its significance.” For instance, the notice may be a loose item in the same envelope with other material. If the notice is stapled inside other material, however, there should be a note on the top page or cover alerting the reader to the placement of the CHIP notice and its importance.

Do we have to mail out paper copies or can we distribute the notice electronically?
The notice may be sent by first-class mail. Alternatively, it can be distributed electronically if the employer follows the DOL’s guidelines for electronic delivery of group health plan materials. That means that the employer first must determine whether the intended recipient has regular access to the electronic media system (e.g., email) as an integral part of his or her job. If so, the notice can be sent electronically provided the employer takes steps to ensure actual receipt, along with notifying the employee of the material’s significance and that a paper copy is available at no cost.

For persons who do not have regular access to the electronic media system, the notice cannot be sent electronically unless the intended recipient provides affirmative consent in advance. The guidelines for obtaining advance consent are fairly cumbersome, so employers are advised to distribute paper copies in these cases.

Summary

Employers offering group health plans are encouraged to review their procedures for distributing CHIP notices. At a minimum, the notice must be given annually to all employees eligible for the employer’s health plan who live in any of the states listed in the notice. Many employers choose to distribute the notice to all workers in an abundance of caution. The DOL provides model notices in English and Spanish that do not need any customization, so employers can simply copy and distribute one or both versions as needed.

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Wearable Technology | North Carolina Employee Benefits

Don’t lie--we ALL love gadgets. From the obscure (but hilariously reviewed on Amazon) Hutzler 571 Banana Slicer to the latest iteration of the Apple empire. Gadgets and technology can make our lives easier, make processes faster, and even help us get healthier. Businesses are now using the popularity of wearable technology to encourage employee wellness and increase productivity and morale.

According to a survey cited on Huffington Post, “82% of wearable technology users in American said it enhanced their lives in one way or another.” How so? Well, in the instance of health and wellness, tech wearers are much more aware of how much, or how little, they are moving throughout the day. We know that our sedentary lifestyles aren’t healthy and can lead to bigger health risks long term. Obesity, heart disease, high blood pressure, and Type 2 Diabetes are all side effects of this non-active lifestyle. But, these are all side effects that can be reversed with physically getting moving. Being aware of the cause of these problems helps us get motivated to work towards a solution.

Fitbit, Apple Watch, Pebble, and Jawbone UP all have activity tracking devices.  Many companies are offering incentives for employees who work on staying fit and healthy by using this wearable technology. For example, BP Oil gave employees a free Fitbit in exchange for them tracking their annual steps. Those BP employees who logged 1 million steps in a year were given lower insurance premiums. These benefits for the employee are monetary but there are other pros to consider as well. The data collected with wearable technology is very accurate and can help the user when she goes to her physician for an ailment. The doctor can look at this data and it can help connect the dots with symptoms and then assist the provider with a diagnosis.

So, what are the advantages to the company who creates wellness programs utilizing wearable technology?

·      Job seekers have said that employee wellness programs like this are very attractive to them when looking for a job.

·      Millennials are already wearing these devices and say that employers who invest in their well-being increases employee morale.

·      Employee healthcare costs are reduced.

·     Improved productivity including fewer disruptions from sick days.

The overall health and fitness of the company can be the driving force behind introducing wearable technology in a business but the benefits are so much more than that. Morale and productivity are intangible benefits but very important ones to consider. All in all, wearable technology is a great incentive for adopting healthy lifestyles and that benefits everyone—employee AND employer. 

 

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The News about Association Health Plans | North Carolina Employee Benefit Advisors

On June 19, 2018, the U.S. Department of Labor released its Final Rule regarding Association Health Plans (AHPs). AHPs are not new, but they have not been widely available in the past and, in some cases, they have not been successful. The Final Rule is designed to make AHPs available to a greater number of small businesses as an alternative to standard ACA-compliant small group insurance policies.

This article answers common questions about AHPs under the current rules (which groups can continue to use) and the new rules.

Is group medical insurance the same for small and large employers?

Yes and no. Federal law imposes certain basic requirements on all group medical plans, regardless of the employer’s size. For instance, plans cannot exclude pre-existing conditions nor impose annual or lifetime dollar limits on basic benefits. If the plan is insured, it also is subject to the insurance laws of the state in which the policy is issued.

Small group policies, which are sold to employers with up to 50 or 100 employees, depending on the state, are subject to additional requirements. These policies must cover 10 categories of essential health benefits (EHBs), including hospitalization, maternity care, mental health and substance abuse treatment, and prescription drugs. (Some states allow certain grandfathered or grandmothered policy exceptions.) For most small employers, their options for group medical insurance are limited to small group policies that comply with the full scope of ACA requirements. On the other hand, the policies are subject to guaranteed issue and adjusted community rating rules, so carriers cannot refuse to insure a small employer nor use any past claims experience in setting rates.

Large group policies, which can only be sold to groups with at least 50 or 100 employees, depending on the state, are not required to cover all EHBs. Carriers have more flexibility in designing coverage options and developing premium rates in the large group market. This means larger employers have more options to choose from and may be able to purchase coverage at a lower cost than would apply to a small group policy. Note, however, that there is no guaranteed issue protection, so carriers can accept or reject each employer’s application or use the employer’s past claims experience in setting rates.

Lastly, self-funded plans are subject to the ACA and other federal laws, but generally are exempt from state laws. They typically are not feasible for small employers, however, due to the financial risk of uninsured programs.

What is an Association Health Plan (AHP)?

Group insurance covers the employees of an employer (or an employee organization such as a labor union). An AHP, as the name implies, covers the members of an association. Unrelated employers can obtain coverage for their employees through an AHP provided the employers form a bona fide association. Traditionally, this has meant that the employers had to have a “commonality of interest” and their primary interest had to be something other than an interest in providing benefits. For this reason, AHPs generally have been limited to associations formed by employers in the same trade, industry, or profession.

The Final Rule makes AHPs available to a wider range of businesses by expanding the meaning of “commonality of interest.” Once the Final Rule takes effect, an association may be formed by employers that are:

  • In the same trade, industry, or profession, regardless of location; or
  • In the same principal place of business; i.e., in the same state or in the same multi-state metropolitan area.

Under the new rules, the employer’s primary interest in associating may be benefits coverage, although they still will need to have at least one other substantial business purpose other than benefits. This is a key difference from the current rules.

When does the new Final Rule take effect?

The Final Rule expanding the definition of an association for purposes of an AHP will take effect on staggered dates:

  • For fully insured AHPs: September 1, 2018
  • For self-funded AHPs:
    • If in existence on or before June 19, 2018: January 1, 2019
    • If created after June 19, 2018: April 1, 2019

As noted, the new rules do not replace existing rules. Employers and associations may continue to follow the existing rules (which generally limit AHPs to employers in the same trade, industry, or profession). The new rules merely expand the opportunities for AHPs, such as making them available to employers in the same state or metropolitan area even if they are in different industries.

Are AHPs limited to employers with employees? What about sole proprietors?

Currently, sole proprietors, such as mom-and-pop shops without any W-2 employees, purchase medical insurance in the individual market. Individual policies often cost more than group policies or AHPs. The new rules will expand the availability of AHPs to include sole proprietors who work a minimum number of hours (so-called working owners).

What about state laws? Will AHPs be available nationwide?

Insurance products, including AHPs, are regulated by state law. Under both the existing and new rules, AHPs are multiple employer welfare arrangements (MEWAs). State laws on MEWAs are quite complicated. In some states, MEWAs are prohibited. In others, insured MEWAs are allowed but self-funded plans are prohibited. The laws vary from state to state, so different carriers will make different decisions about whether they want to design and market AHPs in various jurisdictions around the country.

A number of states are very concerned about AHPs and may prohibit them in their states or impose strict requirements to ensure they will provide reliable and effective coverage. Other states will view AHPs as cost-effective alternatives to ACA-compliant policies for small employers and look to encourage their expansion.

What’s next?

There is no clear answer to what’s next. Over the coming months, carriers across the country likely will review the reasons they have or have not offered AHPs in the past, and whether they want to consider new approaches in the future. Along with economic and market issues to consider, carriers also must consider the state insurance laws in different jurisdictions. At the same time, many state legislatures and insurance commissioners will be reviewing their existing rules and whether they want to promote or expand the availability of AHPs in their area.

Oh … and the lawsuits. Yes, that also is what’s next. As of this writing, attorneys general in different states are planning to join together in challenging the federal government’s Final Rule on AHPs. Their stated concern is that effective regulation is required to ensure that plans provide adequate coverage.

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6 Questions on Dependent Care Spending Accounts | North Carolina Employee Benefits

School’s out! Summer is here, and it’s the time of year when working parents have questions about using their Dependent Care Spending Accounts (DCSAs). Are summer camp expenses eligible? What about day versus overnight camps? Employers and benefit advisors want to be ready with answers about this valuable benefit program.

The following are the top summertime questions about DCSAs and reimbursable expenses:

1. What are the basic rules for reimbursable expenses?

Dependent care expenses, such as babysitting and daycare center costs, must be work-related to qualify for reimbursement. Work-related means the expenses are for the care of the employee’s child under age 13 to allow the employee to work. If the employee is married and filing jointly, the employee’s spouse also must be gainfully employed or looking for work (unless disabled or a full-time student).

In some cases, expenses to care for a disabled dependent, regardless of age, may be reimbursable. This article focuses on expenses for children under 13 since those are by far the most common type of DCSA reimbursement.

2. One of our employees and his family are taking a two-week vacation this summer, but his children’s daycare center will charge its regular fee. Are the expenses reimbursable even if the employee and spouse are off work?

Yes. In most cases, expenses are not eligible unless the dependent care services are necessary for the parents to work, but some exceptions apply. The IRS rules for DCSAs provide that expenses during short, temporary absences are eligible if the employee has to pay the child’s care provider. Absences of up to two weeks are automatically considered short, temporary absences. Depending on the circumstances, longer absences also may qualify.

3. During the school year, our employee uses her DCSA for her 10-year old’s after-school daycare center expenses. This summer, the child’s daycare will be provided by her 20-year old sister. If the older daughter bills for her services, are the costs eligible for reimbursement?

The answer depends on whether the employee or spouse can claim the older daughter as a tax dependent. If the older daughter can be claimed as a dependent, whether or not the employee actually claims her, she is not a qualifying dependent care provider under the DCSA rules.

If the older daughter cannot be claimed as a tax dependent, her charges for providing care are eligible expenses. The specific rule is that a child of the employee, whom the employee cannot claim as a dependent, may be a qualifying provider if the child is age 19 or older by the end of the year.

Note that the employee’s spouse or the child’s parent is never a qualifying provider.

4. One of our employees has to pay an application fee and deposit before her child starts attending a daycare center this summer. Are those expenses eligible for reimbursement?

Prepaid expenses are eligible for DCSA reimbursement, provided the costs are required in order for the child to receive care. In this case, after the daycare center begins providing care, the employee can be reimbursed for the application fee and deposit she paid. On the other hand, if the employee cancels and her child does not attend, then the application fee and deposit are not eligible expenses.

5. An employee will pay day camp expenses for his 8-year-old son and overnight camp expenses for his 12-year-old daughter this summer. Are both types of expenses eligible for reimbursement?

The day camp expenses generally are reimbursable. Expenses for overnight camp, however, are not eligible since overnight care is not work-related.

Under the IRS rules for DCSAs, expenses for food, lodging, clothing, education, and entertainment are not reimbursable. If, however, such expenses are small, incidental expenses that cannot be separated from the cost of caring for the child, they may be included for reimbursement. For instance, the day camp may include lunch, snacks, and some sports activities in its basic fee, which would be eligible for reimbursement.

6. An employee’s children go to private year-round schools. He pays tuition for one child’s grade school and fees for the other child’s nursery school. Are both types of expenses eligible for reimbursement?

Educational expenses are not reimbursable, unless the educational services are merely incidental as part of a child care service. Expenses to attend kindergarten or a higher grade are educational, so the older child’s school fees are not eligible for DCSA reimbursement. (Expenses for before- or after-school care, however, may qualify as reimbursable expenses.)

On the other hand, expenses for a child in nursery school, preschool, or a similar program for children below the level of kindergarten are expenses for care. Such expenses are not considered educational even though the nursery school may include some educational activities.

Originally published by www.thinkhr.com

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Opioids in America | North Carolina Benefit Advisors

Lately, there’s been a big focus on America’s opioid addiction in the news. Whether it’s news on the abuse of the drug or it’s information sharing on how the drug works, Americans are talking about this subject regularly. We want to help educate you on this hot topic.

Opioids are made from the opium poppy plant.  Opium has been around since 3,400 BC and it was first referenced as being cultivated in Southwest Asia. The drug traveled the Silk Road from the Mediterranean to Asia to China. Since then, the drug has gained popularity for pain relief but it also has gained notoriety as an abused drug. Morphine, Codeine, and Heroin are all derived from the opium poppy and are all highly addictive drugs that are abused all around the world. As the demand for these drugs has increased, so has the production.  From 2016 to 2017, the area under opium poppy cultivation in Afghanistan increased by 63 percent. In 2016, it killed some 64,000 Americans, more than double the number in 2005.

We can see that the danger from this drug is growing rapidly. What can we do to recognize potential abuse problems and to get help? Here are some facts about opioid addiction:

·       How do they work? Opioids attach to pain receptors in your brain, spinal cord, and other areas that recognize pain signals. As they attach to the receptors, it reduces the sending of pain messages to the brain and therefore reduces the feelings of pain in your body.

·       Short-acting opiates are typically prescribed for injuries and only for a few days. They take 15-30 minutes for pain relief to begin and this relief lasts for 3-4 hours. Long-acting opiates are prescribed for moderate to severe pain and are used over a long period of time. Relief typically lasts for 8-12 hours and can be used alongside a short-acting drug for breakthrough pain.

·       Dependence is common with long-term use of an opiate. This means that the patient needs to take more of and higher doses of the medicine to get the same pain relieving effect. This does not necessarily mean the patient is addicted. Addiction is the abuse of the drug by taking it in an unprescribed way—like crushing tablets or using intravenously.

·       Americans account for less than 5% of the world’s population, but take 80% of the world’s opioid medications. About 5% of the people who take opiates become addicted to the drug.

·       Help is available through many channels from private recovery centers to insurance providers. The Substance Abuse and Mental Health Services Administration helpline is 1-800-662-HELP. This line is confidential, free, and available 24-hours a day and 7 days a week. Family and friends may also call this number for resources for help. Additional resources can be found at www.drugabuse.com.

Make sure you are educated about the dangers of opioid abuse. But, don’t be discouraged and think that the abuse is incurable! There are many resources that can be used to break the addiction cycle and can make real change in the lives of its victims. Ask for help and offer help.

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Discount Drug Programs | North Carolina Benefit Advisors

Did you know that you can save time and money on your prescription drugs by simply signing up for a discount card online? With savings as much as 80% off, these discount cards keep your health care costs down even when the prices of prescriptions are sharply rising.  At no cost to the patient, discount drug programs negotiate the price of medicines with pharmacies and then pass the savings on to the consumer.  These programs give subscribers a personalized discount card to be used at any pharmacy. While the discount card cannot be used in conjunction with health insurance, the consumer may see that the cost of their medicine is actually LESS with the card than it is with their insurance.

Another benefit to the consumer is that these programs will publish at which pharmacy you can find your medicine. This is especially helpful to the person who has specialty drug prescriptions. For example, Rebekah is prescribed a specialty drug for pain and neuropathy due to Multiple Sclerosis. This drug is not commonly stocked in pharmacies and so many times, she has had to wait for them to order it. By using the discount drug program, Rebekah is able to see which pharmacies have her medicine in stock and the estimated price.

So where do you start? Here are a few discount drug programs to investigate costs and providers for your prescriptions:

·      Provides free drug cards to reduce the out-of-pocket cost of prescription drugs.

·      Click on your state and the site will redirect you to your corresponding prescription assistance program.

·      Compares prices and discounts at thousands of pharmacies.

·      Receive coupons via phone, email, or text to print or present for discounts.

·      Free drug card to present at pharmacy for cost savings on prescriptions.

·      Earn rewards each time you use their card—similar to credit card rewards. Each fill is 500 points and when you reach 5,000 points, you earn a gift card to various retailers.

Being a savvy consumer can save you money! Shop around to find the best cost for your prescription drugs and save time by locating the pharmacy that has your meds in stock. Discount drug programs are a great resource so do your research and find one that fits your needs.

 

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The Rap on Wraps | North Carolina Benefit Advisors

There’s a good chance you use a wrap document to help satisfy your Employee Retirement Income Security Act (ERISA) summary plan description (SPD) obligations. Yet if you look for a definition of wrap document in ERISA statutes or regulations, you will not find one. The wrap is not a defined term or required document; it is simply a format. So why do you need a wrap document? Here are three (of many) reasons why a wrap document is a solid choice.

Reason 1

Your insurance carrier materials are not enough in most cases.

A common misconception is that carrier materials or benefit description booklets meet all ERISA SPD requirements. They rarely do; in fact, they usually fall short.

For example, the SPD must define or explain eligibility for benefits. A carrier’s materials may indicate that a benefit is available for all full-time employees, but not define what constitutes “full-time.” An SPD that does not completely communicate eligibility is deficient, may confuse employees, and could result in costly litigation for your company.

Therefore, to address gaps like these, it’s advisable to use a wrap document to “wrap around’ the existing carrier documents and fill in any required ERISA provisions the carrier documents are missing.

Reason 2

You are an applicable large employer (ALE) and use the lookback measurement method.

ALEs who use the lookback measurement method to determine eligibility for medical benefits must meet a complex set of rules for determining whether and how certain employees are eligible for healthcare coverage under the Affordable Care Act (ACA). The rules are complex and daunting for employers. Even more daunting, however, is explaining these eligibility rules to employees.

Carriers are not required to communicate this information, and very likely will not. Therefore, it is up to you to ensure the information is communicated. While your specific lookback measurement method is not required to be explained in an SPD – and some employers choose to put it in an employment policy or handbook — the SPD is a logical place to include this information because it also communicates your other benefits eligibility requirements.

Reason 3

A wrap reduces your reporting obligations.

You may use a wrap document to combine multiple insurance policies into a single document, which results in one ERISA plan for all combined benefits. This simplifies and reduces reporting requirements for employers who are subject to Form 5500 filing requirements.

Most employers with 100 or more health and welfare benefit plan participants as of the first day of the plan year, as well as certain employers with fewer than 100 participants, are required to file a Form 5500 annually. (Participants include covered employees and former employees who elect COBRA, but spouses and dependents are not counted.) Some plans, such as governmental plans or certain church plans, are exempt from filing a Form 5500.

The wrap document may be a time saver if you have multiple health and welfare benefit plans subject to Form 5500 filing requirements. For example, if you have a vision, dental, and medical plan that each meet the “100 or more participant” threshold, then you would be required to file a Form 5500 for each plan. However, if the plans are all wrapped together into a single document, then they are considered one ERISA plan and you would only have to file one Form 5500.

Do it Right

While there are many other reasons an employer should consider investing in a wrap document, not all wrap documents are made equal. Work with a reputable vendor and/or competent counsel to ensure your wrap document meets all compliance requirements.

Originally published by www.thinkhr.com

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Disability Insurance and why you need it! | North Carolina Employee Benefits

“Your most valued asset isn’t your house, car, or retirement account. It’s the ability to make a living.”

No one foresees needing disability benefits.  But, should a problem arise, the educated and informed employee can plan for the future by purchasing disability insurance to help cover expenses when needed.

When you ask people what is the number one reason disability insurance is needed, most will answer that it is for workplace related injuries. However, the leading causes of long-term absences are back injuries, cancer, and heart disease and most of them are NOT work related.   In addition, the average duration of absences due to disability is 34 months.  So how do you prepare for an unplanned absence from work as a result of an injury or illness? Disability insurance is a great option.

Disability insurance is categorized into two main types.

Short Term Disability covers 40-60% of the employee’s base salary and can last for a few weeks to a few months to a year. There is typically a short waiting period before benefits begin after the report of disability.  This plan is generally sponsored by the employer.

Long Term Disability covers 50-70% of the employee’s base salary and the benefits end when the disability ends or after a pre-set length of time depending on the policy. The wait period for benefits is longer—typically 90 days from onset of disability.  This plan kicks in after the short-term coverage is exhausted. The individual purchases this plan to prevent a loss of coverage after short-term disability benefits are exhausted.

While the benefits of these disability plans are not a total replacement of salary, they are designed for the employee to maintain their current standard of living while recovering from the injury or illness. This also allows the individual to pay regular expenses during this time.

There are many ways to enroll in a disability insurance plan. Often times your employer will offer long-term and short-term coverage as part of a benefits package. Supplemental coverage can also be purchased.  Talk with your company’s HR department for more information on how to enroll in these plans.  Individuals who are interested in purchasing supplemental coverage can also contact outside insurance brokers or even check with any professional organizations to which they belong (such as the American Medical Association for medical professionals) as many times they offer insurance coverage to members.

As you begin planning for your future, make sure you research the types of coverage available and different avenues through which to purchase this coverage. For more information on disability and the workplace, check out:

·      Americans with Disabilities Act

·      The National Organization on Disability

·      Council for Disability Awareness

·      Social Security Administration

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Intro to Self-Funding | North Carolina Benefit Advisors

The topic of Self-Funding is huge, so let's break it down into smaller bites to digest.  Check out this great video on it!