New Accumulator Programs Can Surprise Employees at Pharmacy Counter
March 24, 2020
An ongoing tense relationship between insurers and drug companies is spilling over and hitting enrollees in group health plans, by saddling them with additional out-of-pocket expenses.
Some insurers have started adopting copay accumulator programs — sometimes called accumulator adjustment programs — that change the way a patient’s out-of-pocket medication costs are added up (accumulated) when there is some type of drug company financial assistance for the health plan enrollee.
These accumulator programs do not count the drug company assistance (in the form of coupons or copay cards) that defray the employee’s out-of-pocket expenses.
Unfortunately, many group plan enrollees often do not know that their group health plan has changed its policy to be an ...
Substance-Abuse Benefits under Affordable Care Act
March 17, 2020
One less-touted aspect of the Affordable Care Act is that it provides employers more tools for assisting employees with substance-abuse problems to seek help.
According to a study by the Substance Abuse and Mental Health Services Administration, 10% of America’s workers are dependent on one substance or another. The study also found that 3.1% have used illegal drugs either before or during a shift.
Also, 79% of heavy alcohol users have jobs, and 7% of them say they’ve had drinks while on duty.
Drug use and abuse have been on the rise — both illegal drugs and prescription painkiller abuse, the latter of which led a more than a 500% increase in people seeking treatment for addiction to doctor-prescribed opioids between 2007 and 2017.
As an employer, the costs are great ...
Concerns Rise Over Letting Employers Fund HRAs for Individual Health Plans
March 10, 2020
Employers, health insurers, regulators and hospitals are all raising concerns about the Trump administration’s rules issued last year that allow employers to fund health reimbursement arrangements (HRAs) that their workers can use to purchase health plans on the open market.
The Centers for Medicaid and Medicare Services, IRS and the Department of Labor issued the final rules in late 2019. They reverse one of the major pinch-points of the Affordable Care Act, which bars employers from paying employees to buy their own health insurance either on publicly run health insurance exchanges or on the open market.
The fine for breaching this part of the law is a hefty $36,500 annually.
The rules continue to receive pushback from small business groups, insurers, regulators and others, ...
Employer Guide for Dealing with the Coronavirus
March 4, 2020
As the outbreak of the 2019 novel coronavirus gains momentum and potentially begins to spread in North America, employers will have to start considering what steps they can take to protect their workers while fulfilling their legal obligations.
Employers are in a difficult position because it is likely that the workplace would be a significant source of transmission among people. And if you have employees in occupations that may be of higher risk of contracting the virus, you could be required to take certain measures to comply with OSHA’s General Duty Clause.
On top of that, if you have workers who come down with the virus, you will need to consider how you’re going to deal with sick leave issues. Additionally, workers who are sick or have a family member who is ...
More Employers Expand Mental Health Benefits
February 25, 2020
American workers are more stressed than ever, and an increasing number of people are also struggling with mental health issues.
Sadly, the number of people dying from drugs, alcohol and suicide hit record levels in 2019.
When someone is battling addiction or has mental health issues, it affects all aspects of their life, including work. Stress can have a significant adverse impact on business. It costs employers an average of $300 billion a year in stress-related health care and missed work, according to a Harris Poll conducted for Purchasing Power.
That’s why more employers are stepping up to provide their workers with benefits to support behavioral health and emotional well-being.
Employee assistance programs
One of the most common ways that businesses have ...
Trends Shaping Health Insurance and Health Care in 2020
February 18, 2020
As a new decade begins, the health insurance industry is on the cusp of making a leap towards improved, higher-tech management of health plan participants.
A recent paper by Capgemini, an insurance technology and consulting firm, predicts the following trends that will be taking shape in the health insurance industry and how they may affect businesses that are paying for their employees’ coverage.
1. Realigned relationships — Insurers are trying to shift risk between themselves and pharmaceutical companies in an effort to reduce drug outlays. The report says insurers are also working more closely with health care providers for early intervention in medical issues that may be facing participants. Addressing health issues early can reduce long-run treatment costs.
2. Fluid ...