Health Plan Eligibility: Do’s and Don’ts
Employers sponsoring group health plans have some flexibility when deciding which groups of employees and dependents will be eligible for coverage. However, there are several crucial eligibility requirements employers should adhere to for health coverage. These rules can be categorized into important eligibility “do’s” and “don’ts” for employers to follow.
A basic eligibility “do” is following the terms of the health plan’s written plan document, including its eligibility rules. Also, to avoid potential penalties, applicable large employers (ALEs) should ensure they offer affordable coverage to their full-time employees. Other important “do’s” include making coverage available for adult children up to age 26 and continuing to offer coverage for Medicare-eligible employees when the health plan is the primary payer.
Essential “don’ts” for health plan eligibility include offering coverage to nonemployees, such as independent contractors, andimposing waiting periods that exceed 90 days. Other crucial “don’ts” are overlooking applicable nondiscrimination requirements when establishing eligibility rules and excluding employees from coverage based on health status-related factors.
View and download the latest Health Plans Eligibility: Do’s and Don’ts
Benefits Breakdown: Complex Health Benefits Can Hinder Employee Success
Health care is rarely straightforward for the average consumer. Many individuals need help making sense of their options both during open enrollment and when receiving health services. In fact, 8 out of 10 people said they faced challenges when receiving care, according to a recent study from Quantum Health.
According to the study, the vast majority of consumers have reported facing hurdles in the past two years when receiving care. These challenges include issues understanding coverage levels, locating providers and navigating the insurance claims process. Issues like these were compounded for individuals with chronic conditions—90% of whom said they faced additional challenges, such as making sense of diagnoses or test results.
Understanding Individual Coverage Health Reimbursement
Arrangements (ICHRAs)
HRAs reimburse employees for certain medical costs. Depending on the plan, such expenses may include doctor visits, medical procedures and prescriptions. An employee must be enrolled in their employer’s group health plan to qualify for an HRA.
ICHRAs are a bit different. These accounts can reimburse employees for certain medical expenses, insurance premiums or both. Whether an ICHRA will cover both premium and medical expenses is up to the employer.
Benefits and Me: Preparing for Rising COVID-19 Medical Bills
COVID-19 medical bills are expected to increase next year. During the height of the pandemic, insurers waived the costs of certain COVID-19-related services, such as emergency room (ER) copayments, hospital stay deductibles and testing charges. For example, screening procedures were primarily free during the pandemic, and now they could cost upwards of $200.
Consider the following ways to control your costs:
Understanding Individual Coverage Health Reimbursement
Arrangements
An individual coverage health reimbursement arrangement (ICHRA) uses funds from your employer to help pay for certain medical expenses. To qualify for an ICHRA, you enroll in individual health coverage using a Health Insurance Marketplace, a private insurer, Medicare or another method. In other words, if you’re enrolled in an employer’s group health plan, you don’t qualify for an ICHRA. Here’s how an ICHRA works:
Know Your Benefits: COVID-19 Medical Bills Expected to Rise
COVID-19 medical bills are expected to increase next year. During the height of the pandemic, insurers waived the costs of certain COVID-19-related services, such as emergency room (ER) copayments, hospital stay deductibles, and testing charges.
As the pandemic eases, those previously waived costs are returning. Many insurers are now treating COVID-19 much like other diseases, meaning they no longer provide special exceptions for COVID-19-related services.
This article briefly explains why this pricing change matters to you and what you can do to protect your health budget.
- Where Might Expenses Increase?
- How Might Rising Costs Be Controlled?
- Where Can I Learn More?
Reach out to Evolution of Benefits for all your employee communication needs, including enrollment guides, video messaging, presentations, and more.
Learn more and take action – view the full newsletter below.
Know Your Benefits: Family-building Benefits
FamOver the past decade, there have been shifts in the path to parenthood as many people turn to in vitro fertilization, surrogacy and egg freezing. Routes like these may share some of the same challenges, but how individuals build their families is ultimately unique to them. Although advanced technology provides more opportunities to be a parent, there are still hurdles to overcome often related to finances and access.
- Fertility treatment.
- Donors and surrogacy.
- Adoption.
Family-building benefits are becoming increasingly popular since they inclusively support the complex ways individuals and couples build their families. Benefits may cover options including fertility drugs, medical treatments and procedures, surrogacy, and adoption.
Reach out to Evolution of Benefits for all your employee communication needs, including enrollment guides, video messaging, presentations, and more.
Learn more and take action – view the full newsletter below.
Understanding Prescription Drug Plans and 5 Ways to Lower Your Health Care Costs
Understanding your drug plan and prescriptions can help you save money, stay healthier and receive greater satisfaction from your health benefits. Here are some things to consider when making sense of your prescription drug plan:
- Decide between generic or brand-name drugs.
- Follow directions completely.
- Talk to your doctor.
The continuing trend of rising health care costs can significantly impact your budget. While it’s difficult to control all the contributing factors of growing costs, educating yourself as a health care consumer is one way to help manage or lower your spending.
Reach out to Evolution of Benefits for all your employee communication needs, including enrollment guides, video messaging, presentations, and more.
Learn more and take action – view the full newsletter below.
3 Strategies for Reducing Health Benefits Costs in 2022 and Open Enrollment 2022: Benefit Notices
According to a PricewaterhouseCoopers (PwC) report, medical costs are projected to increase 6.5% in 2022. This is about average for the past decade; although, it is slightly lower than the 7% increase projected this year (as more spending goes toward the COVID-19 pandemic).
- Control Drug Spending
- Encourage Active Benefits Participation
- Embrace Virtual Health Options
Employers that sponsor group health plans should provide certain benefit notices in connection with their plans’ open enrollment periods.
Reach out to Evolution of Benefits for all your employee communication needs, including enrollment guides, video messaging, presentations, and more.
Learn more and take action – view the full newsletter below.
5 Strategies for Reducing Health Benefits Costs in 2022
For the past two decades, health costs have increased each year. This happens for a variety of reasons, such as inflation or, say, a global pandemic. With that in mind, employers can bank on prices going up in 2022.
According to a PricewaterhouseCoopers (PwC) report, medical costs are projected to increase 6.5% in 2022. This is about average for the past decade; although, it is slightly lower than the 7% increase projected this year (as more spending goes toward the COVID-19 pandemic).
Yet, 6.5% is still a considerable increase, especially when so many budgets have been reallocated or slashed due to the pandemic. That’s why employers must think both strategically and creatively about how they can lower their health benefits expenses in 2022.
This article includes five ways to help reduce spending without compromising benefits quality.
Reach out to Evolution of Benefits for all your employee communication needs, including enrollment guides, video messaging, presentations and more.
Learn more and take action – view the full newsletter below.
4 Lessons Learned From Open Enrollment During the Pandemic
The pandemic presented many learning opportunities for organizations as they pivoted and learned how to be resilient during uncertain times. The 2020 open enrollment season was one such opportunity, and many employers rose to the challenge by exploring new ways to engage and educate their employees about their benefits.
With open enrollment approaching and hybrid/remote workplaces still a reality, employers can use last year’s experiences to shape their open enrollment planning and processes. This article discusses key lessons from last year’s open enrollment season that can increase plan participation this fall.
Reach out to Evolution of Benefits for all your employee communication needs, including enrollment guides, video messaging, presentations and more.
Learn more and take action – view the full newsletter below.
Why Starting Open Enrollment Early In 2021 Is More Important Than Ever
Reports suggest that employees who put off job searches during the pandemic are likely to resume them in earnest this fall. That’s because, among other reasons, workers are now more financially secure than they were a year ago and are willing to leave their employers for more favorable arrangements.
Employers should recognize that they have a massive opportunity if they begin open enrollment efforts early in 2021. Revamping benefit offerings can help demonstrate to employees they are valued and convince top performers who may be seeking a new job to remain.
Tailoring Benefits Options
Employee benefits can be powerful retention tools. However, that’s only true if employees see value in the offerings. That’s why employers need to tailor their benefits options to include perks that employees are looking for.
Employers should keep in mind that nearly 50% of employees are willing to change jobs for benefits that matter to them, such as hybrid working arrangements. That’s why it’s critical for employers to seriously consider speaking with employees about which perks provide the most value for their unique circumstances. Adding or tweaking a few benefits options may be enough to retain some workers.
Moreover, gaining employee feedback ahead of enrollment shows a meaningful interest in employee concerns. It can go a long way to proactively retaining employees by showing them that their quality of life matters.
Reach out to Evolution of Benefits for all your employee communication needs, including enrollment guides, video messaging, presentations and more.
Learn more and take action – view the full newsletter below.
Client and Employee Resources
The more your employees understand your benefit plans the more they become educated, empowered consumers. The programs you provide will also gain an enhanced value.
As your strategic partners in employee benefits, we can provide multiple avenues of ongoing support, including:
- Employee Meetings (English and Spanish)
- Webcasts
- Payroll Stuffers
- Poster Campaigns
- Newsletters
Carrier Directories
E-Verify is a web-based system that allows enrolled employers to confirm the eligibility of their employees to work in the United States. Click the image below to begin.
