Month: September 2014

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.

By Laura K. Brestovansky There are two main types of health insurance, PPOs (preferred provider organizations) and HMOs (health maintenance organizations). There are benefits and disadvantages toward each type of coverage and people considering health insurance coverage should do research before deciding which type of policy is best for them and their family. PPO Definition … Continued

A Summary of Benefits and Coverage (SBC) must contain:

• Uniform definitions of standard insurance terms and medical terms (provided in the glossary)
• A description of the coverage for certain categories of benefits
• The exceptions, reductions, and limitations of the coverage
• The cost-sharing provisions of the coverage (deductible, coinsurance, and copayment obligations)
• A statement as to whether the plan offers minimum essential and minimum value coverage
• The renewability and continuation of coverage provisions
• Coverage examples
• A statement that the SBC is only a summary and that the plan document, policy, certificate, or contract of insurance should be consulted to determine the governing contractual provisions of the coverage
• Contact information for questions and obtaining a copy of the plan document or the insurance policy, certificate, or contract of insurance (such as a telephone number for customer service and an Internet address for obtaining a copy of the plan document or the insurance policy, certificate, or contract of insurance)
• For plans and issuers that maintain one or more networks of providers, an Internet address (or similar contact information) for obtaining a list of network providers
• For plans and issuers that use a formulary in providing prescription drug coverage, an Internet address (or similar contact information) for obtaining information on prescription drug coverage
• An Internet address for obtaining the uniform glossary, a contact phone number to obtain a paper copy of the uniform glossary, and a disclosure that paper copies are available

Important: The agencies have issued very specific instructions on how to complete the SBC. If you are completing an SBC, you need to read and follow the instructions. The instructions are available at http://www.dol.gov/ebsa/pdf/SBCInstructionsGroup.pdf.

Since these instructions were issued, the DOL has made a few liberalizations. They are:

• If a plan’s terms deviate significantly from the template or instructions, you may modify the template/entries to the extent needed to be accurate
• You only need to include the footer on the first and last page and the header only needs to be on the first page
• When completing the header, either the company name, any insurer name or the plan name can be listed first
• If there are multiple plan options, list the name commonly used; if there is no common name, a generic name is fine

In addition, for 2014 and 2015 employers and carriers may address the prohibition on annual dollar limits for essential health benefits by either:

• Deleting the row that asks about annual limits; or
• Completing the annual limits question with “no” and stating in the “Why It Matters” column: “The chart starting on page 2 describes any limits on what the plan will pay for specific covered services, such as office visits.”

A blank SBC to use with 2014 and 2015 plan years is at http://www.dol.gov/ebsa/correctedsbctemplate2.doc.

A sample completed SBC for 2014 and 2015 is at http://www.dol.gov/ebsa/pdf/CorrectedSampleCompletedSBC2.pdf.

What do you do if you have multiple benefit options? Dental or vision benefits?  HRA or HSA? EAP or wellness program?

For these answers and additional information on completing the coverage examples, providing the glossary, distribution, language requirements and more, Download a copy of UBA’s “Summary of Benefits and Coverage FAQs” at: http://ubabenefits.sites.hubspot.com/summary-of-benefits-and-coverage-faqs

The Equal Employment Opportunity Commission (EEOC) has sued an employer because the penalty it applied for not participating in its wellness program was, in the eyes of the EEOC, so high that participation was not, as a practical matter, “voluntary.” Under EEOC rules, an employer may conduct medical examinations, which includes obtaining medical histories and blood draws, only in limited situations. One of those permitted situations is a voluntary wellness program. Because the program did not qualify as “voluntary,” the questions employees were asked about their health on a health risk assessment, a blood draw, and a range of motion assessment violated the Americans with Disabilities Act (ADA), according to the EEOC’s Complaint.

This is the first lawsuit brought by the EEOC challenging the incentives of an employer’s wellness program. The situation that created the complaint is a bit unusual, because the employee was terminated shortly after complaining about the wellness program. However, the EEOC also seems disturbed by the terms of the program itself. The program was designed so that the company paid 100% of the health insurance premium for employees who participated in the wellness program and paid nothing toward the premium of any employee who did not participate. The EEOC has described this penalty as “steep” and “enormous.” It remains to be seen whether the court will agree with the EEOC that the penalty violates the ADA rules, but employers considering significant penalties for non-compliance with, or incentives for participating in, a wellness program should understand that their design could lead to an EEOC charge or lawsuit. 

As a reminder, in addition to the ADA requirements, wellness programs need to comply with PPACA’s rules for these programs. Under the 2014 rules, wellness programs are either “participatory” or “health-contingent.” A participatory program is one that either has no reward or penalty (such as providing free flu shots) or simply rewards participation (such as a program that reimburses the cost of a membership to a fitness facility or the cost of a seminar on nutrition). As long as a participatory program is equally offered to all similar employees, no special requirements will apply to the program.

A number of rules apply to “health-contingent” wellness programs. Health-contingent wellness programs are programs that base incentives or requirements in any way on an employee’s health status. Health status includes things like body mass index (BMI), blood glucose level, blood pressure, cholesterol level, fitness level, regularity of exercise, and nicotine use. A wellness program with health-contingent requirements must meet all of these requirements:

• Be reasonably designed to promote health or prevent disease
• Give employees a chance to qualify for the incentive at least once a year
• Cap the incentive at 30% of the cost of coverage if the incentive does not relate to non-use of tobacco and to 50% of the cost of coverage if the incentive relates to non-use of tobacco
• Provide a reasonable alternative way to qualify for the incentive
• Describe the availability of the alternative method of qualifying for the incentive in written program materials

The case was filed in Wisconsin against Orion Energy Systems.

Ask any employee how they’re doing and you’re likely to hear the answer, “I’m feeling stressed today.” Oh, really? EVERYONE at work is stressed at one time or another.

Use of Payroll Debit Cards by Employers On August 6, 2014, Illinois Governor Pat Quinn signed legislation (H.B. 5622) establishing requirements for the use of payroll cards by employers. The law: * Prohibits an employer from making receipt of wages by payroll card a condition of employment. * Sets forth requirements for initiation of payment … Continued