The Affordable Care Act (ACA) requires most individual and small group health insurance plans to cover mental health and substance abuse disorder services, including behavioral health treatment, counseling, and psychotherapy.
Additionally, health plans must comply with the requirements set forth in the Mental Health Parity and Addiction Equity Act (MHPAEA), meaning coverage for mental health and substance abuse services generally cannot be more restrictive than coverage for medical and surgical services.
The need for mental health programs has increased, says Pari Luna, Director of Health Strategies at Hays Companies, with some 3.7 million Americans with significant mental illnesses accessing care through the insurance exchanges and extended Medicaid coverage as of January 2016.
“There is more to the wellbeing of an organization’s workforce than just physical health,” she adds. “Mental health is a highly prevalent condition in most organizations and serves as a barrier to managing other aspects of one’s health. When companies take a holistic approach to the health of their population and appropriately accommodate for those benefits, we see much greater impact on both individual and organizational health goals.”
Trends in Mental Health Services Cases of employee depression increased by 58 percent between 2012 and 2014 and anxiety cases increased by 74 percent, along with cases of employee stress growing by 28 percent, according to a Workplace Options study.
Surveyed employers saw a 3.4 percent increase in mental health and substance abuse claims.
The total number of out-of-network claims for mental health services has grown, perhaps due to adult dependents in college who do not have access to in-network care. Luna adds that this trend is also due to the shortage of providers, resulting in people choosing not to join networks because they don’t necessarily have to.
The Effect of Mental Health Coverage on Employers
Each year, 18 percent of the U.S. population experiences some type of mental illness, according to data released by the U.S. Substance Abuse and Mental Health Services Administration.
Mental illness also causes individuals to miss more workdays than any other chronic condition, resulting in an estimated $100 billion per year in indirect costs to U.S. employers.
Research shows that a mentally healthy workforce is linked to lower medical costs, as well as less absenteeism, notes Luna. Therefore, employers should ensure that they have the resources to support their employees to become as mentally healthy and productive as possible.
Creating a Stigma-Free Workforce and Evaluating Current Mental Health Benefits
In order to encourage a mentally healthy workforce, employers should build a culture that is as stigma-free as possible, encouraging people to seek help rather than hiding their stress and pain. Some efforts could include educating employees about the signs and symptoms of mental health disorders and regularly hosting seminars about stress, workload, and work-life balance, and other issues.
Employers should also evaluate their current mental health benefits to ensure they are sufficient for employee care by asking insurers these questions:
Do they offer readily accessible mental health information through employee educational programs, their website or self-screening tools?
Do they have a toll-free number for your employees to call for help with personal, family or work issues?
Are there available, in-network providers who are trained in screening for and treating depression, anxiety and substance abuse disorders?
Can they integrate their services with your EAP, disease management and disability benefits? Integration results in better coordination of care for employees and can save employers time, effort and money.
Are pharmaceutical benefits sufficient enough for employees to be able to afford needed medication?
“Although the ACA has made an impact on mental health care, further implementation and education regarding appropriate coverage is still needed to realize the full impact,” Luna concludes.
For more information on mental health benefits, contact Pari Luna, the Director of Health Strategies at Hays Companies, at email@example.com.
Congratulations to Bruce Hollcroft and Bruce Lyon, two of Hays Companies’ Risk Control Directors, on their recent textbook publication titled Risk Assessment, A Practical Guide to Assessing Operational Risks. The book was written by Hollcroft, Lyon and Georgi Popov, Associate Professor on risk assessment at the University of Central Missouri.
Risk Assessment, A Practical Guide to Assessing Operational Risks, teaches the fundamentals of risk assessment to students and those in the safety, health and environmental professions, who recognize the need to refine their personal risk assessment capabilities.
Risk assessments have begun to receive more prominence in operational risk management systems. This book fills a content gap in educational material about the growing field of risk assessment.
“Working alongside industry experts at Hays Companies has pushed me to continue developing my risk management skill set and knowledge base. This book is an accumulation of my expertise and similar outside education,” Hollcroft remarked. “I hope it will be a guide to others interested in the topic and help cultivate our future risk assessment leaders.”
The authors intend for this text to assist professors at a university level who sense the need for their students to gain knowledge and aptitude with respect to risk assessment. It will also serve as a primer for employed safety professionals, needing a practical guide on risk assessment techniques.
“I hope this book educates and motivates prospective risk management experts,” Lyon said. “More important than any publications or expertise on my end is the ability to pass this information on to young professionals. Hays Companies has helped me realize the incredible value in educating young learners to ensure the success of not just a company, but an industry and the clients it serves.”
Congratulations to Bruce Hollcroft and Bruce Lyon on the publication. They are proving once again that Hays employees truly are experts in their fields, devoted to educating others.
MINNEAPOLIS, Minn. (June 27th, 2016) – Hays Companies announced Joe Williams has joined its San Francisco operations as Senior Vice President. He will be responsible for spearheading new business development, leading and managing the team and continuing to build Hays’ renowned workforce.
“We are delighted to have Joe on board at Hays,” said Michael Egan, President and Chief Operating Officer of Hays Companies. “His knowledge and experience will add considerable acumen to our employee benefits capacities.”
Williams’s has over eleven years of experience in the employee benefits industry and has held previous high-level leadership positions; he will play a key role in spurring growth and development for Hays at the San Francisco office.
Williams formerly served as the Senior Vice President of Employee Benefits of HUB International, as well as Vice President of BB&T Insurance Services. Williams’s experience includes extensive work with medical/dental/life/disability insurance, underwriting, consulting, as well as ACA compliance.
“I am excited for the opportunity to join such an illustrious company like Hays Companies. They have built a strong reputation in the past 20 years and I look forward to being a part of this fast growing, innovative organization,” said Williams.
ABOUT HAYS COMPANIES
Hays Companies is one of the fastest growing, privately-held risk management, insurance and employee benefits advisors in the country. Our philosophy of delivering the highest-quality, customer-focused service has led to significant growth for 20 years. Today, the company includes 700+ experienced professionals in more than 30 locations throughout the United States. For more information, contact Andrea Field (firstname.lastname@example.org) or visit our website at hayscompanies.com.
WARNING: This is a whimsical look at the difficulty of combining several agency rules with compliance under the ACA. If you have any questions regarding the compliance issues raised in this piece, contact your Hays Team representative and we can provide more detailed guidance.
If you have ever been to a state fair or an arcade, you’ve probably seen the “Whack-A-Mole” game If you haven’t, the goal is for the player to hit the heads of as many pesky moles as possible before they pop down into their hole in the box. But, each time you whack one mole with the foam mallet, another pops up somewhere else. Other than the obvious thrill of playing and winning, why is a Compliance Director writing about this game? And what does this have to do with the Affordable Care Act (ACA)?
It seems we have all been playing “Whack-An-ACA-Rule.” For example, let’s consider the rules related to nondiscriminatory wellness plans. Maybe you decide to reward employees who meet certain biometric standards, such as lowering blood pressure, by giving them a 30 percent discount on their full healthcare premium. If a single-only premium is $600, the employee contribution is set at $200, and the employee satisfies the entire wellness program criteria, he or she gets a premium contribution discount of $180 (30 percent of $600). That employee’s actual monthly contribution is now only $20 and they are healthier. Wow! But wait…the ACA steps in and says, not so fast — is this “affordable?” Of course, you say — it’s $20! But the ACA says affordability must be calculated based on the full non-discounted premium. So, you hit one mole on the head by encouraging potentially healthier outcomes but the next mole — affordability criteria — pops up right behind you.
So, how do we “hit” the next mole? Maybe we reduce the starting single contribution amount to ensure that it is “affordable” under the ACA. But then, for financial reasons, you have to reduce the size of the wellness reward. Doing so may impact the employee’s motivation to work at lowering his or her blood pressure, which contradicts the point of the wellness program and runs counter to the ACA’s goals.
Head spinning? Let’s keep playing.
Next, you implement a High Deductible Health Plan (HDHP) so that employees can establish health savings accounts (HSAs). You are careful to make sure the maximum out-of-pocket (OOP) limits do not exceed limits established by the HSA rules. The HSA maximum annual OOP limit for family coverage is $13,100, but you set the family deductible at $10,000. This means the plan will not pay for covered services until the family, either collectively or even just one member, has incurred $10,000 in deductible expense. So far, so good. But wait, the ACA steps in and says, not so fast — the single allowable OOP max for an individual in 2016 is $6,850. OOP includes deductibles, copayments, coinsurance, and any other OOP expense. Therefore, you need to “embed” a single deductible of no more than $6,850 for any single family member. That’s yet another mole popping up through the hole.
You thought you complied with the rules and you did — just not all of them, unfortunately.
Ultimately, you have designed your wellness plan to be a little less well but a little more affordable, and your HDHP now has an embedded deductible for family coverage. Next, add one more plan design roadblock: although the HSA rules only consider in-network cost for OOP maximums, the current guidance suggests the ACA will take into account all costs next year, including out-of-network, so you need to be ready for that mole.
There is one way to beat the game: enlist your friends to help! In the case of the ACA, your friends are your Hays Team and our Research and Compliance department. We can help you hit all the current moles and anticipate the ones that may be just about to pop up.
Although it is only spring, we now have official guidance on health savings account (HSA) and Affordable Care Act (ACA) limits for 2017 plan years. As before, these two requirements have different limits that will need to be addressed to ensure that a high deductible health plan complies with ACA requirements.
On April 27, 2016, the Internal Revenue Service (IRS) released Revenue Procedure 2016-28 showing updated annual limits for HSA contributions and high deductible health plan (HDHP) design requirements for 2017 as follows:
HDHP minimum annual deductibles:
1,300 for self-only coverage (unchanged from 2016)
2,600 for family coverage (unchanged from 2016)
Out of pocket maximums:
6,550 for self-only coverage (unchanged from 2016)
13,100 for family coverage (unchanged from 2016)
Maximum annual HSA contributions:
3,400 for self-only coverage ($50 increase from 2016)
6,750 for family coverage (no change from 2016)
On Feb. 29, 2016, the U.S. Health and Human Services (HHS), Treasury, and Labor Departments finalized rules addressing 2017 Benefit and Payment Parameters for essential health benefits impacting out-of-pocket maximums for non-grandfathered group health plans:
Annual out-of-pocket maximums for health plans (other than HDHPs with HSAs):
7,150 for individual coverage
14,300 for family coverage
In summary, a high deductible health plan with family deductibles that are higher than the ACA’s cost-sharing limit for self-only coverage must be designed to limit the maximum out-of-pocket limit to no more than $6,550 for any one individual. For example, an issuer can offer a family HDHP with a $10,000 family deductible, as long as it applies a maximum annual limitation on cost sharing of $6,850 to each individual in the plan, even if the family $10,000 deductible has not yet been satisfied. This standard does not conflict with IRS rules on HDHPs.
If you have any questions on how Hays Companies can help your business stay compliant with employee benefit laws and regulations please contact us.
Earlier this year, cyber terrorists launched a well-organized and highly effective attack that cut power to millions serviced by Ukrainian electricity distribution companies, the first verified and successful intrusion into a utility information technology (IT) network.
The sophisticated attack was launched through a well-planned campaign that sent fake emails containing a BlackEnergy-type computer virus to the Ukrainian utilities’ employees. Social engineering techniques such as “spoofing” real email addresses convinced the recipients that the email was legitimate and opened the malware file. The deployed virus and external programming let the hackers collect information on the structure of the utilities’ IT systems and identify programming resources and their methods for external access to utility IT infrastructure.
The cyber-attack consisted of five elements:
1) Infecting the networks via emails;
2) Assuming control of the administration of the automated system for dispatch/control that shuts off sub-stations;
3) Disabling IT infrastructure, including modems, switchboards, and uninterrupted power supply devices;
4) Destroying information on servers and at work stations; and
5) Attacking telephone numbers of utility call centers to deny service to customers experiencing an outage.
Utility companies around the world are now on higher alert that relatively low-tech but increasingly sophisticated email “spoofing” scams could take down a power grid.
There are other threats as well. Several Hays clients have documented receipt of fraudulent emails purporting to be from senior officers. The emails told recipients to transfer money to a bank account (controlled by perpetrators) and advised that the necessary documentation supporting the payment would be made later. So far, quick-thinking employees who questioned the request or deviation from proper procedure have thwarted these attempts.
In another case, which unfortunately may have been successful, a fake email supposedly from a company officer directed an employee in the utility’s HR department to send an electronic file with sensitive employee information. In this type of social engineering scam, emails with spoofed addresses said things such as:
“Kindly send me the individual 2015 W-2 (PDF) and earnings summary of all W-2 of our company staff for a quick review.”
“Can you send me the updated list of employees with full details (Name, Social Security Number, Date of Birth, Home Address, Salary)?”
“I want you to send me the list of W-2 copy of employees wage and tax statement for 2015. I need them in PDF file type, and you can send it as an attachment. Kindly prepare the lists and email them to me asap.”
It is clear by the manner in which these fake internal emails were written — they often imitated the writing style of individual officers — that the perpetrators had gained access to the utilities’ systems for quite some time prior to the events.
The key point for risk managers is to not only ensure these attacks can’t happen because incoming emails are scanned for the latest malware and viruses, but also to identify and educate employees whose responsibilities and IT access make them prime potential targets. By properly informing workers about the various methods used, how to spot a potential fake email, how to effectively confirm legitimate requests, and when to be suspicious about attachments that could contain IT-compromising viruses, utilities companies have a chance to stay a step ahead of clever cyber criminals.
Most Disrupters aren’t all that disruptive anymore. Everyone, including our children, have become quite comfortable with Disrupters and the positive impact they have on business and our everyday lives. A true Disrupter turns a product or service upside-down and inside-out.
Consider one of the biggest Disrupters in recent history — the personal computer. Think of life without Google… More recently, consider smartphones, drones, smart watches, FitBit, Netflix, Nest, Uber, and Airbnb. Since their introduction, life has not been the same. Many of these companies have been incredibly successful. Today, we’re comfortably accepting these Disrupters with open arms and we’re hungry for more.
The Disrupter mentality and Silicon Valley.
Silicon Valley is home to some of the world’s most successful Disrupters. This continues to be true as many of the most visible Disrupters are technology-oriented.
In the first three months of 2015, venture capital (VC) funds invested $13.4 billion, much of it in the tech sector. Not since the dot-com era has there been such a run in VC funding and technology. Many young start-ups seeking funds are turning to crowdfunding and smaller investors, which is disrupting the very ground VC’s used to look to fund — Disrupters.
Two of the most successful Disrupters and their business strategy.
Sir Richard Branson, founder of Virgin Records, Virgin Airlines and Virgin Mobile, and Jeff Bezos, Amazon Founder and CEO, have a similar business philosophy: Constantly strive to improve the customer experience. In fact, they have structured their companies to encourage disruptive thinking and innovation. Bezos has upended the book and publishing industry and nearly displaced electronics retailers. He continues to disrupt and reinvent online shopping and delivery by responding to changing technology.
“We innovate by starting with the customers and working backwards,” says Bezos. “That becomes the touchstone for how we invent. For Amazon, customer focus is a cultural issue.”
The “improve the experience credo” has sparked a revolution in business thinking that fuels most new Disrupter companies.
One of the biggest Disrupters of today is the smartphone. By its very nature, its features are designed to disrupt whatever we’re doing. As a mobile device they are indispensable and frustrating because we can’t seem to put them down. They have changed the way we communicate, live and do business.
Smartphones are also having a dramatic impact on many other businesses, both positively and negatively. Yet smartphones have also created a dynamic new business category — app design. They help promote shopping, banking, health and fitness, news, entertainment, restaurants and better communication between businesses and consumers, just to name a few.
Understanding how Disrupters are affecting insurance and employee benefits begins with big data.
The biggest Disrupter to date is big data and most agree that big data benefits customers by offering them tailored insurance and employee benefits programs for their specific experience, location and risk profile. Collecting this information is no easy feat: it means gathering financial, claims, risk, customer preference and sales data from multiple sources, then scrubbing and analyzing it, all while complying with protective regulations designed to safeguard the data and data-driven decisions.
IBM’s Big Data @ Work survey reported that big data’s influence in the insurance realm is strong: some 47 percent of insurers want to use it to develop customer-centric programs and another 66 percent are conducting or planning big data activities.*
Today, the use of these devices is ubiquitous. We’ve become so accustomed to formerly “disruptive” technology that it doesn’t faze us anymore.
At the heart of the trend is effectively aggregating the data … and we are doing that at Hays.
We are on the edge of the big data trend, developing innovative programs and opportunities that will benefit our customers. At Hays, we have a proprietary technology platform that pulls together data. This allows us to audit the data, provide consistency of data extracts, show continuity of data across multiple vendors, simplify access to data through one portal, and reduce fees by eliminating ad hoc reports.
We help eliminate the “silos” that come from bucketing cost centers to give our customers a data-focused assessment of the true cost of employment.
The dark side of data.
When it comes to customer and employee privacy, however, we should never be complacent about the dark side of Disrupters.
Cyber terrorism and data breaches have shadowy technical roots in the so-called Deep Web and Dark Web, which most people don’t even know exist. Your company’s data is vulnerable through email links, apps, a compromised network, or a web download. But, the threats are not always through a coding attack. Hackers are increasingly using social engineering techniques to trick people into breaking normal security procedures because they think the phone or email contact is a trusted source.
That’s just the start. The rise of the Internet of Things (IoT) means personal data could be hacked or collected by cybercriminals in a way never before possible.
Does your wellness program encourage employees to use wearable fitness trackers or apps? Sure, they can improve employee health but there’s also a risk to private information: the FitBit cloud holding this personal health data has already been hacked, raising fears about their vulnerability. And that’s not even addressing their lack of Health Insurance Portability and Accountability Act (HIPAA) compliance.
With so many ways to hack into your company and your employees’ lives, it’s a top priority to have the best cyber security as well as the best insurance and employee benefits programs that protect your company’s people, property, data, reputation, and — ultimately — your bottom line, no matter what new Disrupter comes down the pike.
Technology is expanding at an unprecedented rate; there are new Disrupters in development that offer improvements and increased risks. Hays is at the forefront, watching the development and the impact on your business. We’ve always believed in providing the best resources available for our clients, so our representatives are prepared to provide guidance in managing the evolving risks. We hope you call on us if you have any questions.
This issue is an excerpt from our quarterly FOCUS publication. If you would like to read more, you can request the full issue below.
Recently, updated guidance has been received from the Federal Government with respect to the ACA, including release of updated health plan “Benefit and Payment Parameters” for 2017. For your information, we have summarized these updates below.
2017 Benefit and Payment Parameters:
On February 29, 2016, the US Health and Human Services (HHS), Treasury and Labor Departments finalized rules addressing 2017 Benefit and Payment Parameters for essential health benefits. The guidance issued is summarized in the linked “Fact Sheet”. Highlights of the changes affecting health plans under the proposed rule include:
Annual out-of-pocket maximums for health plans (other than HDHPs with HSAs) will be indexed in 2017, to $7,150 for individual coverage and $14,300 for family coverage.
HHS proposes to “codify statutory language” defining whether a new entity that was not in existence throughout the preceding year is a “large employer” subject to the play-or-pay mandate. The statutory language, when finalized, will reflect that the determine will be based on the number of employees it expects to employ on business days in the current calendar year.
The individual cost exemption for 2017 from the individual shared responsibility requirement will index to 8.16% of adjusted gross household income.
The Exchange open enrollment period for coverage beginning in 2017 and 2018 will begin November 1 and end the following January 31. For coverage beginning in 2019 and subsequent years, Exchange open enrollment will be from November 1 through December 15.
Click here to find an ACA Compliance Bulletin that contains further details, for your reference. If you have any questions, please contact your local Hays Consultant.
The art of risk assessment requires more than just knowledge — it also requires creativity and imagination to successfully anticipate, recognize, assess and treat potential risks.
Organizations that harness these skills can develop more effective risk management strategies to bolster their strategic goals, says Bruce Lyon, Hays Companies Director of Risk Control, in the cover story for the March 2016 edition of Professional Safety magazine.
The article dives deeper by presenting the sequence of assessing risk and the tools and methodologies used in the Risk Identification, Risk Analytics and Risk Evaluation process. To read more about the financial and non-financial benefits of risk reduction measures, click here.
Professional Safety magazine is published by the American Society of Safety Engineers, a global association of safety professionals founded in 1911. The professional safety society sets the occupational safety, health and environmental community’s standards for excellence and ethics.