This year in healthcare has been both interesting and tumultuous. In 2018 alone, the Affordable Care Act has undergone significant changes at the hand of the current presidential administration. First, the Cadillac Plan tax was delayed from 2020 to 2022, in January.
Then, in April the administration announced two new exceptions to the individual mandate and gave states the authority to cut back on the 10 essential health benefits mandated by the ACA. Later the government released new rules that expanded both association health plans, and short-term ones, in June and August, respectively.
These rules, in addition to multiple cuts in government funding, have worked to cripple the ACA. Still, until the act is officially repealed, it’s the law of the land. As such, you’ll need to know how these changes will affect your 2019 open enrollment.
Luckily, The Olson Group is prepared and ready to help. Here’s a list of top seven healthcare trends and changes you need to be aware of for your 2019 open enrollment.
1. Plan Changes and Limit Increases
The IRS, in May of this year, announced new annual contribution limits for Health Savings Accounts (HSAs) for the upcoming plan year. For 2019, the annual limit on deductible contributions to a health savings account will rise by $50 for individuals and $100 for families.
Now, the annual contribution limits will be $3,500 and $7,000 for individuals and families, respectively. On the other hand, the minimum deductible of a high-deductible health plan (HDHP) is unchanged for 2019. The deductibles for these health plans, the only type that can be paired with an HSA, will remain $1,350 for individuals and $2,700 for families.
Conversely, the annual HDHP out-of-pocket maximums, for 2019, will increase. Next year, out-of-pocket maximum’s for HDHPs will be $6,750 for individuals and $13,500 for families.
2. Penalties Are Still Relevant
Beginning late last year, and continuing through this summer, the IRS sent over 300,000 proposed-penalty letters to employers for violations of the ACA’s employer mandate in 2015. Some of these letters proposed penalties for large employers that exceeded $1 million each.
And, as an employer, you shouldn’t predict these letters to stop. Mark Spittell, managing director at KPMG’s Compensation & Benefits Practice, expects 2016 assessment letters to be issued before the end of this year.
Penalties for violating the “employer shared responsibility payments” (ESRP) come in the form of a 226-J letter. An employer has only 30 days to respond to this letter. And, they must complete and return their response, via Form 14765, to challenge any part of the IRS’ assessment.
It’s important your firm handles these letters and responses as quickly as possible. Because the penalties can be significant. In a worst-case scenario, an employer with inadequate health coverage could pay for the cost of this coverage, in addition to penalties up to $2,000 a year for every full-time employee.
In addition to ESRP penalties, employers need to be aware that Forms 1094-C, 1095-C, and Summary of Benefits Coverage (SBC) all still need to be filed. Employers that fail to complete Forms 1094-C and 1095-C, or complete them with errors, could face both reporting-related penalties and ESRP penalties.
Additionally, the penalty for a failure to provide employees with an SBC is less punitive but still significant. For 2018, a penalty of $1,128 per participant can apply to the failure to provide an SBC as required.
3. Utilize Big Data
Every year, through benefits technology, your organization can collect a treasure-trove of health data. This data, with the help of online resources, can provide an analytics-based guideline for improving employee’s health outcomes.
Employers should use this information to implement personalized clinical management and employee engagement programs. These programs let you maximize your healthcare dollars.
4. Digital Tools
Digital tools today, play as important of a role as ever, in both open enrollment and benefits in general. Online enrollment platforms let employees easily pick and enroll in their benefits plan. As mentioned above, they can also help your firm analyze important health data.
Similarly, digitally-driven benefits such as telemedicine, are growing in importance and utilization. So, it’s crucial your firm both understands and takes advantage of these digital tools, for your 2019 open enrollment. Because the role of this online equipment will only continue to grow.
5. Incentives for Comparison Shopping
Modern consumers are no strangers to spending hours online searching for the best deal for a particular product. Yet, this propensity to comparison shop doesn’t extend to healthcare. According to Employee Benefits Advisor, only a little more than one-third (36 percent) of Americans say they’ve used the Internet or mobile apps during the last year to comparison shop for healthcare.
This number is a huge improvement, since 2012. That year, only 14 percent of consumers said they comparison shopped for healthcare. Still, your business should do all it can to promote comparison shopping for healthcare among your employees.
To encourage your staff to participate in this trend, your firm should consider offering incentives. Even small financial incentives, such as $50 gift cards, can push employees to use these healthcare transparency resources.
The quality and cost of healthcare can vary widely within the same city or even the same neighborhood. So, utilizing these transparency resources can result in significant savings for both your employees and your organization overall.
You wouldn’t expect someone to buy a car without them researching the vehicle first. So, why wouldn’t you expect your staff to do the same for healthcare. Especially, as the cost of healthcare and health benefits continues to rise. In 2019, the cost to provide healthcare coverage is expected to rise to $15,000.
6. Integrate Enhanced Benefits
Enhanced benefits, also known as voluntary or ancillary benefits, are more important to your health plan’s success than you may realize. Benefits such as vision and dental care, identity theft protection, or short-term disability all affect the outcomes of your overall benefits plan’s success.
These ancillary lines of coverage help maximize the effectiveness of your firm’s healthcare dollars. Combining medical and enhanced benefits under a single health plan may enable your company to analyze a wider range of data.
As previously mentioned, the more data you have, the better you can engage in proactive outreach and clinical support for employees. Especially for those with chronic conditions.
Those with chronic conditions, often known as high utilizers, cost billions of dollars themselves. The sickest five percent of patients use a full third of Medicare’s budget. Similarly, this five percent consumes over half the spending of Medicaid.
7. Employee Education
Employee education is or should be, the most vital component of any open enrollment. According to a 2018 poll by Unum, the average employee spends 30 minutes or less reviewing benefits materials before open enrollment.
Despite this fact, 77 percent of employees say they’re prepared for open enrollment, according to a UnitedHealthcare Survey. But, according to the same study, only 6 percent of these respondents could successfully define all four basic health insurance concepts.
And, per an HSA Bank white paper, just 10 percent of employers believe their workers understand their health plans. Clearly, most employees aren’t taking the time to completely understand their benefits plans. It’s an employer’s responsibility to ensure your staff has a thorough understanding of their benefits.
Your broker or HR team can help employees with their benefits selection. But, holding employees’ hands through the process doesn’t actually help these individuals. To get the most from your healthcare dollars, all your staff must know what benefits are available to them, and how they can affect themselves and their family.
Open enrollment is critical for establishing a baseline of prosperity for your employee benefits plan. Follow these seven trends to maximize the success of your company’s 2019 open enrollment.