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Monthly Archives: November, 2015

  • What’s New With the ACA in 2016

    With the end of 2015 fast approaching, it’s time to start planning for 2016. The coming new year will bring with it new elements of the Patient Protection and Affordable Care Act. The ACA was signed into law on March 23, 2010, but its requirements have gone into effect over time — some by design and others because of delays caused by congressional or legal action.

    Here’s what will be new with the ACA in 2016:

    The PACE Act

    One of the biggest changes is a change that isn’t happening. Under the ACA, the definition of small-group employers was set to change from 2 to 50 employees to 2 to 100 employees on January 1, 2016, making more companies subject to offering small-group plans that contain essential health benefits.

    However, President Barack Obama in October signed the Protecting Affordable Coverage for Employees Act, which keeps the definition of a small group at 2 to 50 employees. In addition, it reverts decisions about whether to subject larger employers to ACA mandates back to states, says Joel White, president of the Council for Affordable Health Coverage.

    The new requirements that some companies would have faced might have increased premiums and resulted in lost plans in midsize markets, says Debora Ristau, vice president of group benefits for AEPG Wealth Strategies. With states making the decisions, the marketplace should stay more stable, she says.

    Employer Mandate

    2016 is the first year that smaller employers, generally those with 50 to 99 full-time employees, will be subject to the ACA’s employer mandate, says Mark Lam, vice president of employee benefits compliance at Assurance. Because the PACE Act was signed so late in the year, it’s possible some employers of this size have already looked at plans that meet small-group requirements, so it may not be until 2017 when both mandates’ full effects are felt.

    New Self-Reporting Requirements — and Penalties

    Tracking and reporting employee data will remain key for employers in 2016, says Elizabeth Winchell, an associate at Nilan Johnson Lewis.

    “Beginning early next year, several ACA reporting requirements will take effect,” Winchell says. “As a result, many employers will need to file annual information returns with the IRS and provide annual statements to employees containing health coverage information.”

    Large employers must provide Form 1095-C and small employers must provide Form 1095-B to employees by February 1, 2016, and file with the IRS on or before February 29, 2016 (or March 31, 2016, if they’re filing electronically).

    An employer that fails to comply with these reporting requirements by not reporting, or by reporting incompletely or inaccurately, faces penalties of $250 per return, with total calendar year penalties capped at $3 million, Winchell says.

    “Penalties are doubled in certain situations, such as when a reporting failure is caused by an employer’s intentional disregard,” she says, although penalties resulting from intentional disregard are not subject to the calendar year cap.

    The IRS has indicated that it will not impose penalties in 2016 on employers that can show they made good faith efforts to comply with the reporting requirements, Winchell says.

    Open Enrollment Dates Have Changed

    Employers should note that because open enrollment began on Nov. 1, 2015, it will end on January 31, 2016. Certain life events, such as getting married, having a baby or losing coverage, may qualify an individual for enrollment outside of the open enrollment period.


    Mary Ellen Slayter is CEO and Founder of Reputation Capital Media Services. She has more than 15 years of experience writing about HR and financial services as a journalist and marketer. Any opinions expressed within this document are solely the opinion of the individual author and may not reflect the opinions of Ebix or its personnel.

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  • Is Your Company Culture Hurting Your Employees’ Health?

    Working hard and putting in long hours is often touted as a sure-fire way to get ahead and be successful, but it’s also bad for your health. A recent study published in the U.K. medical journal The Lancet found people who work more than 55 hours a week have a 33% higher risk of suffering a stroke than those working 35 to 40 hours a week. In addition, working long hours may be associated with a higher risk of coronary heart disease.

    With this information, companies with cultures that reward success at any cost or simply sitting at a desk for long hours may want to reconsider their approach. A culture that combines a drive for productivity with a balanced approach to work and life could also result in healthier employees – which could mean lower health care costs. It also could mean lower turnover.

    High voluntary turnover is a good indicator your company culture may be making employees feel like they have no choice but to work long hours, says Neal McNamara, communications manager at employee engagement software company TINYpulse. If you’re churning through employees at a rate that doesn’t make sense in your industry, you’ll need to dig a little deeper and find out if long hours are part of the problem.

    Consider Alternative Schedules

    A workaholic culture can lead to a lack of sleep, making people more susceptible to stress and illness, says Cord Himelstein, vice president of marketing and communications at employee recognition firm Michael C. Fina. Not everyone fits the 9-to-5 (or later) schedule, and employers may be expecting employees to be at work when they aren’t at their most productive.

    Look at flexible scheduling options, such as allowing people to come in earlier or later as long as they get their work done in a day without disrupting the business. Four-day workweeks and telecommuting can also incorporate the flexibility that makes it possible for people to rest and recharge.

    “It’s time to rethink the antiquated 9-to-5, five-day workweek,” Himelstein says.

    Lighten the Load

    It may be that your employees feel like there’s just too much to do and they can’t possibly leave work on time and put off tasks until tomorrow. Take an inventory of how people are spending their time, McNamara says. Are there things they can outsource or delegate to clear their schedules? Working smarter, not harder, can help boost productivity without working longer hours.

    Remember, Employees Are People

    Business leaders need to examine their attitudes toward employees across the board and avoid treating them like machines, says Howard Matalon, a member of The Alternative Board and the labor and employment law partner at OlenderFeldman. As with any business asset, employees require care and maintenance to stay productive throughout their tenures.

    Put a priority on taking breaks, rotating shifts and providing variety in daily tasks to keep employees engaged and refreshed, Matalon says. Informal social gatherings can communicate that the company values employees for who they are. Finally, if long hours are unavoidable, incentive programs that reward achievement can reduce the psychological impact of fatigue and stress, he says.

    Mary Ellen Slayter is CEO and Founder of Reputation Capital Media Services. She has more then 15 years of experience writing about HR and financial services as a journalist and marketer. Any opinions expressed within this document are solely the opinion of the individual author and may not reflect the opinions of Ebix or its personnel.

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  • The Commute, Not the Job, May Cause Burnout

    The term burnout, which describes a state of emotional, mental and physical exhaustion caused by excessive and prolonged stress, is most often associated with a person’s job – but there may be another work-related trigger. A recent study from the University of Montreal found that workers who commute to their workplace every day, especially if the trip between home and the office is longer than 20 minutes, can have an increased risk for burnout.

    Annie Barreck of the University of Montreal’s School of Industrial Relations studied commuting patterns in both rural and urban regions of Quebec. She analyzed a survey of almost 2,000 commuters between the ages of 17 and 69 who worked at 63 organizations to find out how they got to work – whether they drove a car, took a subway or bus, walked or rode a bike. She also documented how long the trek from home to office took and whether those who commuted by car were drivers or passengers.

    To see if the commuters were experiencing burnout, Barreck used the Maslach Burnout Inventory, a widely used psychology research tool that measures burnout symptoms by taking an inventory of complaints such as feeling exhausted and emotionally overextended.

    The results showed that employees who commuted into a large city by car often felt the most symptoms of burnout. Those commuting to rural or suburban areas typically felt less stress – but not if they were taking public transportation. What’s more, workers who had a long commute into rural areas on public transit tended to feel more ineffective at their jobs than their city counterparts.

    “Public transit implies bus or train connections, and as rural regions are less well served, the risk of unforeseeable and uncontrollable delays is increased, causing stress that is carried over into the workplace,” Barreck explains.

    On the other hand, workers in major urban areas who used public transportation to get to work tended to experience fewer burnout symptoms, probably because the variety and frequent service of buses and subways in big cities are more efficient and faster than in rural areas.

    Barreck also found that passengers in cars were likely to experience more burnout-type stress than commuting workers who actually did the driving.

    “Carpooling reduces the passenger commuters’ sense of control, which causes them more stress before they’ve even arrived at work,” she says.

    When it comes to those able and willing to walk or bike to work, the stress of their commute is influenced by whether they are in an urban or suburban environment. Cities with bike lanes and walking paths offer a less stressful way to get to work while commuting by walking and biking in the suburbs was found to produce more burnout symptoms.

    “Cyclists in the suburbs have a lesser sense of control than cyclists in the city,” Barreck says. “Cyclists and walkers in the city have access to safety features such as cycle paths and pedestrian crossings, which increase their sense of control over their commute. Meanwhile, as businesses have been leaving city centers over the past 20 years, car traffic continues to increase in the suburbs. In the country, cyclists and walkers use quiet country roads, which are comparatively less stressful and offer a greater sense of control.”

    Burnout is linked to an increased risk for cardiovascular disease, type 2 diabetes, sleep disorders, musculoskeletal pain and other disorders, according to the American Psychological Association. So finding ways to soothe and prevent employee burnout could help organizations reduce workers’ sick days and even disability.

    Barreck’s research found that the risk of burnout increases significantly when a commute lasts more than 20 minutes – and once it passes 35 minutes, workers expressed more negativity toward their job. Adopting flexible commuting arrangements with staggered work hours to shorten commute time in non-rush hours or incorporating partial telecommuting might be a way to lower workers’ stress.

    “Managing employee commuting flexibly would increase employee efficiency and moreover enable organizations to attract or retain workers,” Barreck says.

    – Sherry Baker is a health and medical journalist whose work has appeared in Psychology Today, Newsweek, Discover and many other publications. She is also the former Director of Public Relations for the Emory Heart Center. Any opinions expressed within this document are solely the opinion of the individual author and may not reflect the opinions of Ebix or its personnel.

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  • Lawsuit Claims Employer Cut Hours to Avoid Health Insurance

    Dave & Buster’s, a restaurant chain, is accused in a lawsuit of cutting employee hours to avoid having to provide insurance as required under the Affordable Care Act, thus violating the Employee Retirement Income Security Act (ERISA). Marín v. Dave & Buster’s was filed by a New York employee earlier in 2015.

    Under the ACA, employers with 100 or more full-time employees – generally those who work 30 or more hours per week – were required to offer health insurance or pay a tax starting January 1, 2015. Restaurants, in particular, were concerned about ACA requirements because of the varying hours employees often work and the seasonal requirements of the industry.

    At Issue: Section 510

    Section 510 of ERISA prohibits discrimination against a participant or beneficiary of an ERISA employee benefit plan, which includes ACA-mandated insurance in this case. The plaintiff, María De Lourdes Parra Marín, filed the suit on behalf of herself and other employees whose hours were reduced, which resulted in a loss or reduction of health insurance. The suit claims Dave & Buster’s cut her hours so it would not have to offer her health insurance under ACA requirements. The suit also claims a general manager said the number of full-time employees would be reduced to avoid ACA provisions.

    The class-action lawsuit could affect thousands of employees at the chain – and hold implications for other employers that are required to provide health insurance for employees.

    “The implications of this case are important to employers, especially as the high cost of health insurance is driving them to cut staff and reduce employee hours across the board in order to save money,” says Louis Klein, a partner with the employment team at Foley & Mansfield.

    “Employers typically have been able to modify the parameters of their workforce as business needs dictate,” says Jorge Leon, partner at Michael Best & Friedrich. “Marín v. Dave & Buster’s highlights the important balancing between an employer’s ability to control the parameters of its workforce and how employers design their benefit offerings.”

    The case could potentially change employers’ traditional decision-making processes and could render certain changes an employer makes as an interference with employee rights under ERISA, he says.

    Watch Staff Levels

    Klein says this is the first of what are likely to be many cases along these lines, and as employers wait for a verdict, he recommends they keep a careful eye on staffing and hours.

    “While the case is pending and before implementing any cost-management decisions affecting employee hours, employers would be wise to carefully review these management decisions for potential violations of the ACA and ERISA 510,” Klein says.

    Employers with more than 50 but fewer than 100 employees should pay attention to this case, as well. It’s important to remember that employers that have 50 or more but fewer than 100 full-time or full-time equivalent employees will have until 2016 before these same rules apply.

    Mary Ellen Slayter is CEO and Founder of Reputation Capital Media Services. She has more then 15 years of experience writing about HR and financial services as a journalist and marketer. Any opinions expressed within this document are solely the opinion of the individual author and may not reflect the opinions of Ebix or its personnel.

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  • HHS-Proposed Rule on Non-Discrimination and ‘Health Equity’

    Who: Health insurance issuers, health care providers, Third Party Administrators (TPAs), and group health plans (including some self-funded plans).

    When: On September 8, 2015, the HHS Office of Civil Rights (OCR) proposed a Rule and requested comments no later than November 9, 2015. The Rule will be effective 60 days after being finalized.

    What: Affordable Care Act (ACA) section 1557 provides that an individual shall not be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any health program or activity. 
    Executive Summary: HHS proposed a Rule to advance Health Equity and reduce disparities in health care. The proposed rule prohibits discrimination based on an individual’s race, color, national origin, sex, age or disability under a health program or activity. Previously, the Office for Civil Rights did not include sex as a potential discriminatory concern in health plans. 
    Sexual Anti-Discrimination: Under the Rule (1) individuals cannot be denied health care or health coverage based on their sex, including their gender identity; (2) individuals must be treated consistent with their gender identity, including access to facilities; (3) sex-specific health care cannot be denied or limited only because the person seeking such services identifies as belonging to another gender; and (4) explicit categorical exclusions in coverage for all health services related to gender transition are discriminatory.

    Disability Services: The Rule includes requirements for auxiliary aides and services for those with disabilities, including alternative formats for written materials and sign language interpreters.

    Language Services: The Rule requires language assistance for those with limited English proficiency, such as oral interpreters and written translations. Affected entities could be required to post a notice of consumer rights regarding communication assistance and provide some information in up to 15 languages.

    Legal Exposure: The Rule provides for a private right of action and damages for violations to the same extent that such enforcement mechanisms are provided for under the current federal civil rights laws, making it clear that individuals have the ability to file a lawsuit. The Rule may bypass existing administrative processes for settling complaints and open the door to direct legal exposure for affected entities.

    Certification of Compliance: Under the Rule, each entity participating in a Federal or State Marketplace would need to certify compliance for all policies and services provided (including any administrative services organization or TPA services), whether inside or outside of the Marketplace offerings.

    Actions: The broad inclusive nature of the proposed Rule means that insurers, employers, TPAs and health care providers need to seek legal and compliance advice to determine if any changes are needed to their products, services and their own employee benefits. Those entities wanting to impact the final ruling must submit comments by November 9, 2015.

    The information presented and contained within this article was submitted by Ronald E. Bachman, President & CEO of Healthcare Visions and a contributor to the Client Community newsletter. This information is general information only, and does not, and is not intended to constitute legal advice. You should consult your legal advisers to determine the laws and regulations impacting your business. Any opinions expressed within this document are solely the opinion of the individual author and may not reflect the opinions of Ebix or its personnel.

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