by Alexandra Goebel

  • Local health-tech company launches a new initiative that disrupts the $3.65 trillion healthcare industry
  • Unheard of participation in annual health screenings and data analysis making headway in the insurance space to predict and prevent health problem
  • BeniComp leverages preventive health management to end the chronic disease epidemic and reduce healthcare expenses

“The future of healthcare is a health solution.” Doug Short, CEO (BeniComp)

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Alexandra Goebel, Community Outreach Specialist

On Monday, June 24, 2019, President Trump signed an executive order requiring hospitals, providers, and insurance companies to publicly disclose their pricing structures for health care services. The purpose of the executive order is to introduce price transparency, quality care, and all-around affordability into the health care system. Trump expresses the importance of revealing this information “in a way that's clear, straightforward, and accessible to all."

“For too long it's been virtually impossible for Americans to know the real price and quality of healthcare services… With today's historic action, we are fundamentally changing the nature of the healthcare marketplace. We will empower patients with the information they need to search for the lowest cost and the highest quality care. In other words, they will be able to seek out... the doctor they want and they will be given vast amounts of information about those doctors.” - President Donald Trump

Details regarding the executive order have yet to be clearly agreed upon and defined. According to various sources they will be released over the next few months. The final regulations are responsible for the successful execution and impacts of the executive order.

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Important Healthcare Development: On June 13th, 2019, the U.S. Departments of Health and Human Services, Labor, and the Treasury announced the Individual Coverage Health Reimbursement Arrangement (ICHRA). ICHRA, at its core, is an expansion of the Qualified Small Employer Health Reimbursement Arrangement (QSEHRA).

The beginning of affordable healthcare for small employers

QSEHRA was introduced in 2016 as a health insurance solution for companies with less than 50 full-time employees and no base medical plan, allowing them to reimburse employees for medical expenses. Small businesses find value in QSEHRA because it gives them the ability to set fixed, tax-free allowance amounts and allows employees to choose the coverage that works for their health needs.

The introduction of QSEHRA was seen as necessary for small business as they were less likely to offer employer-sponsored healthcare than their larger competitors. According to the Kaiser Family Foundation as of 2017, 30.2% of small businesses provided employer-sponsored healthcare compared to 96.6% of companies with more than 50 employees. QSEHRA leveled the playing field of the competitive landscape, allowing small businesses to recruit and retain employees in spite of the benefits larger companies could offer.

Employers of over 50 employees have been hoping for something similar to assist them in offering affordable healthcare. This is what ICHRA is for.

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Patrick Rees, Marketing Operations Superstar

It’s Open Enrollment right now and employers, big and small, are considering their options when it comes to the healthcare benefits they offer their employees. Not all of us can afford to provide our employees the luxurious healthcare packages that multinational conglomerates offer, so it means we have to barter for the best deal and maybe accept an offer that doesn’t benefit all parties. Small employers, in particular, are at a disadvantage and cannot match the big boy's benefits.

However, the playing field has leveled out recently as a result of President Trump’s executive order expanding upon previous healthcare legislation. As of October 22nd 2018, small employers can now offer tax-free reimbursements for health insurance costs to their employees through Health Reimbursement Arrangements (HRA’s). This proposed regulation results in increased health coverage to millions of Americans.

So how does this new executive order, coupled with Open Enrollment, represent a unique opportunity for progressive small-business owners?

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Patrick Rees, Marketing Operations Superstar

The announcement that CVS has closed its $70 billion deal to purchase Aetna, America’s third-largest health insurance company, is sure to shake-up the entire industry. There have been a number of promises by CVS regarding the future of the merger, namely that they are going to cut down on paper waste by reducing the length of those ridiculously long receipts.

Wait… that might not be correct.

What they have promised is much more ambitious and, should they be successful, force those in the health insurance industry to re-think their strategies to combat a potential healthcare juggernaut. Some of CVS’s goals from the merger include:

  • New points of access to the medical system
  • Consumer-centred primary care to reduce costs and improve ease-of-use
  • Building healthier local communities
  • Improving medical care delivery
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Premiums inside the exchange are skyrocketing across the country. With BeniComp Advantage, employers can identify, realign, and manage health risks to control 2017 healthcare costs.


November 1st marked the start of exchange sign-ups for 2017 Obamacare coverage. While rates vary in different states, most insurance premiums rose by an average of 25% around the country. Arizona appeared to have the worst outcome with an enormous 145% increase. There are many reasons rates increase, but a big factor is because insurance companies are leaving the market. Aetna is exiting the exchange in 11 states for 2017; UnitedHealthcare is exiting 31 states; and Blue Cross Blue Shield of Tennessee has announced their departure of three of the state’s largest exchange markets. Is Obamacare imploding?

Tennessee insurance commissioner, Julie Mix McPeak, said recently the exchange in her state is “very near collapse” as she agreed to premium increases of up to 62%. This was after rate increases were authorized in August for an average of 46% for Cigna and 44% for Humana. But while the exchange immediately impacts individuals, how is it impacting employers?

According to Kaiser Health News, big employers can expect health costs to rise 6% in 2017. Although it may be an average increase compared to previous years, new surveys show that it surpasses economic growth. “These cost increases, while stable, are both unsustainable and unacceptable,” said Brian Marcotte, CEO of the National Business Group on Health, a coalition of large employers that received responses from 133 companies.

No longer able to afford health care at current rates, many employers have turned to high-deductible health plans. However, raising deductibles and shifting health costs to employees is only a temporary fix, and puts financial strain on employees. In order to truly control health insurance expenses, companies need to make changes that will help control claims.

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The Equal Employment Opportunity Commission (EEOC) originally proposed amendments to regulations under the Americans with Disabilities Act (ADA) that interpret how the ADA applies to wellness program incentives. The new set of proposed regulations on wellness programs under the Genetic Information Nondisclosure Act (GINA) was issued by the EEOC on 10/30/2015.

The regulations provide relief with regard to employers that reward employees for a spouse’s participation in certain wellness initiatives. 

GINA generally prohibits wellness programs from offering incentives for the provision of genetic information. For that reason, the EEOC has informally cautioned against offering rewards to encourage a spouse to provide medical information via health risk assessments (HRAs) or annual health screenings. 

Employers Can Now Screen Spouses the Same as Employees, and offer incentives!

The new rules allow wellness programs to reward an employee whose spouse answers questions in a health risk assessment or undergoes a medical screening. However, the total incentives offered for the spouse’s participation combined with the employee incentives under the wellness program cannot exceed 30 percent of the total cost of coverage. The reference to total cost of coverage is a significant change for the EEOC, which had previously referred to single employee coverage.

Click here to see the full article on the subject.

In a historic decision by the Supreme Court on June 26th, same-sex marriage is now legal across America. While the LGBT community rejoices with pride parades and the use of #LoveWins on social media, this ruling could have another impact on the health insurance industry in our country. 

The ruling, in conjunction with the Affordable Care Act, makes it now possible for gay and lesbian employees to add their spouses to their company-provided health insurance plan. Also, insurance companies are now mandated to offer the same individual and group health plans to legally married same-sex couples.

While these effects address constitutional questions, some still have unanswered logistical questions. 

Read more on Modern Healthcare's "Same-sex marriage ruling puts health benefits in spotlight" article by Lisa Schencker and Bob Herman.

With yesterday’s ruling, the Supreme Court once again upheld ObamaCare and with it the compliance nightmares.

The compliance web can be daunting and at times feel like a moving target. You have to comply with EEOC, ADA, HSA regulations, the Cadillac tax, non-discrimination rules, affordability guidelines; the list continues and is almost endless.

The good news is there is a solution. BeniComp’s products are excepted benefits and as such are exempt. The even better news, is you are protected.

For more information on BeniComp products, please visit our solutions page at www.benicomp.com/products

Employers have had to watch every step they take for fear that any misstep will result in a huge blow up. The ability for employers to effectively incentivize their employees to a healthier lifestyle really now lays in the knowledge that a third party vendor must administer the wellness plan if any variable incentives would be offered. And, as has been proven, the outcome-based incentives are what produce a positive change. Lifestyle improvements equal reduction in trend, increased presenteeism, employee health and wellbeing, and overall ROI.

If employer sponsored wellness programs are a minefield, then the latest rules have just detonated a few grenades. Outcomes-based wellness programs produce ROI. Plans with no incentives expect 20-30% total participation, which usually end up being the healthy employees. This kind of turnout gives smoking cessation tools or diabetic tools to the wrong people. It’s not the healthy that need a doctor but the sick.

Incentives can boost engagement to 60-70%, or 90-95% if well thought out. Higher participation provides ROI and early detection because the right tools are in the right hands. And to the employer, the wellness world finally makes sense. Their goal of providing employees with continued access to affordable health care coverage is accomplished for yet another year, right? Well not so fast…

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Steep Penalties for Not Participating Said to Make Program Involuntary
and Violate Disabilities Act

MILWAUKEE -- Manitowoc, Wis.-based Orion Energy Systems violated federal law by requiring an employee to submit to medical exams and inquiries that were not job-related and consistent with business necessity as part of a so-called "wellness program," which was not voluntary, and then by firing the employee when she objected to the program, the U.S. Equal Employment Opportunity Commission (EEOC) charged in a lawsuit it filed today. 

In a lawsuit filed in Green Bay, Wis., today, the federal agency contends that Orion instituted a wellness program that required medical examinations and made disability-related inquiries.  When employee Wendy Schobert declined to participate in the program, Orion shifted responsibility for payment of the entire premium for her employee health benefits from Orion to Schobert.  Shortly thereafter, Orion fired Schobert.  

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The Equal Employment Opportunity Commission (EEOC) issued final rules describing their interpretation of what employers are able to do to encourage employee participation in employer-sponsored wellness programs, while still complying with the Americans with Disabilities Act (ADA) and the Genetic Information Nondiscrimination Act (GINA). However, the new rules come during legal battles about whether the commission's interpretation is even correct.

In an interview with Cook County Record, Mark Casciari, a partner with Seyfarth Shaw LLP said “The EEOC now has issued wellness regulations under the ADA and GINA, but they're being challenged in court.” Casciari went on to point out that "Barbara Crabb [the district court judge] said the EEOC's reading of the Americans with Disabilities Act is wrong and not consistent with the statute, which undermines the regulations.”

At a time critical time in history when health insurance has risen drastically, and many Americans have adopted unhealthy lifestyles creating additional health risks, employers are looking for answers. “There are a lot of employers who think wellness is good and that health risk assessments are good, that biometric screening is good, and that people should know about their risks so they can change their behavior and reduce health expenses,” Cascari said. “If you take away wellness incentives, which the EEOC would want you to do in substantial part, it may be counter-productive in promoting wellness.”

Historically, wellness programs comply with regulations under the Affordable Care Act (ACA) and the Health Insurance Portability and Accountability Act (HIPAA). Cascari noted that following those already settled regulations is important for employers to protect themselves. Cascari stated, “When it comes to the EEOC, the question is whether any litigation from the EEOC about non-compliance with the regulations will continue to be unsuccessful. If the employer wants to reduce all risk of EEOC litigation, it could comply with the EEOC regulations. On the other hand, the EEOC regulations could be illegal, so you may unnecessarily be complying.”

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