10 Ways to Win with Employee Wellness Programs

How One Employee Lost 70 Pounds & Turned Her Life Around

Why Employee Wellness?

employee wellnessLifestyle choices, family issues and financial worries impact employee productivity and absenteeism. At MedCost, our nurses see it every day working with health plan members.

A well-designed employee wellness program can help address many of these issues. And it doesn’t have to be big and complicated. It simply has to work for your employees.

At MedCost, we had these same challenges within our own workplace. Part of what we do is advise clients on programs that help improve the health of their employees. We determined first to work with our own staff for greater improvements in each employee’s health.

Patrenia’s Story

The truth about her health never got through to Patrenia Johnson until a year ago. She had always struggled with her weight; and was diagnosed with type II diabetes at the age of 24. But denial was a comfortable way to continue her eating habits and to manage every emotion she felt.

A year ago, Patrenia met with her endocrinologist. After examining her history of A1C numbers, which were once again out of control, the doctor looked intently at Patrenia.

“Do you want to live, or die?” the doctor said.

Patrenia finally faced the truth – she might die from diabetes.

Just like her dad. Just like her close friend.

Making Wellness a Priority

employee wellnessWe wanted our employees and those of our clients to have practical tools to support real changes in their lives. We wanted to keep low-risk members from developing more serious conditions.

Hiring a corporate wellness manager allowed us to benefit our own staff and provide expert wellness consultations for our clients.

New wellness features implemented for MedCost employees began to have an immediate impact. During breaks and at lunch, conversations could be heard about calories, healthy foods, or how many steps had been logged that day.

More employees purchased standing desks and took the stairs. People began to think about their lifestyle choices and how to implement healthier habits.

We recruited new members from more departments for the wellness committee, led by our employee wellness manager.

The company also launched a comprehensive program for clients called Healthy & Wholewith fresh ideas to balance care for employees with a company’s financial health. Watch the video here.

Employee Wellness: 10 Ways to Win

Here are 10 ways we’re encouraging employee wellness:

  1. Offered a $500 incentive for completing employee wellness requirements—even if not on the company health plan.
  2. Ongoing exercise classes, subsidized by MedCost
  3. employee wellnessFree wearable device with fitness app that tracks activity, nutrition, sleep, mood and hydration
  4. Lifestyle coaching resources for weight loss, tobacco cessation, financial health and dealing with stress
  5. Company softball and kickball teams to compete in adult recreational leagues
  6. An online platform, myStrength, for stress management and emotional health
  7. A “Wellness Moment” at regular middle management meetings and company Town Halls
  8. Monthly Lunch-n-Learns on health topics
  9. Walk with Me Wednesdays
  10. Fresh Fruit Fridays in break rooms

Patrenia’s Success

Patrenia enrolled in the Personal Care Management program as a diabetic. Her nurse health coach regularly contacted Patrenia, offering resources, suggestions and ongoing support.

She joined company exercise classes and the coed softball team. Patrenia began to incorporate these actions into her daily life:

  • Reducing food portions
  • Giving up carbonated soft drinks
  • Not depriving herself of certain foods, but limiting them
  • Walking with coworkers during breaks
  • Taking onsite exercise classes
  • Welcoming accountability from fellow employees for her eating habits
employee wellness

Patrenia before losing 70 lbs.

employee wellness

Patrenia one year later

Change wasn’t easy.

So far, she has dropped 10 dress sizes, losing almost 70 pounds. She says it’s still a daily struggle, but the results are worth it.

“I’m not as tired anymore. The doctors say that my kidneys look good. My eyes look good. I want to keep hearing that from my doctors.

“And most of all—I want to be here for my family.”

Employee Wellness—Winning for a Lifetime

Employers care about more than a profit-and-loss column. They provide health care benefits because they care about their employees. For the 75% of employees and families who are healthier, wellness programs can help prevent conditions from escalating.

Lifestyle changes—even small ones—create measurable outcomes of better health, productivity and an employer’s bottom line.MedCost

Watch this informative video about our new comprehensive program, Healthy & Whole.

“Do you want to live, or die?” the doctor said.

When Nurse Support Makes All the Difference: One Family’s Story

nurse support

The Vincent White Family

Facing a Difficult Surgery

Vincent White tried everything to get rid of his back pain. Neck clamps. Surgery. Spinal decompression. This lab supervisor at Carolinas Healthcare had persistent pain from a narrowed bone channel housing the spinal cord and nerves.

The calcification worsened. Finally, doctors recommended another back surgery. “He was stumbling around the house,” said wife Lisa. “He could barely move.”

When Lisa walked into her husband’s hospital room after the operation, a doctor from the critical ICU team delivered bad news. Vincent was paralyzed.

“He was in ICU for 21 days,” said Lisa. “Doctors said he probably would not walk again.” Vincent had another surgery while in ICU to repair a spinal cord leak. After six weeks in rehab, he came home to his wife and 11-year-old daughter Olivia.

Experienced Nurse Support
Stepped In

Long before Vincent’s release, Lindsay Spainhour, RN, BSN, the Whites’ MedCost Case Manager*, was working with the medical providers, planners and discharge team. Lindsay followed his progress closely to ensure that he received all the care needed in this crucial time of their lives.

“Lindsay got to know me and took time to care about what my husband and I were going through,” Lisa said. “She got the special kind of air mattress we needed, and told us not to worry about authorization.” nurse supportLindsay called the supplier for Vincent’s wheelchair until it finally arrived. And when Vincent was diagnosed with a wound two weeks after arriving home, she provided education, supplies and questions for Lisa to ask medical staff when Vincent was readmitted to the hospital.

Vincent and Lisa continue to make lifestyle adjustments. He wears a catheter. He can’t take a normal vacation with his family. But Lisa says that their MedCost Case Manager made a big difference.

More Than Just a Job

“She did things she didn’t have to do, to make sure my husband’s needs were met over and beyond. I could tell in Lindsay’s voice that it was more than just a job.

“We sometimes complain about what we pay for premiums, but the benefits of having a case manager like Lindsay far outweighed the cost. Get a case worker. It can save you energy to focus on your family.MedCost


*The Whites gave MedCost permission to share their story to help others realize the benefits of the Complex Case Management program. MedCost Complex Case Management is a program where registered nurses who are also certified case managers work with individuals who have experienced a life-changing illness or injury. The goal of the program is to ensure the best use of available health plan resources while enhancing quality of life.

 

7 Care Management Results: Balancing Medical Care, Benefit Costs

How Can Employers Balance Medical Care & Benefit Costs?

MedCost Care Management programs are designed to conserve health care costs for our clients while improving an individual’s health.

Our nursing staff averages 22 years of experience; and includes board-certified case managers and nurses certified in intrinsic coaching and grief counseling.

Here are our 2017 results that exceed industry averages, resulting in lower health care costs for our clients.

Care Management

Care Management Resources

Want to know more about how to manage medical costs? These resources give employers more details:

  1. Complex Case Management 
  2. Inpatient Management
  3. Outpatient Management
  4. Telehealth Services
  5. Nurse Health Coaching
  6. Maternity Management
  7. Behavioral Health

To print this infographic, click on the title and scroll to “PRINT THIS PAGE” at the bottom.MedCost

HSA 2018 Contribution Limits Adjusted by IRS

Michael Berwanger

By Michael Berwanger, JD, Director, Quality Management & Compliance

On March 5, 2018, as a result of the tax reform law (P.L. 115-97), the IRS released Bulletin No. 2018-10, adjusting dollar limitations for health savings accounts (HSAs) and high-deductible health plans (HDHPs) for 2018.

The only change impacting HSAs was to adjust the contribution limits for family coverage from $6,900 to $6,850.

HSA 2018 Contribution Limits

HSA 2018 Contribution Limits: FAQs

For guidance on HSAs, please review the IRS frequently asked questions pageMedCost

This blog post should not be considered as legal advice.

 

Helping Employers Achieve the Benefits Balance

Employers Benefits Balance

CLICK IMAGE TO WATCH VIDEO

Balance.

An even distribution of weight enabling someone or something to remain upright and steady.

A condition in which different elements are equal or in the correct proportions.

The definitions make it sound easy—spreading the load around so no one person or group is under duress.

But balance is quite elusive.

We strive for it in all aspects of our lives.

Employers are no exception.

Employers Benefits BalanceThey struggle with it in the workplace, especially as it pertains to benefits.

CEOs, CFOs and HR directors are caught in the tugs of emotion and cost spreadsheets.

MedCost helps employers in their pursuit of balance.

Balancing medical care and cost management. Balancing the ideal with the reality.

Other benefits administrators can’t match our integrated clinical programs that combine member care with effective claims management.

And big name insurance companies, well, they use a scale. Scales are not negotiable. They don’t allow employers to make choices.

Achieving Employers Benefits Balance

MedCost helps self-funded companies balance self-care, the health of their company, with the care of others, their employees.

We enable companies to achieve the benefits balance™ that’s right for them.

MedCost. That balance is built right into our name.MedCost

(This is a transcript of the video, “Helping Employers Achieve the Benefits Balance.”)

Employers Benefits Balance

CLICK IMAGE TO WATCH VIDEO

*More Information for VA Employers
*More Information for NC Employers
*More Information for SC Employers

 

How to Help Employees Become HEALTHY & WHOLE (Video)

Ready to Balance the Care of Your Employees
with the Financial Health of Your Company?
HEALTHY & WHOLE

WATCH VIDEO NOW

  • Annual health care costs in America are $3.2 trillion.
  • Employees average 5.3 unplanned sick days per year.
  • That productivity lost is more than 1 and 1/2 hours of an 8-hour day.

When disease management and wellness programs combine, employers average $30 per member per month in decreased health care costs.

HEALTHY & WHOLE

That’s why we’ve developed a comprehensive program called HEALTHY & WHOLE.

HEALTHY & WHOLE encompasses physical, emotional, financial and social health – and
greater job satisfaction for employees.

The goal is to help employers balance the care of employees with the financial health of your
company.

HEALTHY & WHOLE Includes Disease Management

Our nurse health coaches provide hands-on support, helping members reduce blood
pressure, glucose levels and lose weight.

And for complex conditions, case managers provide expert help for families in very difficult
situations.

Over 73% of businesses offer corporate wellness to attract and retain talent, and strengthen
company culture. Another advantage is to encourage enrollment in consumer-directed health
plans, a growing trend.

HEALTHY & WHOLE Supports Lifestyle Changes

HEALTHY & WHOLE addresses not only members with chronic diseases, but the 75% who
need support with lifestyle changes.

Lifestyle changes – even small ones – create measurable outcomes of better health, productivity and bottom line.

The Results of Corporate Wellness Programs

HEALTHY & WHOLE

http://www.nahueducationfoundation.org/materials/WellnessBrochure.pdf

Implementing corporate wellness programs dropped claims costs -28%, doctor visits -17% and hospital admissions -63%.

This same study showed disability costs down -34% and injury incidence down -25%.

An employer we worked with said that he is passionate about having happy employees. If they
are happy, they will be productive and engaged.

A Program That Benefits Employees and Companies

Lifestyle coaching. Financial education. Fitness. Nurse health coaching. Long-term medical
conditions. HEALTHY & WHOLE serves everyone’s needs, including your company’s.

We want to see everyone HEALTHY & WHOLE. That’s why it’s important to us to balance the care of your employees with the financial health of your company.MedCost

HEALTHY & WHOLE

PLAY VIDEO

(This post is a transcript from the video, “MedCost HEALTHY & WHOLE.”)

For more information on wellness consultations for employers, email Kati Davis.

 

IRS Extends Deadline to Furnish 1095 Forms to Individuals

Michael BerwangerBy Michael Berwanger, JD, Director, Quality Management & Compliance

The IRS has announced good-faith transition relief for information reporting on Forms 1094 and 1095 for the 2017 tax year, mirroring guidance it provided for the 2016 tax year (see IRS Notice 2018-06 HERE).

Some notable highlights include:

Extension for Furnishing Statements to Individuals. 

The deadline for furnishing Forms 1095-B and 1095-C to individuals is extended by 30 days, from January 31 to March 2, 2018. There is no action necessary from self-funded health plans to take advantage of this extension, it is automatic.

Due to this extension, the discretionary 30-day extension is not available, and no further extensions may be obtained by application to the IRS.

No Extension for Filing Returns with the IRS.

The notice does not extend the due date for filing Forms 1094-B and 1094-C (and accompanying Forms 1095) with the IRS. Accordingly, the deadline remains February 28, 2018, for paper filings, and April 2, 2018, for electronic filings (see 2017 Forms 1094, 1095 B & C Released by IRS).

Please note, electronic filing is mandatory for entities required to file 250 or more Forms 1095. However, filers may obtain an automatic 30-day extension by filing Form 8809 on or before the regular due date.

2017 Forms 1094 1095Good Faith Penalty Relief.

The IRS will again provide penalty relief for entities that can show they have made good faith efforts at compliance.

The IRS reports that no penalties will be imposed on entities that report incorrect or incomplete information, either on statements furnished to individuals or returns filed with the IRS, if they can show they made good faith efforts to comply with the reporting requirements.

The notice specifies that the relief applies to missing and inaccurate taxpayer identification numbers and dates of birth, as well as other required information.

Penalty relief is not available to entities that fail to furnish statements or file returns, miss an applicable deadline, or are otherwise not making good faith efforts to comply.

Evidence of good faith efforts may include gathering necessary data and transmitting it to a third-party to prepare the required reports, testing the ability to transmit data to the IRS, and taking steps to ensure compliance for the 2018 tax year.

ACA deadlinesThose unable to meet the due dates are still encouraged to furnish and file as soon as possible, as the IRS says it will take such furnishing and filing into consideration when determining whether to abate penalties for reasonable cause.

Reasonable cause is distinct from good faith relief and requires, among other things, proof of significant mitigating factors or events beyond the reporting entity’s control.MedCost


MedCost is not a tax preparation company, and you may have additional tax obligations for other benefit plans that you offer to your employees. Please consult with your tax adviser for guidance.

This blog post should not be considered as legal advice.

10 Terms You Need to Know in Self-Insured Health Plans

Confused by all the “insurance-speak” in your company health plan? Here’s a quick guide for phrases in benefit plans for self-insured employers.


self-insured

WATCH VIDEO HERE

Self-Insured: What Does It Mean?

1 Self-Insured: Also called self-funding. Employers choose this model of funding to pay for health claims from company assets and employee premiums. Self-insurance allows employers to pay only for actual claims, instead of the fixed premiums of fully-insured plans. A 2013 study by the Kaiser Family Foundation noted three of five covered employees are in self-insured health plans.[1]

2 ERISA: Employee Retirement Income Security Act of 1974, passed by Congress to establish federal regulations for self-funded benefit plans. Self-funded employers avoid fees such as the Health Insurance Provider Fee,[2] Risk Adjustment Fee[3] and Federally Facilitated Exchange User FeeSelf-funded employers also avoid certain state premium taxes.

3 SPD: Summary Plan Description that lists health plan terms and conditions, written for a particular employer or organization. The SPD defines the benefit coverage and exclusions. MedCost ensures that coverage and exclusions mirror the stop loss contract. If the stop loss contract does not mirror benefits offered, the employer may have to pay claims that were not covered by the stop loss carrier.

Fixed Vs. Variable Cost

self-insured

4 Fixed Cost: Predetermined fees that are paid as part of a health plan, regardless of actual expenses. Fully-insured plans are 100% fixed cost, paid out in set premium rates to the carrier. Self-insured fixed costs range from 18%—21% of total plan costs for administrative fees and stop loss insurance.

5 Variable Cost: Also called soft dollars, which may translate into potential savings for a self-funded employer. Prudent employers deposit funds for the total estimated employee claims into a reserve account in the company’s name. These dedicated funds remain in the employer’s account for future medical expenses if not spent during a plan year. MedCost provides professional underwriting services to help employers ensure that they are adequately covered for both expected and unexpected claims.

6 Corridor: Also known as claims or risk corridor, or margin. Underwriters include this as a cushion to cover unexpected claims. Generally this amount is around 25% for self-funded plans and 20% for fully-insured plans. Expected claims plus risk corridor (for variable expenses) determine the maximum liability (or attachment point).

Stop Loss Insurance

7 Stop Loss Insurance: Coverage designed to protect self-funded employers from the risk of catastrophic claims beyond a predetermined liability. MedCost underwriters recommend policies with consistency between the stop loss policy and the employer’s SPD, to avoid any gaps in coverage when claims are submitted.[4]

8 Specific Stop Loss Deductible: The limit of liability under stop loss coverage on an individual employee covered under an employer’s heath care plan. The employer chooses this amount based on total group size and selected risk tolerance.

Stop Loss Coverage Specific Example

Self-insured
Jane Smith suffers from renal failure and undergoes kidney dialysis. Her claims total $300,000. Jane’s employer is self-funded and has purchased specific stop loss with a $75,000 deductible.

Total Claim $300,000
Employer Deductible $75,000
Amount Reimbursed by Stop Loss Carrier $225,000

9 Aggregate Stop Loss Deductible: This amount is the self-funded employer’s overall or group liability under a stop loss policy. Underwriters typically project expected claims plus a 25% margin to determine an employer’s maximum liability (or attachment point).

Stop Loss Coverage Aggregate Example

self-insured

  • Includes claims paid that do not exceed the specific deductible
  • When underwritten appropriately, expenses should approach the amount of expected claims ($4 million), rather than the maximum liability ($5 million)
Expected claims $4,000,000
25% Margin $1,000,000
Maximum Claims Liability $5,000,000

10 Benefits Administrator: Also called a third party administrator (TPA) or administrative services organization (ASO). Employers typically contract with an administrator to handle benefits plan documents, claims payments and provide other services. Experienced administrative companies like MedCost can preserve significant savings for employers through careful management of resources, with customized benefits and targeted products to meet employer needs.

We’ve spent over 30 years in the industry. We know health care choices are complicated and not getting any simpler.

Questions?

Have questions? Contact your health care consultant or Jason at MedCost for more resources.


 

[1] “2013 Employer Health Benefits Survey,” Kaiser Family Foundation, August 20, 2013, http://kff.org/report-section/ehbs-2013-section-10/

[2] “Affordable Care Act Provision 9010, Health Insurance Providers Fee,” http://www.irs.gov/Businesses/Corporations/Affordable-Care-Act-Provision-9010

[3] “Explaining Health Care Reform: Risk Adjustment, Reinsurance, and Risk Corridors,” Kaiser Family Foundation, January 22, 2014, http://kff.org/health-reform/issue-brief/explaining-health-care-reform-risk-adjustment-reinsurance-and-risk-corridors/

[4] For more information, download Stop Loss Coverage White Paper: Maximizing Benefits, Limiting Risk

Telemedicine: Yes, There’s a Doctor in the House

telehealth A sick child might have a fever at 3:00 am. Or the family might be visiting grandparents a long way from home. But if an employer-sponsored health plan includes telemedicine services, a board-certified doctor’s consultation is only a phone call away.

Employers Are Choosing Telemedicine

An overwhelming 96% of US employers plan to offer telemedicine services in applicable states* in 2018, the National Business Group on Health reports. The reasons for this rapidly growing health benefit are obvious:

  1. Quick ResponseTeladoc, the nation’s largest provider of telemedicine consultations, averages 22 minutes for a call-back from a licensed, board-certified doctor who practices in the caller’s state.
  2. Convenience. This consultation can be held by phone or online. Teladoc requests some medical information before having the doctor return the call.
  3. Appropriate Care for Less. Almost 80% of adult Emergency Room visits are due to lack of access to other providers.** Access to telemedicine visits can limit hours spent away from work, as well as more expensive care at any hour, day or night.

Telemedicine Offers Treatment Alternatives

Telemedicine consultations are not meant to replace primary care providers. But if an employee has one of the minor ailments listed below, 24/7 access is convenient, and reduces spiraling costs for the employer and the employee.

Treatment Alternatives to the Emergency Room

Telemedicine

Common conditions treated through a telemedicine phone call or online visit are:

  • Infections
  • Allergies
  • Pain
  • Minor joint trauma
  • Gastroenteritis (stomach flu)

Telemedicine Services Are Expanding

Teladoc has expanded optional services for employer health plans to include behavioral health. If an employer chooses to add this option, experienced psychiatrists, therapists and counselors would be available at a flat, per-encounter fee. Members can choose to see the same provider throughout the course of care.

Behavioral health conditions*** range from:

  • Stress/anxiety
  • Depression
  • Addiction
  • Domestic abuse
  • Grief counseling

Just a Phone Call Away

Need a better prescription for your health care expenses? Expert care from area doctors may be available with a phone call, whether on vacation at Disney World or in pajamas at 3:00 a.m.

With telemedicine services, there is a doctor in the house.MedCost

______________________________________________________________________________

*Teladoc operates subject to state regulation and may not be available in certain states.

**“Emergency Room Use Among Adults Aged 18-64: Early Release of Estimates from the National Health Interview Survey, January-June 2011.” National Center for Health Statistics. May 2012. https://www.cdc.gov/nchs/nhis/releases.htm (accessed October 31, 2017).

***Consult your employer’s summary plan description for complete coverage details.

2017 Forms 1094, 1095 (B & C) Released by IRS

2017 Forms 1094 1095

Michael BerwangerBy Michael Berwanger, JD, Director, Quality Management & Compliance

The IRS has released the final Forms 1094-B, 1095-B, 1094-C, and 1095-C for calendar year 2017 reporting. Employers are required to report in early 2018 for calendar year 2017. You can find the forms for calendar year 2017 reporting here:

 

What Changed?

For calendar year 2017, the 6055 and 6056 reporting process seems to have stabilized. One notable difference, please note the removal of the “Section 4980H Transition Relief” box from line 22 of Form 1094-C, as this transition relief is no longer available to employers.

There are no substantive changes to the B Forms for 2017, and the instructions are also mostly unchanged.

For purposes of determining affordability of employer-sponsored coverage when using the Qualified Offer method, the instructions note inflation adjustments to the 9.5% threshold, increasing the percentage to 9.66% for plan years beginning in 2016 and 9.69% for plan years beginning in 2017. (This percentage will drop to 9.56% for plan years beginning in 2018. See IRS Publication for details.)

Who Is Required to Report?

2017 Forms 1094-B and 1095-B:

These forms are used by insurers, self-insuring employers, and other parties that provide minimum essential health coverage (regardless of size, except for large self-insuring employers) to report information on this coverage to the IRS and to covered individuals.

Note: Self-insuring employers with less than 50 full-time or full-time equivalent employees will use these forms to report information on coverage to the IRS and to covered individuals. Self-insuring employers with 50 or more full-time or full-time equivalent employees will use the C forms—see below.

1094-C and 1095-C:

Applicable large employers (generally those with 50 or more full-time employees, including full-time equivalents or FTEs) will use Forms 1094-C and 1095-C to report information to the IRS and to their employees about their compliance with the employer-shared responsibility provisions (“pay or play”) and the health care coverage they have offered. Employers subject to both reporting provisions (generally self-insured employers with 50 or more full-time employees, including FTEs) will satisfy their reporting obligations using the C Forms.

Information Reporting Deadlines

The upcoming deadlines for submitting Forms 1094 and 1095 B or C are as follows:

To the IRS:

If filing on paper – February 28, 2018

If filing electronically – April 2, 2018

Any employer who would like to file electronically should refer to the IRS for more information on the AIR Program, which requires at least 30 days for testing for first-time users. Please note that employers submitting more than 250 forms must file electronically.

To Individuals:

Both Form 1095-B and 1095-C are due to the person identified as the “responsible individual” by January 31, 2018.MedCost

MedCost is not a tax preparation company, and you may have additional tax obligations for other benefit plans that you offer to your employees. Please consult with your tax advisor for guidance.This blog post should not be considered as legal advice.