UBP blog


Gross total of Baucus’ proposed health care reform bill estimated at $774 billion over 10 years: Where will all this money go?

Filed under: health care reform legislation — ubpblogger @ 10:12 am
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After their preliminary analysis of Senate Finance Committee Chairman Max Baucus’ proposed health care reform bill, the Congressional Budget Office (CBO) estimates its gross total cost to be $774 billion over 10 years. The CBO states that if enacted, this bill will increase the rate of insured non-elderly Americans from approximately 83 to 94 percent.

Also, although the CBO estimates 25 million Americans will purchase insurance under the newly established exchanges, the number of people purchasing health insurance outside of the exchanges (or getting it through an employer) will only decline slightly.

But where will the proposed $774 billion in Baucus’ bill go?

Here’s a breakdown of the bill’s costs:

  • $287 billion will go towards expanding Medicaid and the Children’s Health Insurance Program
  • $463 billion in subsidies will help low income people buy insurance 
  • $24 billion tax credits will go towards helping small employers insure their workers
  • $10.9 billion will go towards stopping payment cuts to physicians under Medicare for a year
  • $54 billion will go towards other costs such as bonus payments to encourage more primary care physicians and creating an innovation center within Medicare

How will we pay for it?

We all know money doesn’t grow on trees and our government is going to need some way to pay for all of these expansions, subsidies and tax credits.

To pay for all of this, Baucus’ bill proposes the following, cuts, taxes and fees: 

  • An excise tax of 35% on insurance plans worth more than $8,000 a year per-person or $21,000 a year per-family (expected to generate $215 billion in revenues)
  • An annual maximum FSA contribution amount of $2,000 per-person (expected to generate $16.5 billion in revenues)
  • Fees imposed on drug and medical device manufacturers, health insurers and clinical laboratories (expected to generate $93.3 billion in revenues)
  • Paying for penalties incurred by employers for employees who enroll in government subsidized care (expected to generate $27 billion in revenues)
  • Payment cuts to private Medicare Advantage plans (expected to generate $125 billion in revenues)

Senator Baucus proposed a solution, but to what problem?

Whenever something is proposed as a “solution”, there needs to first be a clearly defined “problem” that it addresses. In the minds of employers and employees alike, what is the most pressing problem with U.S. health care?

With health insurance premiums skyrocketing at 2-3 times the rate of inflation and wage growth alike, the huge problem is clearly out-of-control costs.

Baucus’ bill is designed to help lower-income Americans afford health insurance through new exchanges, but most people will continue to purchase insurance outside of these exchanges (i.e. through their employers). So in the grand scheme of things, the bill only subsidizes the health insurance coverage of a few.

While the bill does have some plusses for employers, such as tax credits to help them insure their workers, it falls short of addressing the reason why they need these credits in the first place. Namely, health insurance is growing costlier by the year for employers to provide.

Is the health care crisis an issue of “health care for all” or is it a crisis in affordability?

Is it even possible to solve one issue without solving the other one? If so, which issue is most pressing for our government to tackle first?


3 ways to enhance your dental plan’s value through communication

For employers who want to improve the value of their dental benefits, making plan changes is just part of the solution. Effective communication is the next step, and this means providing employees with the meaningful information and tools necessary to understand both their dental benefits and oral health risks.

According to a recent MetLife survey, only 1 in 5 employees know what their dental insurance does and does not cover. This lack of employee knowledge oftentimes results from lackluster employer communication of dental benefit offerings.

The following are three ways employers can enhance their communication of employees’ dental benefits.

   1.      Promote the importance of oral health and educate employee on oral health risks.

Data from MetLife’s survey also revealed that just 9% of employees believe they have beneficial information on oral health available to them. Yet, 28% of employees believe that this information would be of value in helping them understand dental benefit offerings. Employees who know most about their oral health are the ones that are most likely to utilize their plan’s covered dental services.

To educate employees on oral health and oral health risks, employers can create a pamphlet, memo or web resource, distribute it to employees and also make it readily available for them to access on a later date. 

   2.      Provide complete information on employee coverage.

The survey data also shows that only 35% of employees feel that they have all the information they need to make the best decision on their dental coverage. This means employers have a huge opportunity to educate the remaining 65% of employees with complete coverage information. That way, all employees will understand their benefit offerings, appreciate them and have fewer surprises about what is and is not covered when they get their Explanations of Benefits.

  3.      When communicating benefits, use multiple resource

Most employers believe that email and the company website are the most effective tools for communicating employee benefits. Although these tools are great ones to use, employers should not stop there.

Employers should also develop alternative ways to educate their employees on their benefits, dental benefits included. In-person and online seminars  as well as oral risk assessment tools are just a couple of the resources employers can use to round out their dental benefits education.

By applying these three methods, employees will feel the value of the dental benefits you are providing. As a result, their understanding and appreciation of the dental benefits they’re offered will grow.


4 Items Employers Need to Know About the HIPAA Breach Notification Rules Effective 9/23

Filed under: HR compliance — ubpblogger @ 8:26 am
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Effective September 23, health care providers, clearinghouses and health plans that are “covered entities” under HIPAA must notify affected individuals in an event of a breach of their individually identifiable personal health information (PHI).

 This HIPAA Breach Notification Rule is essential for you to understand but it can be a pretty big pain for busy HR and IT professionals to digest and make sense of. To help you all out, we’ve put together a short list of things you need to know.

We’ve eliminated some of the “government-ese” from this blog entry to save you time (and help you avoid any headaches from all the confusion). However, since it is the law we’re talking about, we couldn’t quite get rid of it entirely (our apologies for that).

 Here are 4 items to know about the HIPAA Breach Notification Rule:

Item#1: If a breach involves data that is encrypted or de-identified, no one needs to be notified.

The new HIPAA Breach Notification Rule only applies to Personal Health Information (PHI) that is “unsecured”. They define “unsecured” as:

“not rendered unusable, unreadable, or indecipherable to unauthorized individuals through the use of a technology or methodology specified by The Department of Health and Human Services [HHS].”

In order for data to no longer be “unsecured” it will need to be:

  • Digitally encrypted in accordance with National Institute Standards and Technology (NIST) standards (These standards can be found at http://www.csrc.nist.gov.)
  • In the case of electronic media, destroyed in accordance with National Institute Standards and Technology (NIST) standards
  • In the case of physical records containing PHI, shredded

De-identified personal health information is not actually PHI and therefore a breach of it would not need to be reported.

Item #2: If a breach falls under the following exceptions, no one needs to be notified.

  • Unintentional acquisition, access to or use of PHI by an employee acting under the authority of a HIPAA Covered Entity or Business Associate (provided that it was done in good faith and is not further used and/or disclosed in violation of the privacy rule).
  • Inadvertent Disclosure of PHI from a person authorized to access it at a Covered Entity or Business Associate  to another person at the same organization who is authorized to access the PHI (provided that the PHI is not further used and/or disclosed in violation of the privacy rule).
  • Instances of unauthorized disclosure where the Covered Entity or Business Associate has a good faith reason to believe that the person the information was disclosed to was not reasonably able to retain the information.

Item #3: If a breach does not pose a risk to an individual, no one needs to be notified.

To determine if a breach poses a significant financial, reputational, or other risk to affected individuals, HIPAA covered entities will need to go through a risk assessment.

Item #4: For a reportable breach ( i.e. one that doesn’t fall under the 3 conditions mentioned above), the following entities must be notified:

  •  Department of Health and Human Services (HHS)
  • All individuals whose PHI was affected by the breach (Individuals must be notified in writing and on their company’s website.)
  • If the breach compromised the PHI of 500+ individuals (or if you cannot find the affected individuals you’ll need to contact), the media must be notified.

Although this new rule goes into effect this month, sanctions will not be imposed on it until after February 22, 2010. In the meantime, employers and HR teams should:

  • Update HIPAA privacy policies and procedures as required by the new rules
  • Have a plan in place for the event that a breach of PHI does occur
  • Make sure everyone is trained on it


When it comes to communicating employee benefits, no news is the worst news you can give

Filed under: employee benefit communication — ubpblogger @ 9:15 am
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In spite of this, many employers are currently giving employees no news on their benefits. Data from the report Watson Wyatt 2009/2010 Communication ROI reveals that just 28% of companies plan to increase communication on employee benefits.

The report’s findings paint an even bleaker picture from the employee end of the spectrum. Case in point, 54% of employees nationwide (that’s more than half of all working Americans) have not received any communications this past year from their employers about their company’s current benefits or future plans regarding their benefit programs.

Two possible reasons for this are as follows:

  • Many company leaders feel it’s not their responsibility to communicate employee benefits
  • Many other leaders within companies are opting to simply communicate the negative effects of the current economic recession to employees, and nothing further.

What should be done?

As the economy remains weak, companies should reassure employees of the positive offerings still available to them. For example, if money at your company is tight yet you’re still able to offer employees a robust benefits package, why, then should you not communicate this to them?

Also, we all know that in difficult economic times, change (whether positive or negative) is inevitable and no company is completely immune to it.  Employers can reduce or possibly eliminate fear and confusion in the minds of employees caused by major changes if they do the following:

  • Sufficiently prepare employees for changes they’ve anticipated
  • Let employees know what will stay the same
  • Make sure employees know what is expected of them

Why is this employer-employee communication necessary? 

If employers fail to communicate vital benefits and company information to their employees, they risk losing their trust, making them feel undervalued or even leading them to search for other employment.

Providing employees with information about their benefits and keeping them in the loop regarding company developments, good or bad, gives them a sense of understanding and aids in their overall motivation. With no news at all, employers create a void between themselves and their employees that will ultimately hurt their organization.

So, when it comes to discussing employee benefits, it’s best for HR professionals to keep the lines of communication wide open.


New mandate on dependent eligibility, Michelle’s Law, goes into effect October 9, 2009

Filed under: HR compliance — ubpblogger @ 9:09 am
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On October 9, 2008, then-President George W. Bush signed Michelle’s Law ensuring full-time students who take a medically-necessary leave of absence do not lose their health insurance coverage as a result. This new law is effective for plan years beginning on or after October 9, 2009.

Brief History of the Law:

Michelle’s Law was named after Michelle Morse, a full-time college student at the University of New Hampshire who had colon cancer. Despite her doctor’s orders, Michelle remained a full-time student while she underwent chemotherapy. She did this so that her chemotherapy would be covered under her parents’ health insurance plan.   

What the Law does:

Starting October 9th of this year, Michelle’s Law will provide that group health plans may not terminate coverage for a dependent child that is a full-time student if he or she:

  • Takes a medically-necessary leave of absence
  • Drops to part-time student status due to a medically-related condition

The leave of absence (or drop from full-time to part-time student status) must:

  • Be medically necessary
  • Start when the child is suffering from a serious illness or injury
  • Cause the child to otherwise lose coverage under his or her parent’s health insurance plan

In order to maintain health insurance coverage under Michelle’s Law:

–          The dependent child must have been a full-time student immediately prior to his or her leave of absence.

–          The child’s physician must give verification in writing that the leave of absence is medically-necessary.

With the passage of Michelle’s Law, students suffering from acute illness and injury will no longer be forced to balance the suffering of their conditions with the pressures of being a full-time college student.  Instead, they will be given medical coverage for one full year from the declared dates of their leaves of absence.


What employers need to know about the “Balancing Act”, a paid-FMLA bill with a good chance of passing.

Filed under: FMLA,HR compliance — ubpblogger @ 12:10 pm
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There’s been a good amount of talk recently about the “Balancing Act of 2009”, a bill proposed by  Democrat Lynn Woolsey that seems to have a strong chance of passing.

 This bill incorporates portions of the Family Leave Insurance Act allowing eligible employees 12 weeks of paid leave over a 12 month period for the following purposes among others:

  • To care for their own illness
  • To care for a sick family member or new child
  • To place a child up for adoption or foster care
  • To address a “qualifying exigency” arising from a family member’s call to active duty
  • To care for a relative who is a wounded veteran

 If the “Balancing Act” becomes a law, employers in all 50 states would need to know about quite a few significant FMLA-related changes.

A few noteworthy ones are as follows:

  •  The terms of FMLA coverage for “family wellness” related leave (as outlined in the Family and Medical Leave Enhancement Act) would be extended to employers with 25+ employees from the original 50+ employees.


  • Borrowing from the Healthy Families Act eligible employees at companies with 15 or more employees will earn one hour of paid six leave per-30 hours worked (not to exceed 56 hours, or 7 days, per-year).


  • Eligibility for the paid leave covered under the Balancing Act would be extended to certain part-time and temporary employees not previously included. It would be extended to include employees working 1,050 hours or more in a given calendar year (up from employees working 1,250 hours or more in a given calendar year).

How will employees’ 12 week paid leaves be funded? 

Under the Family and Medical Leave Act (FMLA), The U.S. Department of Labor would manage a joint fund between employer and employee and 0.2% of employee earnings would be put towards the fund


Face your stuff or stuff your face. Here’s where so many workplace wellness programs are “missing the boat”

When someone mentions the term “workplace wellness program”, what are the first things that come to mind?

Many people would start off by naming some common services that almost all traditional programs have (i.e. weight management and smoke cessation).

There’s a lot of research out there showing us that these services are a good thing. Study after study reveals that obesity and smoking both lead to higher levels of absenteeism, “presenteeism” (you know, when someone is there are work but isn’t 100 percent “there”) and other productivity-related cost issues in a workplace. It’s plain to see why employers put programs with these services into place: they improve the bottom line.

Wellness programs that improve the bottom line are definitely not a bad thing, and they’re easy to keep around. All you’ll have to do is show that they produce a quantifiable return on investment (ROI) and management will give you the green light to keep them.

But, the question that you’ll need to ask now is this one, are traditional wellness programs really doing their job of promoting total workplace wellness?

Are they addressing the root causes for employees “stuffing their faces” with food, drugs, alcohol, etc. or are they just addressing the symptoms (i.e. smoking, obesity, substance abuse) once employees faces have already been “stuffed”?

To answer these questions we’ll need to take a deeper look at what exactly total wellness is, and where traditional wellness programs that focus solely on physical health issues fall short.

What is total wellness?

Total wellness is a state of being made up of three different components, Physical, Mental and Spiritual wellness. Let’s leave the spirits out of this blog and focus on mental wellness, our emotional wellness.

Our emotional wellness is what helps us to stay on the right track towards physical health. When employees are emotionally well, they are better able to make healthy lifestyle choices and steer clear from “stuffing their faces” with substances and habits that compromise their physical health.  

Step #1 to total wellness, Know Your Health Plan:

When employees know their health plans, they not only know about the service available to them for their physical health, they also know where to go for the mental health needs of themselves and their families.

One great thing that you can do in your workplace to help employees out with the mental health component of total wellness is to host a lecture series on mental health topics (i.e. eating disorders (includes both overeating and under-eating), alcoholism, substance abuse, etc.) that employees may attend to learn what to do if they, a co-worker or a family member at home are dealing with these issues. Also, the lecturers could let them know where they can go to for help.

Knowing your plan is only the beginning:

Knowing your health plan is just the first step to total wellness in your workplace. To help employers achieve total “wellness workplaces”, Universal Benefit Plans has created our proprietary 13 steps to total wellness. To get your very own 13 steps to total wellness plan, give us a call at 617-859-1777 or fill out a Contact Form on our website, www.universalbenefitplans.com


Are your employees financially ready for retirement?

Filed under: Uncategorized — ubpblogger @ 9:02 am
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And are they equipped with the financial planning tools and know-how that will help them out along the way?


According to the recent Study of Consumer Finances (SCF), 30% of U.S. households have no retirement wealth whatsoever. On top of all this, most of the people in these households are adults over age 50 who believe that they’re financially prepared for retirement.


From these results it’s safe to assume the following:


  •  Many  employees ages 50+ are ill-prepared and under-educated on financial preparedness for retirement


  • They lack the skills to plan for their future fiscal well-being 


What can employers do?


A possible  solution for employers to consider is providing  employees with the noncash benefit of financial planning.

Here are three possible options to offer to your employees to help them plan for and achieve a healthy retirement:


–          Bring in a third-party professional to educate and assist your employees with their personal financial needs

–          Hold a mandatory orientation meeting for new employees to ensure they understanding their own financial needs, and are aware of the retirement plan your company provides

–          Provide tangible information for your employees to learn about the benefits of proactive financial planning for their futures (i.e. pamphlets, memos, etc.)

When it comes to your prescription drugs, don’t let the brand-name labels fool you

That’s  because if you do, you’ll end up paying a lot more money than you have to every time you go to the pharmacy.


Did you know that one of out three employees doesn’t realize that generic drugs are equally as effective as their brand-name counterparts?


Recent results from a PBM Prescription Solutions and UnitedHealth Group survey  show that many people are  misled to believe that brand-name prescription  drugs have different and superior active ingredients than generics. 


However, the only true differences between a brand-name and generic prescription drug is  the label;and the higher price that goes along with it.. 


One thing employers can do to help their employee reap cost-savings in a down economy is to educate them on the benefits of using generic prescription drugs. Their generic drugs will have the same effectiveness as brand-name drugs, just a lower co-pay.


Stay tuned for more tips on cost-savings in a down economy as our team will keep them coming over the next few weeks.


Can employers demand access to tax and bank records to determine benefits eligibility?

This question was raised recently in The Boston Globe by an employee of a large private company. Employees there were told not too long ago that they’d have to submit tax returns and bank statements to verify their dependents’ benefits eligibility.

The employee who raised the question expressed concerns that it wasn’t legal and/or appropriate for employers to demand access to these private documents. He or she also cited the fact that employees can choose not to comply with this employer request, but was concerned about the possibility of losing health coverage as a result.

Reason for concern:

As web technology becomes more advanced both proving and protecting identities will get more challenging. This will be an issue for both employees and employers.

Verifying benefits eligibility involves several different parties (employers, employees, insurers and various government entities at times) all with different needs for information. Employers will need to find a way to prove their employees’ (and their employees’ dependents) benefits eligibility while protecting their identities at the same time.

The issue discussed in The Globe calls into question a couple of things:

1. Can (and should) an employer demand access to tax and bank documents to verify benefits eligibility?

According to an employment lawyer cited by The Boston Globe, employers may demand access to these documents, but can only get access with an employees’ consent, the attorney also suggested that before giving their employers consent to access private information, employees should first consider the purpose behind the information request. What is the employer trying to verify?

Are there other documents employees can present that will verify this?

For the particular case in question, employees can offer to present documents such as birth certificates and marriage licenses to verify benefits eligibility of their spouses and dependents.

They could also present the required documents but request that their employers not make and retain a copy of it. Or, they could give employers copies of the documents with personal information (i.e. bank account numbers) blacked out.

2. Can employers deny health insurance coverage to employees who don’t comply with this demand?

The answer to this question is technically “yes.” Employers are not required by federal law to offer health insurance to their employees. However, in Massachusetts, if they don’t offer employees coverage (or similarly if they take away an offer of coverage), they’ll need to pay a penalty.

Another tactic for discouraging employees to take health insurance that covers spouses and dependents is to subsidize as little as legally required of the premium. Employers who approach “family” health insurance in this way want their employees’ family members to get health insurance elsewhere, perhaps through a spouse or state programs. That is a different agenda than employers who simply want to verify spouses’ and dependents’ eligibility so they are not unnecessarily paying to insure people who don’t qualify for their plan.

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