Legal Alert: Offering Telehealth to Employees Not Eligible for Group Health Plans

Many employers that sponsor group health plans have portions of their employee population that are not eligible for the group health plan, typically because they are part-time employees. Employers sometimes wish to give these part-time employees something to assist them with their health care needs or expenditures, and it can be tempting to offer that population telemedicine benefits instead of the group health plan.

There are significant compliance concerns with this design however, as a telemedicine program can be robust enough to qualify as a group health plan subject to ERISA, COBRA, HIPAA, and other regulations. When telemedicine is coupled with a major medical program, this only raises minor concerns or compliance needs. When offered as a stand-alone service however, this raises more serious issues. This is because on its own, a telemedicine program cannot meet the ACA’s market reforms, such as offering preventive care like immunizations; or certain health screenings. A group health plan that fails to meet market reforms can be subject to penalties of up to $100 a day per employee.

Offering these employees telemedicine in the short term during the COVID-19 pandemic is likely less risky than a blanket offer of telemedicine coverage for an entire calendar or plan year, but it is currently unclear how regulators will respond to this approach. If an employer wishes to offer telemedicine to employees who are not eligible for the group health plan, they should consult with counsel to ensure they understand the potential risks. Alternatively, employers in this situation could offer part-time employees Individual Coverage HRAs (ICHRAs) to offset the cost of coverage the employee purchases individually. Alera Group will continue to monitor for any signals from Washington DC that telemedicine may be used in unique ways during the COVID-19 pandemic.

COVID-19 Info Hub

COVID 19 Employer resourcesSo much information, so little time. Our goal is to cut through the clutter and get you the most pertinent information in a timely manner. Below you will find articles and resources that can help answer your questions, including but not limited to those that relate to:

  • Leave management, including the newly expanded FMLA program
  • Health plan coverage pertaining to COVID-19 testing and treatment
  • Furloughs, termination and benefits news
  • Health & safety tips
  • Compliance
  • P&C coverage
  • Insurance market impacts

Whitepapers

COVID-19 and Employee Termination and Benefits Consideration

Legal Alerts

Dependent Care Assistance Programs & COVID-19
Congress Passes the Coronavirus Aid, Relief, and Economic Security Act (CARES Act)
The CARES Act – Retirement Plan Provisions
What Employers are Subject to the Families First Coronavirus Response Act
FFCRA Employee Notice
How Does FMLA and EFMLA Apply to Leaves?
Collecting Premiums During Employee’s Leave of Absence
Notice Requirements When Making Health Plan Design Changes
Families First Coronavirus Response Act Passes
COVID-19 Update Employee Terminations, Furloughs, and Lay-offs: COBRA, Reinstatement, and Closed Businesses
Offering Telehealth to Employees Not Eligible for Group Health Plans

Insights & Other Resources

FAQs for Employers
COVID-19 and Civil Authority Coverage 
Q&A: Telemedicine & Benefits
Q&A: Employment Issues Catchall
Q&A: Medical Screenings and Sick Employees
How COVID-19 Will Impact These 8 P&C Policies
Families First Coronavirus Response Act FAQs
COVID Scenarios and Benefit Implications
What Does Your Health Plan Cover? How Different Carriers Are Addressing COVID-19
State Insurance Regulatory COVID-19 Updates
State Department of Insurance Responses to COVID-19
Business Interruption Claim: What to Expect

Webinars

Upcoming – Thursday, April 9th: OSHA, COVID-19 & Construction
(Recording) CARES and COVID-19

 

Spring’s SVP Speaking at the National Workers’ Compensation and Disability Conference

We are excited to share that our Senior Vice President, Karen English, has been invited to speak at this year’s National Workers’ Compensation and Disability Conference & Expo, which runs from November 6th-8th in Las Vegas. Karen, winner of the 2019 Power Broker award for Workers’ Compensation, is an expert in the field and will bring great value to the audience. Workers' Comp and Disability

Her session, Getting Smart Integrating Workers’ Comp, Disability and Leave Programs, runs from 2:30-3:45 PM on Wednesday, November 6th. She will be presenting alongside Kerry Daley, Absence Program Manager at Robert Half. Together they will cover the full spectrum of integrated program benefits, such as:

  • Cost reductions
  • Increased productivity
  • Greater efficiency
  • Deeper understanding of employee health
  • More consistent claims

The duo will offer best practices for integrating, and will demonstrate different approaches, implementation challenges and results through a case study. Attendees will leave with enhanced knowledge about the dangers of a program of silos, and with a plan of attack for integrating and/or maintaining their leave program.

 

4 Areas That Kept Popping Up at the DMEC Annual Conference

Now that the dust has settled and we are even ahead to next year’s conference, we’ve had the time to reflect on key learnings from the 2019 DMEC Annual Conference. Spring, and myself, have been active participants in the organization’s events and programs for many years, and the Annual Conference is one of the industry’s largest hubs for thought leadership. This year was no exception. Between cocktail receptions and dueling piano bar outings, there was a lot of knowledge shared among the (approximately) 500 professionals who came together from August 5th-8th in the D.C. metropolitan area.

As a general practice, we at Spring like to reinforce a conference’s highlights by putting pen to paper (or fingers to keyboards) and jotting them down to share with our colleagues. While the pre-conference material was focused on behavioral health in the workplace, there were four other hot topics that we couldn’t help but notice creating a thematic backbone to the main conference. Generally, what piques people’s interest most at a conference like DMEC is a good indicator of trends in the HR and benefits market at large. So, here they are!

  1. Paid Leave

I wasn’t surprised that paid leave was on a lot of people’s minds at the conference. After all, eight states and Washington D.C. have now enacted statewide paid leave policies, and there are several more, similar legislations being proposed in other states. While this is all great progress for the American workforce, it does complicate things from an HR and leave administration and compliance perspective. Various DMEC presenters were out to share their experience to help employers across the country who are grappling with the policies.

 

There was, “A Case Study: Developing a Paid Parental Leave Program”, which walked the audience through Halliburton’s approach. We also heard from an attorney on how to design a compliant paid sick leave policy, and in “They’re Here! A Deep Dive Into Paid Family and Medical Leaves”, we were given a national, trend-based overview as well as a granular, state-by-state look at the existing paid family and medical leave programs, as well as tips for employers getting started with a program.

  1. Data

Not all of the work of benefits and disability management professionals is always at the forefront of a business, but it sure does make an impact. As such, there was a heavy focus on the data and numbers behind all of that work being done. In “Got ROI?”, led by two of our Senior Vice Presidents, Teri Weber and Karen English, data was name of the game  – what types to look for, how to collect it, how to measure success, and how to take numbers and turn them into actionable insights.

 

Further, one session focused on paid leave data, and how it ties into corporate communications, cyber security and onboarding. CoreHealth Technologies presented on data specifically for healthcare organizations, focusing on their unique challenges. Lastly, in “How to Use Absence and Disability Data to Understand Your Workforce”, discussions revolved around turning health and populatio

Employee Absence Management

n data into insights you can use for various early intervention tactics.

 

  1. Employee Experience

It’s the employee’s world and we’re just living in it. Not really, but there was a definite emphasis at DMEC on the customer, which in many cases means the employee. Our very own Teri Weber led a workshop called “Your Self-Audit Checklist”, which, at its core, is really centered around making processes more seamless and compliant-friendly so that employee and employer alike have a more pleasant work environment. Another session revolved around advocacy, and how it can be used to elevate the employee experience. In “Winning the War for Talent by Perfecting the Employee Experience”, a panel discussed the importance of the employee experience for retention and recruitment, and suggested strategies for improvement.

 

  1. ADA/FMLA

With a name like Disability Management Employer Coalition, the ADA and FMLA are always prevalent at the conference. This year, however, with the DOL’s proposal of form changes for FMLA and several high-profile court cases around both policies, we wanted to make sure to note it yet again as a pressing priority for professionals in this space. The topic(s) appeared in the following presentations:

  • “It’s Complicated: The Always-Evolving ADA/FMLA Relationship”, which covered how shifts in technology and business needs necessitates pivots to your FMLA and ADA approach.
  • “Opioids and the ADA/FMLA”, where a doctor and a representative from Lincoln Financial Group discussed the opioid epidemic, how it came about, how it impacts the workplace, what to watch out for and how to develop employer policies and strategies for prevention and management.
  • “Reducing Your ADA Burden by Implementing a Return to Work Strategy” outlined myths and benefits of return-to-work and stay-at-work programs, an employer’s ADA obligations, EEOC guidelines and tips for a successful program.
  • “FMLA/ADA Lessons Learned: Jury Verdicts, Settlements & Recent Court Cases” provided an overview of court cases like Gunter v. Bemis Company, Hawkins v. Grinnel Regional Medical Center, Jacobs v. Wal-Mart Stores, and Ramirez v. Jack in the Box. The presenters reiterated what it means to be compliant in areas such as reasonable accommodations and “essential job functions”, so that employers in the audience were better equipped to prevent having their own court case on their hands one day.

I hope you found our event recap useful. From attending great industry events like DMEC, we know that sharing knowledge is the best way to make progress, so we wanted to pay it forward. You might also be interested in this summary on another session my colleague Karen English led, called “The RFP Process: A Deep Dive”.

We are already looking forward to – and planning for – DMEC’s two annual conferences next year.

Navigating Transgender Leave

The societal understanding of what it means for an employer to be truly inclusive of all diversity groups has expanded exponentially since the turn of the 21st century. Employers are increasingly faced with multifaceted Human Resources related topics including cannabis, cybersecurity, sexual harassment, and a push, in many states, for equal opportunity for paid leave. Equal opportunity accommodations do not just vary between male and female employees but also between groups based on race, religion, and gender identity.

Gender identity itself varies extensively, but one concentration is the difference between individuals that identify as either cisgender (the same gender as their sex at birth) or non-cisgender (not the same gender as their sex at birth). The non-cisgender identity includes a wide umbrella of individuals who do not identify or present themselves with the sex they were assigned at birth, including transgender (not the same gender as their sex at birth) and non-binary (neither exclusively female or male) individuals. This particular group of individuals has historically faced major roadblocks in society and until recently, had not experienced inclusion and accommodations in the corporate world. Even with the progress that has been made, there is still a gap in today’s employee benefits environment for anyone deviating from “the norm”.

Fill out the form below for the full white paper, which covers:

  • Unique challenges faced by LGBTQ employees and their employers, including leaves of absence and insurance coverage
  • Terminology and proper usage
  • Protective regulations, including a state-by-state analysis
  • How to expand inclusivity to the LGBTQ population and tips for building a benefits program and culture that accommodates accordingly

 

Spring to Speak in 3 Sessions at DMEC Annual Conference

As a long-time sponsor and advocate for the Disability Management Employer Coalition (DMEC), Spring is excited to continue our involvement in this year’s annual conference.

The event, which takes place from August 5-8 in Washington, D.C., will bring together around 500 professionals in HR, Benefits, Disability and Absence Management fields, and is sure to be a thought-provoking and fun few days. This year, Spring team members will be featured a few times on the conference agenda:DMEC Annual Conference

  • Launching Your Organization’s Self-Audit Checklist: Tuesday, August 6th, 3:35PM
    Senior Vice President Teri Weber will be running this short quick-dive session, which will guide audience members on effectively conducting an internal compliance audit.
  •  The RFP Process: A Deep Dive: Wednesday, August 7th, 2:30PM
    Teri Weber and Senior Vice President Karen English will be joined by clients on this panel that outlines the who, what, and the how of conducting an RFP. Best practices and case studies will be shared.
  • Got ROI?: Thursday, August 8th, 9:30AM
    In this general session, Karen, Teri and Disability Management professionals from Baystate Health Systems and Chevron will speak to how to determine if an absence management program is producing ROI. The audience will be left with a framework to overcome common challenges and learn from the success of large employers.

So, if you are heading to the DMEC Annual Conference, be sure to catch us at one (or all!) of these sessions, and say hello to our team at booth #312. We promise good conversation and fun giveaways!

The Latest in MA Paid Family and Medical Leave

By Karen English and Teri Weber

What You Need to Know

In June of 2018, Massachusetts passed a paid family and medical leave policy, making it the fifth state to do so after California, New Jersey, Rhode Island, New York, and Washington, and almost in tandem with D.C. Since then, Massachusetts employers, employees and industry professionals like ourselves have been closely following the regulatory progress and stipulations of this new program.

The Law: A Brief Overview

The Massachusetts Paid Family and Medical Leave law provides employees working for a Massachusetts employer with up to 26 weeks of job protected, paid family and medical leave for qualifying reasons, which include but are not limited to:

  • One’s own or a family member’s serious health condition
  • Bonding with a newborn or adopted child
  • Tending to a family member who is an injured servicemember

The law also offers job protection during and after a leave. The nuances of the policy and modifications have been slowly rolled out over the last year. More details about employee eligibility, employer requirements and readiness, and pay allocation can be found here. As with all state-wide legal overhauls, the policy is quite complex.Paid Family and Medical Leave Massachusetts

The program is meant to be funded through employer and employee contributions, with employers using MassTaxConnect to determine contributions and appropriate tax filing.

The Latest

The Paid Family and Medical Leave benefits were set to be available to employees starting January 1st, 2021 for bonding, military exigency and one’s own serious health condition, with a second wave being rolled out on July 1st, 2021 for other available and applicable benefits. To ensure sufficient funding for the program, employers were to start paying paid leave taxes starting July 1st, 2019.

As the deadline approached, however, employers in the state became concerned over unanswered questions and lack of time to prepare. Members of the Associated Industries of Massachusetts sent more than 2,500 messages to Governor Charlie Baker explaining that they lacked the time and clarity to stay on track for the July 1st deadline. Massachusetts lawmakers heard the grievances and acted accordingly. On June 11th, 2019, the state agreed to a three-month delay on paid leave tax collection, which will now begin on October 1st, 2019.

What This Means For Employers

The extension allows us all to get more familiarized with the ins and outs of the law and plan accordingly. Employers will be focused on whether an exemption applies, how the breakdown of corporate tax vs. payroll deduction will work, and what portion(s) of their workforce are eligible for the different benefits outlined. The additional time will also enable employers to effectively communicate the changes. Updated key dates to be aware of include:

  • Required Withholding Now Starts October 1, 2019
  • Contribution Rate Has Been Adjusted from 0.63% to 0.75% of Employee Qualifying Earnings
  • Remittance of Contributions for the October 1 to December 31 Quarter Will Be Due January 31, 2020
  • Timeline Has Been Extended for Required Employee Notices to September 30, 2019
  • Timeline Has Been Extended for Exemption Applications to December 20, 2019
  • PFML Final Regulations Are Scheduled To Be Posted on June 17, 2019 and Become Effective on July 1, 2019

Please get in touch if you have questions about the Massachusetts Paid Family and Medical Leave law and how to prepare for the program’s rollout. We have experts in leave management and compliance that are happy to help you navigate this new policy.

 

5 Reasons to Consider an Integrated Workers’ Comp and Disability Program

For employers with robust benefits programs in place, an integrated approach is continuing to become an increasingly popular way to take things to the next level, and for good reason. Although the concept is not new, and our team of experts has been developing solutions for years, certain aspects are getting employers’ attention.

Spring’s 2016 and 2018 employer surveys, led by Spring’s Senior Vice President Karen English, show that the core drivers to developing an integrated program are:

  • Costs savings
  • Simpler administration
  • Upgraded employee experience
  • Enhanced tracking capabilities
  • Improved compliance

There’s a lot more impacting these areas than you might think, so let’s take a deeper dive.

Cost Savings:

Having an efficient benefits program with systems that speak to and work with each other can go a long way for your bottom line. Integration provides greater transparency into your workforce – absence management challenges, productivity, employee health – among other things. This knowledge is an opportunity to create a healthier, more present workforce.

If this sounds like qualitative “fluff”, it’s not. One healthcare client was able to save over $10M in direct and indirect costs through integration. These savings resulted from savings in the following areas:

  • Workers’ compensation
  • Disability
  • Unplanned absence
  • Vacation
  • Other Leaves of Absence

Their program, done in tandem with captive insurance company funding, also yielded risk diversification and stability, as well as further saIntegrated disability managementvings of 10% of premiums.

The graph to the right shows the average levels of employer savings achieved by implementing an integrated program, spanning a range of direct and indirect cost categories.

 

Simpler Administration:

All parties benefit from an integrated benefits system. An immeasurable amount of time and effort is saved from not having to go to different platforms for critical information. This will speed up the claims process.

The best integrated programs send notifications and communications, and offer automated triggers, case management and documentation. For managers, results are easier to explain. For employees, access is simpler and more approachable. At the corporate level, you can expect faster turnaround time and greater visibility.

Upgraded Employee Experience:

Employees do not typically understand the nuances surrounding absences, nor the various policies, plans, and processes involved. They simply need time away. By integrating absence to include occupational and non-occupational events, your employees will experience:

  • Fewer points of contact
  • Clearer processes to follow
  • Faster turnaround times
  • Improved information access
  • Increase self-service options
  • Decreased confusion

These benefits lead to an enhanced employee experience including higher engagement, both at the organization and with their health. As all HR professionals know, engagement is critical for recruiting, retention and overall performance. Whether at risk or not, all employees will appreciate a smarter, more robust benefits program and an employer that is looking out for their wellbeing.

Enhanced Tracking Capabilities:

To make sustainable improvements, it is imperative to track your integrated program and mine the data across all absences to investigate patterns and draw predictions. An integrated program allows for metrics across plans and policies with drill-down features such as:

  • Occupational vs. non-occupational
  • Paid vs. unpaid
  • Job protected vs. non job protected
  • Return-to-work vs. stay-at-work
  • Sick, vacation, etc.
  • Self vs. family
  • Continuous vs. intermittent
  • Diagnosis specific

With all these different facets captured uniformly, you have reporting that is comprehensive; supports workforce planning and budget; allows for strategic planning with HR as a business partner; and offers opportunities for prevention; so that your organization can be proactive instead of reactive. These kinds of insights allow employers to move into population health management.

Improved Compliance:

With the hub of intelligence that an integrated program offers, employers have a more reliable way of remaining compliant when it comes to things like the ADA, FMLA and ERISA, as well as any state-specific regulations and policies unique to the company. Automation will make leave requests and absence tracking much easier to manage, and accurate documentation will aid accountability for employers and employees alike.

Ultimately, an integrated workers’ compensation and disability program can have significant positive impact on a company and its employees, especially for larger employers. We have seen great, quantifiable success with integrated programs from our clients. If you are thinking that this process seems too big a task to take on, don’t worry. Any company can start at any point along the continuum shown below, and gradually work their way to a model that facilitates population health management in the workforce.

 

Population health management