Background

In 2018 the State of Hawaii Legislature passed a bill, Session Law Act 109, directing the Legislative Reference Bureau (LRB) to conduct an analysis to determine the impacts of establishing a state paid family leave (PFL) program. Stakeholders considered in the impact analysis included industry, consumers, employees, employers, and caregivers. The goal of Act 109 was to create a potential framework for the development of a PFL program that would offer paid leave for workers who need to care for a family member. The bill allowed the LRB to contract with a consultant for completion of the impact study, and after a formal Request for Proposal (RFP) process, Spring was selected to partner with the State of Hawaii on this initiative.

The Challenge

The objectives of the impact study were to:

At the time, six states plus D.C. had a paid leave program for family and/or medical reasons in place, and part of our evaluation was not only a cross-model comparison of existing plans, but also a provision of the PFML landscape overall, including states with pending or rejected legislation. Both qualitative and qualitative factors needed to be assessed, including required operational activities, outreach and education approaches, state administration models, headcount modeling, IT infrastructure development, and projected startup costs. Integration with Hawaii’s existing State Temporary Disability Insurance (TDI) program was also explored.

Spring’s Work

Through Spring’s three-phased approach, the impact study covered a wide range of areas in detail that were critical in deciding on the development of a PFL plan in Hawaii. Starting with a deep dive into existing state PFL programs which included California, Massachusetts, New Jersey, New York, Rhode Island, Washington D.C., and Washington as seen below.

Plan Structure:

Funding:

Administration:

Implementation Timeline

Within this evaluation, factors like gender equity, hiring practices, speed of benefit payments, ease of making applications or claims, financial sustainability, data collection capabilities, and compliance monitoring capabilities were also assessed. To arrive at these impact answers, Spring’s actuaries developed an actuarial impact model that utilizes actual PFL claim and other industry data to project claim incidence rates, duration of benefits, average benefit payments, expected costs and funding rates under existing state models and Hawaii’s current TDI structure.

The Results

Spring’s comprehensive impact study for the State of Hawaii’s Legislative Reference Bureau is available for public viewing here. Our team presented it in person to various legislators. While the State has not moved forward with a PFL program to date, we continue to keep the dialogue open and all parties are pleased with the framework set out in this project, as it was an imperative piece of due diligence on behalf of the State.

Employees have a whole host of responsibilities outside of work, and compassionate and strategic employers understand this and act accordingly. Below is our checklist of considerations for an employee benefits program that is family-friendly, enabling work-life balance and lessening the need to choose between job and familial needs, ultimately helping solve for some of HR’s biggest challenges: recruitment, retention, absenteeism, mental health and productivity.

Get familiar with your population and demographics
o   Does your workforce trend younger, older, or a balanced mix?
o   Are there cultural, regional, or gender-based considerations at play?
o   Do your claims demonstrate specific health issues among employees or dependents?
o   Are most of your employees remote, hybrid or on-site?
o   Does the nature of employees’ work or work schedule present any concerns (e.g., physical labor, night shifts, healthcare staff susceptible to illness)?
Evaluate family-oriented provisions that are already in place via your health plan, corporate policies, voluntary benefits, or wellness programs 
o   Where are there gaps or room for improvement?
o   Have you accounted for nontraditional families in a way that aligns with diversity, equity, and inclusion (DEI) goals? 
o   What benefits do you provide compared to similar companies with whom you are competing with for talent?
Armed with this information, consider a broad range of benefits or perks:
o   Paid parental leave (for mothers and fathers), including for adoption
o  Take it a step further by designing a plan that offers insurance coverage and/or assistance related to fertility treatments, adoption, surrogacy, and post-partum needs
o   Paid family leave / caregiver leave, for employees to care for aging parents, sick children, partners recovering from surgery, and more
o   Bereavement leave, so that workers have space to grieve and spend time with loved ones during a time of need
o   Flextime or alternative work schedules, for daycare pickup, doctors’ appointments, sporting events, and the like
o   Childcare assistance, such as an on-site facility or a stipend
o   Eldercare assistance, which could include financial and/or counselling and navigational help
o   Financial wellness benefits, for traditional use cases like retirement but extending to consider things like tuition, student debt and long-term care planning
o   Long-term care insurance, or related financial/educational resources, especially as states begin to consider statutory long-term care programs
o   Paid Time Off (PTO) – in many cases this represents a set number of days that can be used for various reasons, including the fun (vacation) and the not-so-fun
o   Enhanced mental health benefits or resources beyond standard EAP benefits for all members of the family
o   Pet insurance or “pawternity” leave – while it may seem offbeat, most pet owners consider their pets to be family members
Identify which family-focused benefits are most appropriate and feasible for your population, and fit with your company culture
Determine your budget or how desired benefits could be funded (e.g., fully funded by employer, fully funded by employee, or some combination) and contribution methods
Understand how different leave types and benefits would integrate with current offerings or if adjustments will be needed (e.g., phasing out sick banks for a more flexible paid time off policy)
Ensure compliance and cohesion with national, state and local policies surrounding family leave (FMLA, state Paid Family and Medical Leave, parental leave policies, etc.)
If appropriate, conduct a Request for Proposal (RFP) for any vendor-provided products or services
Consider engaging a consultant like Spring to guide you through this checklist!

Background

With terms like “quiet quitting”, the “great resignation”, and “burnout” becoming regularly intertwined in our vernacular, attracting and retaining key talent has never been more nuanced. Since benefits priorities and expectations are constantly shifting, validating the benefit offerings through competitive benchmarking may be the most important tool in an employer’s arsenal.

At its core, benchmarking is a process of measuring or comparing against certain indicators, industry standards, or best practices. It is used to evaluate various aspects of the program and develop plans to improve upon the current state. Benchmarking can yield actionable insights, enhance your metrics standards (e.g., what constitutes success), enable you to build a business case for change, or defend the current process and programs available.

Types of Benchmarking

Performance benchmarking, one of two main types of benchmarking, uses quantitative data and measures to inform decision-making and business cases for change. Practice benchmarking, the other main type, is more qualitative in nature. It focuses on how an activity is conducted through people, processes and technology and provides insight into gaps and best practices that could be applied. Both play a critical role in comparing employee benefit programs and should be used in tandem.

Each of these can involve internal benchmarking, where the comparison is made against your own data over time, either in the aggregate or by different business units, product lines, departments, programs, geographies, and the like. They can also entail external benchmarking, where metrics or practices of your company are compared to one or many other companies. This involves external sources or custom surveys and provides an objective understanding of current state. External benchmarks are necessary to validate your offering remains competitive in the market; however, internal benchmarks are imperative to track against previously set metrics and targets.

Your vendor partners, including insurers, coalitions, trade organizations and benefit advisors (i.e., Spring / Alera), can typically support the demand for external benchmarking.

Getting Started

The good news is that you may be better positioned to begin benchmarking than you think.
We recommend the following roadmap for effective benchmarking:

  1. Define Your Objectives
    1. Roles and responsibilities
    2. Timeliness
    3. Metrics for success
  2. Determine Your Data Gathering Strategy
    1. Understand definitions and what you are trying to measure
  3. Identify Data and Tools You Have Available
    1. What tracking tools are at your disposal in-house or through partners
    2. What data is available internally
    3. Consider supplemental sources of information
      • Insurance carriers
      • Third party administrators
      • Brokers, Consultants and Advisors
      • Benefit associations
      • Research firms
  4. Organize Results Into Actionable Reports
    1. Identify areas where change is needed
    2. Use results to provide support in business case to C-suite / upper management
  5. Continually Monitor
    1. Benchmarking is most successful when it is not a one-and-done activity, but rather a regular business activity, as the benefits landscape is always changing. Further, if your benchmarking results bring about a change in policy or protocol, you want to be sure you are prepared to measure whether that change yields the intended result.

There are many different areas of benefits an organization can benchmark, from health plan design to retirement benefits and disability insurance. If you are unclear about where to start, consider where your biggest pain points exist and consider those the highest priorities. If significant pain points do not exist, benefit plan design is usually an optimal place to begin benchmarking as process details hinge on plan design.

As employers fight for top talent and work to deliver equitable benefits, family-first benefits have risen to the top of the priority list for most progressive employers, but the definition of family first continues to evolve. An increase in parental and caregiving leave, use of lifestyle accounts, coverage for family planning and infertility including at times travel reimbursement demonstrates an employers’ commitment to their diverse population and the constantly changing definition of family friendly. Women’s health, however, during and beyond childbearing years, is beginning to take center stage.

In recent years, the stigma around infertility and reproductive health issues has lessened. The CDC reports that around 19% of American women struggle to get pregnant. In vitro fertilization (IVF) can cost between $15,000 – $30,000 per cycle without insurance, and surrogacy costs range from a staggering $100,000 – $200,000.1 Given the expense as well as the physical and mental toll of reproductive challenges, employers and lawmakers responded, with almost half of U.S. states requiring fertility insurance coverage. Most of these laws require benefits be provided for the diagnosis and treatment of infertility, as defined by the state. Many require IVF to be a covered benefit for plans that provide pregnancy-related benefits, while others may only mandate that insurers offer coverage options related to infertility for employers to select.

Under these fully insured plans, some restrictions apply and requirements must be made for coverage. For example, coverage may be restricted by various clauses such as the definition of infertility (i.e., 2-year history of infertility, infertility associated with certain conditions such as endometriosis, etc.), lifetime maximums (e.g., $15,000), and approved treating providers. Further, laws may only apply to certain plans, such as those with more than 100 lives.

In Massachusetts, for example, all insurers who provide pregnancy-related benefits must provide coverage for the diagnosis and treatment of infertility, including artificial insemination, IVF, Gamete Intrafallopian Transfer (GIFT), egg banking, and more. Infertility is defined by being unable to conceive during a period of 1 year if the female is 35 or younger, or during a period of 6 months if the female is over 35. There is no legal limit on a number of treatments, however, insurers may set limits based on clinical guidelines and patient medical history.2

Although states with fertility insurance laws often provide a minimum level of coverage, many employers are not subject to those state requirements (i.e., self-insured plans). Therefore, employers must make critical decisions surrounding plan design for infertility or alternative family planning benefits. This analysis should include benchmarking against peer groups to ensure the offering is competitive as well as a cost-benefit analysis to account for the additional spend.

The healthcare system for women’s health is fragmented. The healthcare lifecycle for women is centered around one life stage – childbearing – during which years healthcare spend is considerably higher than for male counterparts (i.e., ages 19-44).3 However, women are experiencing poor outcomes across many health metrics.4 In addition, many women do not feel heard by their healthcare provider, especially women of color who experience considerable disparities in care and health outcomes. 

Spring would encourage employers to think about women’s health as a priority and begin to track metrics against standards (i.e., preventive services, primary care, etc.). Thinking about women’s health without infertility at the center is important. Consider creative services around birthing (i.e., doula services), support postpartum (i.e., breast milk storage and shipping), and movement into menopause support. Perhaps most critical is working to support women seeking care and ensuring their voices are heard, a pivotal component in bettering health metrics for women.

1 https://money.usnews.com/money/personal-finance/family-finance/articles/how-much-surrogacy-costs-and-how-to-pay-for-it
2 https://resolve.org/learn/financial-resources-for-family-buildinEmg/insurance-coverage/insurance-coverage-by-state/
3 https://www.healthsystemtracker.org/chart-collection/health-expenditures-vary-across-population/#Average%20individual%20health%20spending,%202019%C2%A0
4 https://hologic.womenshealthindex.com/en

The U.S. is one of the only countries in the world without a federally mandated paid parental leave policy. This gap has motivated many states to take matters into their own hands, creating their own statewide paid family and medical leave (PFML) laws, which typically include parental leave (bonding with a new child) but also additional absences from work due to common life events such as a serious illness or to care for a sick family member. Similarly, individual companies often have their own parental leave offerings, knowing that it is critical to a successful employee attraction and retention strategy. 

In years past, the focus was on the mother’s access to maternity leave, and any paternity leave offered was perceived as a “bonus.” However, modern assessments of equity and discrimination should have employers reassessing how their parental leave programs are framed, especially given guidance recently released by the Equal Employment Opportunity Commission (EEOC).

What You Need to Know

Parental leave is a key example of how employers can ensure they are putting their diversity, equity, and inclusion (DEI) values to work. Recent guidance, legislation, and general buzz around this topic make it a prime time to ensure that your programs are compliant. Please get in touch if you should have any questions about leave laws or best practices in this area.

As we progress through 2023, maneuvering changing regulations and compliance updates have been challenging for HR professionals across the nation. Many COVID-19 provisions are expiring soon, states are constantly shifting paid leave policies and managing hybrid/remote workforces are just a few hurdles employers are facing when it comes establishing effective and compliant leave programs. Every year the Disability Management Employer Coalition (DMEC) hosts their Compliance Conference, where experts from around the nation discuss current trends in compliance, best practices for employers, and the future of the industry. This year I traveled to the beautiful (and warm) Orlando, Florida, to attend this year’s conference. As per usual, the conference provided a great platform for networking and ensuring attendees are tuned into the most pressing compliance matters.

This year, my colleague, Jennifer Campagna and I presented on Navigating Ancillary Paid Leave Options to Support Employee Well-Being, but with a unique twist. We included an interactive game to help attendees understand the benefits of ancillary leave options and how they can intertwine with your current offerings. During the session we handed out “Leave Bingo”, a Bingo-style game where attendees listened for key works and concepts throughout the presentation, to see if they have the words on their Bingo board. Winners received prizes and we all got a little pick-me-up from the chocolate provided. I was impressed with the leave offerings employers across the nation have adopted, some of which we covered in our presentation, like leave related to domestic violence, bereavement, mental health, and more. Although all these ancillary options sound great, they can be costly and difficult to manage from a compliance standpoint.

Aside from the game, we reviewed federal and state laws influencing corporate leave policies and how successful companies are managing their policies. Our presentation included case studies on organizations that implemented alternative leave programs and how it impacted their workforce. Many employers have realized one key to retaining/recruiting talent and combating productivity loss is by revaluating their leave policies and addressing pain points.

Some less traditional types of leave include:

As a board member of DMEC and an advocate for equitable paid leave programs, I am delighted to see where the future of the industry is headed. It is unlikely that we will see a nation-wide Paid Family and Medical Leave (PFML) program introduced in 2023, but we are consistently seeing updates and clarifications to regulations such as the Family and Medical Leave Act (FMLA) and the Americans with Disabilities Act (ADA), in addition to the uptick in state PFML programs and adjustments to existing state plans. Spring and I will continue to keep you up to date with updates in the absence management space and provide our clients with industry-leading programs that best match the needs of their specific workforce.

*Additionally, all Spring/Alera clients receive complimentary access to AleraHR and Alera Dashboard, which provide digital tools that help employers and HR teams manage employee benefits compliance deadlines and updates. It also provides users with a robust compliance library with insightful guides, comprehensive checklists, tools and calculators to create forms, job descriptions, explore salary comparisons.

In 2023 we are expecting to see lots of changes when it comes to Paid Family and Medical Leave on both the state and nation-wide level. In this whitepaper, we break down the current landscape of paid leave programs and recommendations for employers to adopt and manage effective paid leave policies.

Title:

Senior Vice President and Co-Founder.

Joined Spring:

I was one of the original founders of Spring (alongside Karin Landry) back in 2004, as a spin out from Watson Wyatt Insurance & Financial Services, Inc.

Hometown:

I was born and raised in Golden Valley, Minnesota (Minneapolis area), but went to college in Wisconsin.

At Work Responsibilities:

I lead our absence management team, and work with employers of all sizes and industries and leading insurance carriers and administrators in the space. I also head up our Spring’s market research surveys and benchmarking. 

Outside of Work Hobbies/Interests:

Being outside, going for walks; spending time with family, and of course, watching my kids play basketball.

Fun Fact:

One thing many people don’t know about me is that I actually use to run track in high school and led the 4×100 relay.

Describe Spring in 3 Words:

Interesting work & caring culture, I guess that’s actually 5 but that’s how I would describe Spring. The people all care about each other and have each other’s backs and support each other. We have a motivated team that is eager to collaborate.

Do You Have Any Children?

Yes, I have two beautiful children, my daughter is 17 and my son is 15.

Favorite Place Visited:

Greece, by land and sea! It has to be my favorite because of the history, beautiful architecture and amazing weather!

If You Were a Superhero, Who Would You Be?:

It would be Elastigirl from The Incredibles because her arms are so long and she can hold everybody. She can take care of everything!

the International Foundation of Employee Benefit Plans recently wrapped-up their 32nd Annual Health Benefits + Conference Expo (HBCE) in Clearwater Beach, Florida. The conference brought together healthcare and benefits professionals from a range of industries to discuss leading topics and share expectations for the future. Having heard such positive feedback about the event, Spring was glad to attend, exhibit, and speak at the conference. Below are some of our biggest takeaways.

Spring Booth HBCE

1) Pharmacy Cost Containment

This year there was a lot of talk surrounding the price of prescription drugs and tactics employers can adopt to help control costs without cutting benefits. There are many factors influencing the high costs of pharmacy drugs, some of which include chronic disease prevalence, the aging population and the growing volume of specialty medications. Below are some of the top sessions focused on controlling Rx costs.

– Representatives from Express Scripts explained the upsides to working with a Pharmacy Benefit Manger (PBM) and how they can help address pharmacy policies in their session titled, “How to Work With Your Pharmacy Benefit Manager.”

– The CEO and Co-Founder of TruDataRx, Cataline Gorla, discussed how comparative effectiveness research (CER) is being used by other countries to decide which drugs work best for specific medical conditions, and how self-insured employers can save money with said data.

2) Addressing Chronic Conditions

According to the Center for Disease Control (CDC), 90% of the nation’s healthcare spending goes towards people with chronic and mental health conditions1. As chronic diseases are very common among the American workforce, employers have started implementing specific benefits and policies to address common conditions, such as diabetes and obesity. Some of the sessions around this topic that we found most interesting include:

– Speakers representing the Nashville Public School System explained how they were able to introduce free resources such as telenutrition and fitness center access to help combat obesity and other health disparities.

– Dr. Mudita Upadhyaya from St. Jude Children’s Research Hospital presented on prevention strategies to address mental health and obesity in a pre- and post-COVID world; and why a mixed approach may be best.

– The Diabetes Leadership Council’s CEO, George J. Huntley spoke on diabetes and chronic disease risk management strategies, including medicines and technology that can help patients manage and prevent the disease.

3) The Future of Healthcare & Benefits

In recent years we have seen a great shift in the healthcare and benefits industry; we saw a great increase in telehealth, mental health resources, new/alternative types of paid leave, including sick leave and more. As we transition to a post-COVID world, we expect the evolution to continue. Below are some of the top trends professionals believe we will face in the coming years.

– Our Senior Vice President, Teri Weber, presented on market forces employers can utilize to meet future absence management challenges. Her session listed techniques employers can adopt to improve day-to-day administration of disability, absence and accommodations.

– In a session titled “Innovative Health Care Models—The Future of Direct Primary Care,” the presenter explained how many employers are changing to value-driving healthcare models to boost access and reduce costs.

– A session titled “Breaking the PTO Mold, Without Breaking the Bank,” reviewed how typical Paid Time Off (PTO) programs can be altered to better support employees’ well-being and financial health.

– The final session of the conference spotlighted how the pandemic has led to an increase in personal, economic and other stressors and has had a drastic impact on mental health, substance misuse and addiction. Attendees were informed on how they can implement workplace solutions that address these issues as well as identify warning signs.

The warmer weather was certainly a bonus, but the insights we gleaned and connections we made were what will keep us coming back to the HBCE conference. We want to thank IFEBP and our fellow colleagues who took the time to share their experience, stop by our booth, and make the energy so positive.

1https://www.cdc.gov/chronicdisease/about/costs/index.htm