All businesses today are aware that a healthy workforce translates to a happier and more productive employee. Nearly a quarter of participants in SHRM’s latest benefits survey plan to increase their Health & Wellness benefits, whose percentage was higher than other categories such as professional and career development, flexible work schedules, retirement and family-friendly policies. One unusual offering, workstations that allow people to stand, soared to 44% from just 13% in 2013 when the data was first tracked.
Helping your employees strive towards physical, emotional, mental, and even spiritual well-being can lead to increased productivity and employee longevity. But how can you offer wellness programs that your employees will actually use and find beneficial? There’s no one size fits all solution, and the best way to get started is to invite employee input. Need some inspiration? Here are 5 employee wellness programs that might be the right fit for your company this coming year:
1. Online Wellness/Health Screening
Did you know many health nurses today pay their employees to take an online health risk assessment? Covered members receive a lump sum benefit payment once a year if they complete certain health-related activities (i.e. routine screenings, programs like smoking cessation and weight reduction, and more). Payment options range from $50 to $150. Empire Blue Cross, for example, pays up to $300 for this including a smoking cessation online questionnaire and flu vaccination.
2. Gym Reimbursements
You might not be able to build a gym at the office, but that doesn’t mean you can’t take advantage of your neighborhood businesses. Did you know most healthcare compare today to offer up to $400 annual gym reimbursement? Most include a $200 spousal gym reimbursement as well.
3. Start a Walking Group
This solution is easy, free, and can be employee-driven. Failing to take breaks leads to burnout and eventually employee resentment. Encourage employees to take frequent breaks, but not just to the break room for more artificial lighting and a caffeine boost. Rally eager employees to lead morning, lunch, and/or after-work walking groups. The fresh air is energizing, boosts creativity, and helps feed social wellness needs, too.
4. Create a Healthy Challenge That Isn’t Based on Numbers
Although some businesses have success with Biggest Loser-style in-office challenges, it can also trigger disordered eating. Instead of focusing on numbers, focus on more subjective goals—like how many consecutive days fresh, local fresh vegetables can be part of a lunch. Kicking off these challenges with a brief intro to the importance of a healthy diet for life can help employees re-think their choices.
5. Seek Help from Outside Resources
There are several organizations that employers can turn to for information, research, and guidance on wellness programs. Below are just a few for you to explore for helpful ideas on how to develop a culture of health in your organization.
HERO is a national non-profit dedicated to identifying and sharing best practices in the field of workplace health and well-being (HWB). Their mission is to improve the health and well-being of workers, their spouses, dependents, and retirees. Check out the wealth of information on their site, including research studies and a blog.
The Health Project is a tax-exempt not-for-profit corporation formed to bring about critical attitudinal and behavioral changes in addressing the health and well-being of Americans. The Health Project focuses on improving personal healthcare practices and supporting population health by reaching adults where they spend most of their waking hours: at work. Many organizations have adopted health promotion (wellness) programs that encourage good health habits and an improved understanding of how individual workers and their families can more effectively use health services.
Harvard Health Newsletters are free newsletters targeted to individuals with the purpose of providing educational information to help them invest in their own health or the health of their families.
Contact us to learn more about how health and wellness benefits can help you attract and retain your top talent.
This Compliance Overview is not intended to be exhaustive nor should any discussion or opinions be construed as legal advice. Readers should contact legal counsel for legal advice.
In preparation for open enrollment, Employers should review their plan documents in light of changes for the plan year beginning Jan 1, 2023. Below is an Employer 2023 Open Enrollment Checklist including some administrative items to prepare for in 2023.
Health plan sponsors should also confirm that their open enrollment materials contain certain required participant notices, when applicable—for example, the summary of benefits and coverage (SBC). There are also some participant notices that must be provided annually or upon initial enrollment. To minimize costs and streamline administration, employers should consider including these notices in their open enrollment materials.
PLAN DESIGN CHANGES
Effective for plan years beginning on or after Jan. 1, 2014, non-grandfathered health plans are subject to limits on cost-sharing for essential health benefits (EHB). The ACA’s out-of-pocket maximum applies to all non-grandfathered group health plans, including self-insured health plans and insured plans.
$9,100 for self-only coverage and $18,200 for family coverage out-of-pocket maximum.
$7,500 for self-only coverage and $15,000 for family coverage HSA Maximum.
Preventive Care Benefits
The ACA requires non-grandfathered health plans to cover certain preventive health services without imposing cost-sharing requirements (that is, deductibles, copayments or coinsurance) for the services. Health plans are required to adjust their first-dollar coverage of preventive care services based on the latest preventive care recommendations. If you have a non-grandfathered plan, you should confirm that your plan covers the latest recommended preventive care services without imposing any cost-sharing.
The ACA imposes a dollar limit on employees’ salary reduction contributions to a health flexible spending account (FSA) offered under a cafeteria plan. An employer may impose its own dollar limit on employees’ salary reduction contributions to a health FSA, as long as the employer’s limit does not exceed the ACA’s maximum limit in effect for the plan year.
The ACA set the health FSA contribution limit at $2,500. For years after 2013, the dollar limit is indexed for cost-of-living adjustments. For 2023 plan years, the health FSA limit is $3,050. The DFSA Rollover Maximum is $610.
Communicate the health FSA limit to employees as part of the open enrollment process.
If you offer an HDHP to your employees that is compatible with an HSA, you should confirm that the HDHP’s minimum deductible and out-of-pocket maximum comply with the 2020 limits. The IRS limits for HSA contributions and HDHP cost-sharing increase for 2023. The HSA contribution limits will increase effective Jan. 1, 2023, while the HDHP limits will increase effective for plan years beginning on or after Jan. 1, 2023.
Check whether your HDHP’s cost-sharing limits need to be adjusted for the 2023 limits.
If you communicate the HSA contribution limits to employees as part of the enrollment process, these enrollment materials should be updated to reflect the increased limits that apply for 2023.
The following table contains the HDHP and HSA limits for 2023 as compared to 2022. It also includes the catch-up contribution limit that applies to HSA-eligible individuals who are age 55 or older, which is not adjusted for inflation and stays the same from year to year.
Type of Limit
HSA Contribution Limit
HSA Catch-up Contributions (not subject to adjustment for inflation)
Age 55 or older
HDHP Minimum Deductible
HDHP Maximum Out-of-pocket Expense Limit (deductibles, copayments and other amounts, but not premiums)
ACA EMPLOYER MANDATE AND OTHER REQUIREMENTS
Applicable Large Employer Status (ALE)
Under the ACA’s employer penalty rules, applicable large employers (ALEs) that do not offer health coverage to their full-time employees (and dependent children) that is affordable and provides minimum value will be subject to penalties if any full-time employee receives a government subsidy for health coverage through an Exchange.
To qualify as an ALE, an employer must employ, on average, at least 50 full-time employees, including full-time equivalent employees (FTEs), on business days during the preceding calendar year. All employers that employ at least 50 full-time employees, including FTEs, are subject to the ACA’s pay or play rules.
Determine your ALE status for 2023
Calculate the number of full-time employees for all 12 calendar months of 2022. A full-time employee is an employee who is employed on average for at least 30 hours of service per week.
Calculate the number of FTEs for all 12 calendar months of 2022 by calculating the aggregate number of hours of service (but not more than 120 hours of service for any employee) for all employees who were not full-time employees for that month and dividing the total hours of service by 120.
Add the number of full-time employees and FTEs (including fractions) calculated above for all 12 calendar months of 2022.
Add up the monthly numbers from the preceding step and divide the sum by 12. Disregard fractions.
If your result is 50 or more, you are likely an ALE for 2023.
Identify Full-time Employees
All full-time employees must be offered affordable minimum-value coverage. A full-time employee is an employee who was employed on average at least 30 hours of service per week. The final regulations generally treat 130 hours of service in a calendar month as the monthly equivalent of 30 hours of service per week. The IRS has provided two methods for determining full-time employee status—the monthly measurement method and the look-back measurement method.
Determine which method you are going to use to determine full-time status
The monthly measurement method involves a month-to-month analysis where full-time employees are identified based on their hours of service for each month. This method is not based on averaging hours of service over a prior measurement method. Month-to-month measuring may cause practical difficulties for employers, particularly if there are employees with varying hours or employment schedules, and could result in employees moving in and out of employer coverage on a monthly
The look-back measurement method allows an employer to determine full-time status based on average hours worked by an employee in a prior period. This method involves a measurement period for counting/averaging hours of service, an administrative period that allows time for enrollment and disenrollment, and a stability period when coverage may need to be provided, depending on an employee’s average hours of service during the measurement
Audit FTEs for FMLA Compliance
Audit your FTEs to determine if you have reached or exceeded 50 employees and are required to comply with the Family Medical Leave Act (FMLA) in 2022. Employers covered by the FMLA are obligated to provide their employees with certain important FMLA notices, so both employees and the employer have a shared understanding of the terms of the FMLA leave. Note that FMLA compliance requirements are different from ACA compliance.
Offer of Coverage
An ALE may be liable for a penalty under the pay or play rules if it does not offer coverage to “substantially all” (95%) full-time employees (and dependents) and any one of its full-time employees receives a premium tax credit or cost-sharing reduction for coverage purchased through an Exchange. For employees who are offered health coverage that is affordable and provides minimum value are generally not eligible for these Exchange subsidies. The IRS lowered the 2023 employer health plan affordability threshold, or cost-sharing limit, to 9.12% of an employee’s income. The threshold in 2022 was 9.61%.
Offer minimum essential coverage to all full-time employees
Ensure that at least one of those plans provides minimum value (60% actuarial value)
Ensure that the minimum value plan offered is affordable to all full-time employees by ensuring that the employee contribution for the lowest cost single minimum value plan does not exceed 78% of an employee’s earnings based on the employee’s W-2 wages, the employee’s rate of pay, or the federal poverty level for a single individual.
Reporting of Coverage
The ACA requires ALEs to report information to the IRS and to employees regarding employer-sponsored health coverage on Form 1095-C. The IRS will use the information that ALEs report to verify employer-sponsored coverage and to administer the employer-shared responsibility provisions (Code Section 6056).
In addition, the ACA requires every health insurance issuer, sponsor of a self-insured health plan, government agency that administers government-sponsored health insurance programs and any other entity that provides minimum essential coverage (MEC) to file an annual return with the IRS and individuals reporting information for each individual who is provided with this coverage (Code Section 6055).
Determine which reporting requirements apply to you and your health plans
Determine the information you will need for reporting and coordinate internal and external resources to help compile the required data for the 1094-C and 1095-C
1095 forms delivered to employees
Jan. 31 (extended to March 2)
Paper filing with IRS*
Electronic filing with IRS
Comparative Effectiveness Research Fee (PCORI)
Sponsors of self-funded plans and health insurance issuers of fully insured plans are required to pay a fee each year, by July 31st, to fund comparative effectiveness research. Fees will increase to $2.45 per covered life in 2021 and are next due July 31, 2022.
Healthcare Reform requires employers to report the aggregate cost of employer-sponsored group health plan coverage on their employees’ Forms W-2. This reporting requirement was originally effective for the 2011 tax year. However, the IRS later made reporting optional for 2011 for all employers.
The IRS further delayed the reporting requirement for small employers (those that file fewer than 250 Forms W-2) by making it optional for these employers until further guidance is issued. For the larger employers, the reporting requirement was mandatory for the 2012 Forms W-2 and continues.
ACA DISCLOSURE REQUIREMENTS
Summary of Benefits and Coverage
The ACA requires health plans and health insurance issuers to provide an SBC to applicants and enrollees to help them understand their coverage and make coverage decisions. Plans and issuers must provide the SBC to participants and beneficiaries who enroll or re-enroll during an open enrollment period. The SBC also must be provided to participants and beneficiaries who enroll other than through an open enrollment period (including those who are newly eligible for coverage and special enrollees).
In connection with a plan’s 2023 open enrollment period, the SBC should be included with the plan’s application materials. If coverage automatically renews for current participants, the SBC must generally be provided no later than 30 days before the beginning of the new plan year.
For self-funded plans, the plan administrator is responsible for providing the SBC. For insured plans, both the plan and the issuer are obligated to provide the SBC, although this obligation is satisfied for both parties if either one provides the SBC. Thus, if you have an insured plan, you should confirm that your health insurance issuer will assume responsibility for providing the SBCs.
SBCs must be given to anyone who enrolls in benefits, during or outside of open enrollment.. Generally, provide no later than 30 days before the start of the plan year.
Self-funded plans: Plan sponsor is responsible for SBC distribution.
Grandfathered Plan Notice
If you have a grandfathered plan, make sure to include information about the plan’s grandfathered status in plan materials describing the coverage under the plan, such as SPDs and open enrollment materials. Model language is available from the DOL.
Notice of Patient Protections
Under the ACA, non-grandfathered group health plans and issuers that require designation of a participating primary care provider must permit each participant, beneficiary and enrollee to designate any available participating primary care provider (including a pediatrician for children). Also, plans and issuers that provide obstetrical/gynecological care and require a designation of a participating primary care provider may not require preauthorization or referral for obstetrical/gynecological care.
If a non-grandfathered plan requires participants to designate a participating primary care provider, the plan or issuer must provide a notice of these patient protections whenever the SPD or similar description of benefits is provided to a participant. If your plan is subject to this notice requirement, you should confirm that it is included in the plan’s open enrollment materials. Model language is available from the DOL.
Group health plan sponsors should consider including the following enrollment and annual notices with the plan’s open enrollment materials.
Initial COBRA Notice
The Consolidated Omnibus Budget Reconciliation Act (COBRA) applies to employers with 20+ employees that sponsor group health plans. Plan administrators must provide an initial COBRA notice to new participants and certain dependents within 90 days after plan coverage begins. The initial COBRA notice may be incorporated into the plan’s SPD. A model initial COBRA notice is available from the DOL.
Notice of HIPAA Special Enrollment Rights
At or prior to the time of enrollment, a group health plan must provide each eligible employee with a notice of his or her special enrollment rights under HIPAA. This notice may be included in the plan’s SPD. Notice must be given to participants before or at the time of group health plan enrollment. Model language for this disclosure is available on the DOL’s website.
Annual CHIPRA Notice
Group health plans covering residents in a state that provides a premium subsidy to low-income children and their families to help pay for employer-sponsored coverage must send an annual notice about the available assistance to all employees residing in that state. The DOL has provided a model notice.
Plans and issuers must provide notice of participants’ rights to mastectomy-related benefits under the Women’s Health and Cancer Rights Act (WHCRA) at the time of enrollment and on an annual basis. Model language for this disclosure is available on the DOL’s website.
Plan administrators must include a statement within the Summary Plan Description (SPD) timeframe describing requirements relating to any hospital length of stay in connection with childbirth for a mother or newborn child under the Newborns’ and Mothers’ Health Protections Act. Model language for this disclosure is available on the DOL’s website.
Medicare Part D Notices
Group health plan sponsors must provide a notice of creditable or non-creditable prescription drug coverage to Medicare Part D eligible individuals who are covered by, or who apply for, prescription drug coverage under the health plan. This creditable coverage notice alerts the individuals as to whether or not their prescription drug coverage is at least as good as the Medicare Part D coverage. The notice generally must be provided at various times, including when an individual enrolls in the plan and each year before Oct. 15th(when the Medicare annual open enrollment period begins). Model notices are available on the Centers for Medicare and Medicaid Services’ website.
HIPAA Privacy Notice
The HIPAA Privacy Rule requires covered entities (including group health plans and issuers) to provide a Notice of Privacy Practices (or Privacy Notice) to each individual who is the subject of protected health information (PHI). Health plans are required to send the Privacy Notice at certain times, including to new enrollees at the time of enrollment. Also, at least once every three years, health plans must either redistribute the Privacy Notice or notify participants that the Privacy Notice is available and explain how to obtain a copy.
Self-insured health plans are required to maintain and provide their own Privacy Notices. Special rules, however, apply for fully insured plans. Under these rules, the health insurance issuer, and not the health plan itself, is primarily responsible for the Privacy Notice.
Plan administrators must provide an SPD to new participants within 90 days after plan coverage begins. Any changes that are made to the plan should be reflected in an updated SPD booklet or described to participants through a summary of material modifications (SMM).
Also, an updated SPD must be furnished every five years if changes are made to SPD information or the plan is amended. Otherwise, a new SPD must be provided every 10 years.
Summary Annual Report
Plan administrators that are required to file a Form 5500 (> 100 participants in plan) must provide participants with a narrative summary of the information in the Form 5500, called a summary annual report (SAR). The plan administrator generally must provide the SAR within nine months of the close of the plan year. If an extension of time to file the Form 5500 is obtained, the plan administrator must furnish the SAR within two months after the close of the extension period.
Wellness Program Notices
Group health plans that include wellness programs may be required to provide certain notices regarding the program’s design. As a general rule, these notices should be provided when the wellness program is communicated to employees and before employees provide any health-related information or undergo medical examinations.
HIPAA Wellness Program Notice—HIPAA imposes a notice requirement on health-contingent wellness programs that are offered under group health plans. Health-contingent wellness plans require individuals to satisfy standards related to health factors (for example, not smoking) in order to obtain rewards. The notice must disclose the availability of a reasonable alternative standard to qualify for the reward (and, if applicable, the possibility of waiver of the otherwise applicable standard) in all plan materials describing the terms of a health-contingent wellness program. Final regulations provide sample language that can be used to satisfy this requirement.
ADA Wellness Program Notice—Employers with 15+ employees are subject to the Americans with Disabilities Act (ADA). Wellness programs that include health-related questions or medical examinations must comply with the ADA’s requirements, including an employee notice requirement. Employers must give participating employees a notice that tells them what information will be collected as part of the wellness program, with whom it will be shared and for what purpose, the limits on disclosure and the way information will be kept confidential. The Equal Employment Opportunity Commission (EEOC) has provided a sample notice to help employers comply with this ADA requirement.
Enhance Your Employee Benefits Package. A competitive benefits package is key to keeping and attracting top talent.Assess your current benefits package and consider making necessary adjustments to include options, such as expanded mental health support, for example.
Review Employee Records. The fourth quarter is a good time to review your employee records and check record retention guidelines. Don’t forget to dispose of outdated termination and outdated job applications properly. With W2s around the corner, make sure all addresses and information are updated.
Develop and Distribute Your 2023 Calendar. Create and distribute a calendar outlining important dates, vacation time, pay dates, and company-observed holidays for 2023.
Review and Update Employee Handbook. Review your employee handbook to make sure it is up-to-date and addresses areas, such as employment law mandates, new COVID-related policies, guidelines for remote working, privacy policies, compensation and performance reviews, social media policies, attendance, and time-off, break periods, benefits, and procedures for termination, discipline, workplace safety, and emergency procedures.
PLEASE NOTE: This information is for general reference purposes only. Because laws, regulations, and filing deadlines are likely to change, please check with the appropriate organizations or government agencies for the latest information and consult your employment attorney and/or benefits advisor regarding your responsibilities. In addition, your business may be exempt from certain requirements and/or be subject to different requirements under the laws of your state. (Updated Oct. 3, 2022)
Contact us at (855) 667-4621 or email us at firstname.lastname@example.org
Winter holidays are a festive joyful time but also a time of experienced anxiety by many as well. While eliminating all seasonal stressors isn’t likely, there may be ways you can minimize and manage them. Here are three ideas to help you get through the holiday season with minimal stress:
1. Create a plan. Have you been easily overwhelmed by the extra activities and responsibilities of the holiday season in the past? This year, think about setting up a more realistic plan for yourself.
You don’t have to create the perfect holiday for others or attend every party you’re invited to. Instead, consider setting boundaries and attending only the events that mean the most to you.
2. Set up a holiday budget. Overspending is always a concern but even more so during the holidays. That’s why budgeting for gifts and holiday extras is a good idea.
It’s okay to put purchases on your credit card if you’ve saved up for them ahead of time. It can even be a great way to earn a sign-up bonus on a new card if you have very good credit. Pay your balance in full by the due date to avoid interest and fees.
Tempted to try the ubiquitous buy now, pay later loans for online purchases? Carefully review their interest rates and fees first.
3. Take time for self-care. Sticking with healthy eating and self-care habits may also help you better deal with anxiety. Get plenty of rest (including naps) and take time to decompress when you need to — it can really help.
Finally, don’t expect conflicts or old patterns to be resolved over the holidays. This can be a stressful time for families, and thus likely not the ideal time to try to work out long-standing issues. It’s not a personal failure if you can’t “fix” your family. Focus on taking care of yourself. And if you feel like you might benefit from professional help, don’t be afraid to seek it out. Many insurance plans offer mental health benefits that can make this care more affordable.
If you need help choosing a health or life insurance plan, need to make changes for the new year, or have questions about your coverage, contact us anytime.
Some organizations are facing a movement known as the “Great Return” as they reopen in-person workplaces and require employees to come into the office.
Many workers are paying more attention to their benefits and wondering how to stretch their dollars further. Employers are uniquely positioned to offer more than just a health care plan, including holistic benefits, resources and perks that today’s workers most need. This article highlights benefits that are likely to be popular in 2023.
The IRS has released the 2023 Flexible Savings Account (FSA) inflation adjustments. These changes will take place for plan years that begin on or after January 1, 2023.
For employers who currently allow the FSA maximum, unless told otherwise, OCA will automatically amend the new FSA maximum to reflect the 2023 increase. OCA will also be providing additional 2023 employee guides/marketing material in the upcoming days. *The limit also applies to limited-purpose FSAs.
Workers seek empathy and flexibility in a post-pandemic work world
Benefits, empathy, and flexibility are close behind salary in terms of what matters most to workers when evaluating employment opportunities.
The dramatic impact of the events of the past two years has altered the traditional employer-employee contract. Workers are responding positively to the gains in flexibility, investments in technology, and additional mental health resources that were added during the pandemic. It’s in employers’ interest not to abandon that more empathetic mindset, especially from a retention perspective:
1 in 5 workers quit their job in the past two years due to inflexibility.
Workers who feel their employer cares about their well-being are more likely to want to stay at their job for 10+ years (58% versus 31% of those who don’t feel their employer cares).
Download the report for more insights on what your workforce is looking for when it comes to benefits, enrollment, and corporate culture.
Schedule your Open Enrollment review and our 2023 Open Enrollment checklist contact us at email@example.com or (855)667-4621.