Employers in Arizona may think they are immune to the nationwide surge in the enactment of Paid Family Medical Leave (PFML) programs. Nevertheless, they may want to reconsider this as they review their overall benefits strategy. This is especially true because there are actions Arizona employers can take now to better adapt in the future.

From a national perspective, there are 13 states that either have or are implementing PFML programs, representing over 25% of the country where employers will need to participate in some fashion.

States with PFML, such as California, Oregon, Washington, and Colorado, all surround Arizona, and some of our neighbors, such as New Mexico, have tried to get a PFML law passed for the last few years.

With over a million ballots cast so far statewide, Arizona voters are already making their voices heard in the 2022 mid-term election. In addition to Arizona's more obvious races in the national spotlight, Arizona has a measure on the ballot that may also interest those living outside the state.
 
Known as Prop 209, this measure would reduce the maximum interest rate allowable on medical debt from 10% to 3% and expand the assets exempt from medical debt collectors.

If it passes, it may prompt other states to move in this direction, especially those more progressive states or those states with significant populations in medical debt.

All across the country, a sweeping movement to combat surprise medical bills has been slowly percolating and is now finally gaining traction on a national level.

What began as grievances filed by wronged patients has grown into government officials at both the state and federal level championing legislation against this industry practice.

A law that recently went into effect in Arizona and recent remarks from President Trump are merely the latest in an ongoing trend that has the force to reshape how patients are billed for out-of-network expenses.

Unexpected Out-of-Network Charges Result in Surprise Medical Bills

Surprise medical billing isn’t so much an intentional practice of healthcare companies, as much as it’s a byproduct of the fractured healthcare industry. Specifically, it’s a result of multiple institutions and providers treating patients simultaneously while working for different employers.

In its simplest form, a surprise medical bill is an unexpected medical bill that patients receive for out-of-network services that they thought were in-network. The bill is sent after the services are provided, leaving patients with little recourse and high fees since out-of-network charges tend to be much higher than those in-network.

An all too common scenario shows how easy this can happen to patients. A patient goes to a hospital for a covered surgical procedure. They’ve done their research and have made sure that both the hospital and the surgeon’s practice are within their insurer’s network. In completing this due diligence, they then assume that the entire procedure will be covered as an in-network expense. Seems reasonable, right?

Best-in-class employee benefits evolve with the times and our changing values. We saw marriage equality granted to all people in this country after Obergefell v. Hodges, opening employee benefits to many additional spouses and families. Now, we’re seeing more and more employers (including Fortune 100 and 500 companies) embrace transgender-inclusive health insurance plans as gender identity awareness improves. However, medical professionals have been stressing the importance of transgender health for years.

In 2008, the American Medical Association (AMA) first voiced its concerns for the discrimination of transgender individuals when it published a guidance supporting “public and private health insurance coverage for treatment of gender dysphoria as recommended by the patient's physician.” (This policy was updated in 2016).

In order to truly be an equal opportunity employer, you should have at least one transgender-inclusive health insurance plan in your employee benefits package. It’s not as complicated or expensive as it may sound. In fact, right here in our home state of Arizona, there are quite a few employers already offering such benefits.

Here are some practical issues you should consider when expanding your employee benefits to make sure they include transgender employees and how doing so could help you recruit and retain the workforce of the future — namely, millennials and generation Z, who see inclusivity as an important attribute of prospective employers.

College tuition has been steadily increasing for the past couple decades. While many colleges are trying to increase endowments and offer more scholarships for high-achieving students, other options exist for students to avoid debt. A 529 plan is one of the best tools students have to do just that.

In fact, the new tax law passed by Congress, as well as the recently introduced bi-partisan Boost Saving for College Act, both bring about a few changes to 529s worth checking out (read below). 

Just consider that in 2017, the average cost of a four-year undergraduate degree at a public college for in-state residents was nearly $57,000 for tuition, fees, and room and board — of course, that’s assuming the student graduates in four years. Many degrees are stretched to four and a half or five years if internships or cooperative education programs (co-ops) are involved.

Families who can afford it have been saving for college for a long time, and thanks to 529 plans, many are able to do so with tax advantages. Some employers have even started to offer them to employees as a way to incentivize them to plan ahead for college savings. And thankfully, some state governments (like Arizona) have begun to offer extra state tax incentives, as well.

What is a 529 Plan?

Congress developed 529 plans in 1996 as a way to “make it easier to save for college and other post-secondary training for a designated beneficiary, such as a child or grandchild.” While not-so-cleverly nicknamed after the section of the Internal Revenue code that discusses them, 529 plans are legally called “qualified tuition plans.”

Governor Ducey is working on a plan to fund Arizona’s CHIP program until Congress either passes a new budget or finds a way to pass an independent CHIP bill, which would require some legislative maneuvering with very few legislative days left in the year and a tremendous backlog of bills.

On September 30, 2017, the government’s fiscal year ended without passing a new budget, essentially cutting off all federal funding for the Children’s Health Insurance Program (CHIP) across the country. Because 9 million children in the U.S. (and their parents) depend on the insurance CHIP provides, states are trying to find extra cash to sustain the program.

Who Does CHIP Cover?

CHIP was created to fill in the gaps for families that make too much money to qualify for Medicaid, but not necessarily enough to pay for private or employer-sponsored health insurance.

Children up to age 19 are eligible for the program, but states have discretion over further eligibility standards, including those related to income. The Affordable Care Act (ACA) also expanded CHIP eligibility to children of state employees.

This June, Arizona experienced a near-historic heat wave that caused all kinds of strange things to happen, such as cacti falling over and planes being grounded. This is a safety concern for everyone, as heatstroke is a very real problem that causes death every year, especially among the infant and elderly populations. The Center for Disease Control (CDC) reported nearly 3,500 heatstroke-related deaths between 1999 and 2003.

Taking precautions at work, at home, and while on the road is extremely prudent. It can help keep your workforce safe by literally saving lives and/or helping prevent hospitalization. So as we enter August, in what is typically the hottest month of the year, consider implementing these tips in your workplace. Pass them along to your employees as well so everyone can be vigilant.

ON THE ROAD

Keep Extra Water in Vehicles

For companies with a workforce on the roads, it’s a great idea to keep extra water stocked in all work vehicles. Supplying large volume coolers will help encourage employees to stay hydrated. Even warm water stored in a truck will come in handy should an unanticipated roadside breakdown occur.  

In the November 2016 general election, Arizona voters passed Proposition 206, which instituted an incremental increase in the state’s minimum wage, as well as mandated paid sick leave for all employees — not just full-time, but part-time, temporary, and seasonal workers as well. All HR professionals and business owners should be apprised to the changes this law will bring and what it means for themselves and their employees.

To assist with complying with the new law, we're providing you with sample paid sick leave policies, not only for employers with over 15 employees, but also for employers with under 15 employees. Feel fee to use these new sample policies in posters, updated employee handbooks, and wherever else you post your HR policies. Of course as always, you should consult with your legal council and benefits advisor to ensure accuracy and applicability to your business,*

Here's a recap of the new law.

While employers across the country are battling the rising cost of health care, Arizona employers are facing unique challenges of their own. Arizona’s border with Mexico presents unique circumstances many states don’t encounter, and certain state laws have created a challenging environment for employers to cultivate meaningful employee benefits packages. Here are four issues Arizona employers are facing in 2017 when it comes to employee benefits:

Arizona Employee Benefits Issue #1: Lack of Exchange Options

For small businesses with fewer than 50 full-time equivalents (FTEs), offering a SBHRA (Small Business Healthcare Reimbursement Arrangement) can be a challenge. Taking advantage of newly passed legislation regarding SBHRAs should generally help small businesses with recruitment and retention — however, the lack of Exchange options in Arizona is likely to frustrate employees, rather than appeal to them.  

This lack of Exchange options means competition is virtually non-existent, which generally leads to higher healthcare prices. Of course, this means employees are having difficulty finding affordable healthcare that fits within their budget, leading some employers to feel obligated to increase the amount they offer via SBHRAs.

State lawmakers are currently reviewing a piece of legislation that could improve Arizona healthcare for a number of residents. Senate Bill 1441 seeks to solve a common Arizona healthcare problem: surprise medical bills from out-of-network physicians after receiving treatment or having surgery through in-network providers. It’s a frustrating (and confusing) situation, especially for those who have done their research beforehand to make sure all providers were covered by their insurance policy. How are people getting unexpected bills? And what will this legislation do about it?

The Arizona Healthcare Problem: Surprise Bills

In the state of Arizona, people seeing in-network doctors and utilizing in-network hospitals systems frequently receive surprise bills from out-of-network providers. It’s become a common Arizona healthcare narrative these days. If it hasn’t happened to you, you probably know someone who has encountered this issue in the past.

How does this happen? Well, it’s actually pretty complicated.

Let’s say you need surgery. You do your necessary diligence by researching the hospital, the surgeon, and the other doctors you know you’ll be in contact with. You make sure they’re all in-network so you’re minimizing the bills you receive after the fact. Everyone (including the hospital network) is covered. You should be all set, right?