Arizona Healthcare Could Improve with New Legislation

David Rook

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?

Read More
Topics: Employee Benefits, Compliance, Legislation, Arizona

Related posts

6 Ways Employee Benefits Administration Automation Can Save You Time (and Money)

David Rook

Some employers choose to take on employee benefits administration with paper forms and spreadsheets, thinking they’ll save money. They see the cost of online automation, coupled with the monthly commitment — usually per employee, per month (PEPM) — and find it hard to believe the benefits of the software would be worth the investment. It’s true that employee benefits administration software is not free, but the benefits of automation far outweigh the cost.

The reality of the situation is that regulation complications, paperwork, and human error end up costing employers far more time than it's worth. And of course, that doesn’t include the fines your business could incur as a result. Here are six ways employee benefits administration automation can save you time and money.

1. Increased Efficiency for Both Employer and Employee

Automated employee benefits administration increases efficiency for both you, the administrator, and your employees who use it. Regardless of the task you are trying to complete, it will, in short order, take less time when it’s automated as opposed to old-fashioned spreadsheets, or worse, paper. 

Many companies still have employees fill out paper forms, which an HR director or assistant then has to manually enter into a payroll system, an HR system, and the health insurance system. What took two or three people to accomplish could have taken one — the employee — if an employee benefits administration platform was used. With well-organized systems, all those different parts talk to each other and disperse the information where it needs to go, which means you get to focus on real work instead of paperwork.

Read More
Topics: Compliance, Enrollment, Disruption, Technology, Automation

Related posts

Protecting Your Employee Benefits Plan Through a Dependent Eligibility Audit

David Rook

As the end of the year approaches, it a good time to talk about making a fresh start in the new year. One way to ensure your employee benefits program gets off to a good start in January is through a series of audits.

Two of the more popular benefits audits are Dependent Eligibility Audits and Claims Audits; both are typically conducted to drive longer-term health plan objectives as well as to receive immediate, short term returns or a one-time recovery of funds. 

By making use of these periodic audits, businesses can more easily control the rising costs of employee benefits, while protecting the program from purposeful fraud or accidental waste. These audits also protect your workforce from unnecessary expenses and possible denials of coverage which could prove financially disastrous.

We'll cover the "ins and outs" of claim audits in another post, but for now, here are some general guidelines to follow with Dependent Eligibility Audits.

Dependent Eligibility Audits 101

Eligibility audits identify plan participants who should be purged from the rolls because they no longer qualify for benefits. Examples include divorced spouses, adult children who age-out of eligibility, and nieces or nephews living with an employee.

According to AON, these audits typically find 5 to 7 percent of dependents do not meet eligibility criteria. Other sources peg the number at closer to 20 percent. With the average cost of covering a dependent costing an employer $3,500 a year, companies can easily lose upwards of hundreds of thousands of dollars when providing health care to ineligible dependents. Losses of this magnitude can affect a company's bottom line, and its ability to fund other important employee benefits.

Read More
Topics: Compliance, Cost Containment, Audits

Related posts

Stay Compliant: Notices to Include in Your Annual Employee Benefits Open Enrollment Materials

David Rook

Whenever an employer offers a group health plan, it's imperative to properly administer all of the health plan notices required under the DOL, PPACA, ERISA, COBRA and HIPAA. Failure to comply with these directives can lead to costly penalties.

So when it comes to your employee benefits communications this open enrollment season, how confident are you in providing your employees (and their dependents) with all of these legally-required notices in the time and manner in which the law specifies?

Savvy employers can generally minimize both the administrative burden and cost of sending these notices by simply including them with the health plan enrollment materials they distribute each year. Although yearly distribution is not required for most federally mandated health plan notices, employers should consider including some of them with enrollment materials anyway. Doing so may cure any previous failure to give the notice, and it demonstrates an employer’s good faith effort to apprise plan participants of their rights.

Here is a rundown of the notices you might wish to include in your open enrollment communication efforts. Note that these notices, in general, apply to all types of group health plans, including both fully-insured and self-funded group health insurance plans. That said, some of the requirements vary by the type of health plan offered as well as the size of your company.

Read More
Topics: Employee Benefits, Communications, Compliance

Related posts

Crossing State Lines: Multi-State Employee Benefit Challenges

David Rook


There can be no denying the fact that the landscape of employee benefits is a challenging one at best. And for multi-state workforces, employee benefits challenges multiply exponentially. HR departments around the nation struggle with the unique issues surrounding multi-state employment.

Compliance is the Sticking Point

One of the main issues complicated by multi-state work is proper risk assessment and management of compliance issues. Employers hiring multi-state employees must comply with all federal laws and state laws in all the states in which they conduct business.

This is more easily said than done. Here are just a few areas where compliance can be an issue:

Read More
Topics: Employee Benefits, Compliance

Related posts

Should Vaping be Encouraged as a Smoking Cessation Tool?

David Rook

Should Vaping be Encouraged as a Smoking Cessation Tool?

A reader of last week’s blog post on vaping asked us if employers should actively promote e-cigarettes in their wellness programs as a smoking cessation tool. This is an excellent question. It’s admittedly tough to ascertain if e-cigarettes are going to be the next major health hazard or the most effective smoking cessation technique ever created. Unfortunately, there’s not a straightforward answer to this question, but we will attempt to answer it as best we can.

What is Vaping?

For the uninitiated, vaping is the act of inhaling atomized liquid, usually nicotine dissolved in propylene glycol plus flavoring and colors. The device used for this activity is called an e-cigarette; a battery-operated device, often shaped like a cigarette, which is designed to deliver nicotine in the form of an inhalable vapor rather than tobacco smoke.

Read More
Topics: Employee Benefits, Compliance, wellness, Legislation

Related posts

E-cigarettes Remain a Dilemma for Employers

David Rook

E-cigarettes Remain a Dilemma for Employers

Electronic cigarettes, or vape pens, don’t contain tobacco and they don’t produce smoke, yet they do contain nicotine, and this has left insurers and employers in a quandary. Should “vapers”, as these people are commonly called, be categorized as smokers, and therefore be penalized with higher insurance rates?

The Categorization Quandary

Despite the growing popularity of vapers (they’ve gotten so popular that even icons like Leonardo DiCaprio are comfortable “vaping” in public), they present a somewhat troublesome gray area to insurance companies. This has left employers wondering if their employees who vape are considered smokers and if so, by whom.

Some businesses have weighed-in on the matter. According to the Wall Street Journal, Wal-Mart and UPS, for example, categorize vapers as smokers, and accordingly charge them higher insurance premiums. Cleveland Clinic, which refuses to hire smokers, similarly won't hire e-smokers, while CVS Caremark doesn't allow employees to use e-cigarettes at its corporate campuses. Starbucks bans e-cigarettes for employees and customers; and almost every state has enacted disparate legislation to regulate where e-cigarettes may and may not be used.

Read More
Topics: Employee Benefits, Compliance, wellness, Legislation

Related posts

Form 1095 FAQs - ACA Reporting & Employee Benefits Compliance

David Rook

Form 1095 FAQs - ACA Reporting & Employee Benefits Compiance

If you are struggling with ACA reporting forms 1095 and 1094, you’re not alone. Form 1095 is the first new major tax form to be introduced in the U.S. in more than 70 years, making it a significant source of concern for many employers.

Rest assured, with the new deadline of March 31st, 2016 to distribute 1095 forms to your employees, you still have time, but you do need to get moving. And since the arrival of the forms in the mail may raise questions, we recommend that you proactively reach out to your workforce to help them understand what they'll be receiving.

Read More
Topics: Employee Benefits, Compliance, Automation

Related posts

SCOTUS Gay Marriage Decision: How Will It Impact Employee Benefits?

Jeff Griffin

SCOTUS Gay Marriage Decision: How Will It Impact Employee Benefits?  

How will the recent Supreme Court ruling legalizing same-sex marriage affect employee benefits? The short answer is that it will streamline the administration of benefits packages, but may complicate things in the near term as employers adapt to the new rules.

The Supreme Court, in a 5-4 ruling, has effectively made same-sex marriage the law of the land in all 50 states. While political and legal wrangling remains where this new right may conflict with religious belief, same-sex marrige have effectively become, in the eyes of the law, the same as what may consider "traditional marriage". Marriage Equality Now the Law of the Land

The decision is the culmination of a long struggle by gays and lesbians to gain the same marriage rights that heterosexual couples already enjoy. The legal battles that have consumed the courts and the political fights that have roiled state legislatures have effectively come to an end: marriage equality is the law of the land.

Read More
Topics: Compliance, Cost Containment

Related posts

SCOTUS Decision Settles Subsidies. Now Let's Tackle Runaway Healthcare Costs

Jeff Griffin

SCOTUS Decision Settles Subsidies. Now Let's Tackle Runaway Healthcare Costs. 

Well that was a close one! If anyone missed it, the Supreme Court of the United States last Friday held in favor of the defendants and found subsidies included in the Affordable Care Act (ACA) applied to all states and not just the ones that set-up state-run Exchanges.Did anyone really expect this 30,000+/- page body of work to fall, based upon the interpretation of just a few words?

Regardless of your feelings about this latest ruling, or the law in general, most folks agree that it is time to move on. The last four years have been action packed and filled with non-stop controversy regarding this law. In the end, another four years of confusion and uncertainty won't help the citizens of this country.

While there are many aspects of the law that make absolutely no sense and are terribly problematic, there are also many aspects that are great: guaranteed issue, no medical questions for enrollees, 100% coverage for preventative services and streamlined enrollment are all good things that have come from the law. Mandates, reporting and penalties are areas that will require years for individuals and employers to fully understand and fully comply.at it is time to move on. The last four years have been action packed and filled with non-stop controversy regarding this law. In the end, another four years of confusion and uncertainty won't help the citizens of this country. 

Read More
Topics: Compliance, Cost Containment

Related posts

Subscribe for New Blog Post Notifications

Free_White_Paper_Employee_Benefits_Branding
Free_White_Paper_Private_Exchange_Employee_Benefits
Free_White_Paper_Employee_Benefits_Branding
Free_White_Paper_Employee_Benefits_Hospitality
Free_White_Paper_Improving_Employee_Benefits_Communications
Free_White_Paper_Employee_Benefits_Construction
Free_White_Paper_Employee_Benefits_Branding