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What Employers Need to Know about Healthcare and Privacy

As an employer, you are entrusted with a lot of personal information about your employees. This is especially true when it comes to their healthcare. You provide their health insurance plan, and you are the one who will need to obtain health information in case of a work-related injury, or if your employee requests medical leave or accommodation for a disability. All of this information is confidential, but many employers are unsure what their obligations are when it comes to protecting their employees’ privacy. The Health Insurance Portability and Accountability Act (HIPAA) is what regulates how private health information is treated, but you may be surprised to know that HIPAA doesn’t always apply to employee health information that is maintained by an employer.

What Is HIPAA?

The Health Insurance Portability and Accountability Act, or HIPAA, was established in 1996 as technology was advancing and medical records were beginning to be kept, accessed, and transferred digitally. HIPAA provides federal protection for personal health information, including medical records, conversations regarding medical treatment, and billing information related to a patient’s healthcare.

In the workplace, the main way that HIPAA is applied pertains to your employees’ right to privacy. The HIPAA right to privacy rule gives employees:

The right to authorize disclosure of their health records
The right to request or inspect a copy of their health records
The right to have mistakes corrected at any time

HIPAA rules surrounding employee health information are balanced, and they do not mean that you can never ask for or obtain any medical information about your employees – you just need to get it in the right way, and protect it once you have it.

HIPAA specifically says that its rules apply to what are known as “covered entities,” which are insurance companies and healthcare providers, or any other organization that transmits medical records electronically. These “covered entities” need to be HIPAA compliant. For you, as an employer, HIPAA applies to your request for information from those covered entities. What this simply means is that an insurance company or healthcare provider cannot give you any health-related information about your employee without your employee’s express authorization.

illustration of a hand writing on a piece of paper with a red cross in the corner. — *HIPAA does not stop you from asking an employee for a doctor’s note.*

Common HIPAA Misconceptions

HIPAA can seem complicated. You have obligations when it comes to protecting your employees’ healthcare information, but, unless you are a healthcare company or a healthcare provider, you aren’t technically subject to HIPAA. The law really just regulates how employees’ protected healthcare information maintained by a healthcare plan can be shared with employers.

There are some myths surrounding how HIPAA affects you as an employer that we can debunk for you right now. HIPAA does NOT:

Stop you from asking for a doctor’s note for an absence
Affect your ability to ask for information related to workers compensation claims, wellness programs, or administering your healthcare plan
Apply to employment records – but if health information is contained in them, you’ll have to get authorization from your employee’s physician and state that you will only use the records for the intended purposes.
Cover all employee benefit information. For example, employee life insurance, disability and workers’ compensation, and wellness programs are generally not covered under HIPAA.

HIPAA Rules

While there are many ways that employers are not subject to HIPAA, there are still certain HIPAA rules that employers need to pay special attention to in order to remain in compliance with the law. Examples of these include:

Electronic security rule – This rule requires that you take all reasonable measures to physically, technically, and administratively safeguard your employees’ personal information. Businesses are expected to take steps to ensure privacy, protect against threats, make sure employees are in compliance, and protect against unauthorized uses or disclosures of information.
Breach notification rule – If your insurance company or a healthcare provider experiences a data breach, everyone affected needs to be notified. The same goes if it happens to your business.
Privacy and personal health information rule (PHI) – According to the Department of Health and Human Services, “The HIPAA Privacy Rule protects most ‘individually identifiable health information’ held or transmitted by a covered entity or its business associate, in any form or medium, whether electronic, on paper, or oral.” Again, this really only applies to “covered entities” – or insurance companies and providers. But these covered entities need to make clear to you how PHI may be used or shared, and you need to remain in compliance with those privacy policies.

Common Violations of HIPAA

illustration of people with the heads as tv screens, one with an eye, one with an ear and one with a mouth — *Unauthorized access or disclosure of an employee’s health information is a direct violation of HIPAA.*

Despite some of the technicalities of what HIPAA covers, if you’re in possession of health information about your employees, it’s a good idea to stay on the safe side and use best practice to remain compliant with the law. This mainly means keeping your employees’ data safe and secure, and always going through the proper channels to obtain medical information. To give you some idea of what you should be looking out for, the most common HIPAA violations for employers are as follows:

Hacking/data breaches – If you don’t have the proper security measures in place, your employees’ information, including their health information, could be at risk of being hacked.

Theft/loss – Similarly, devices storing sensitive information could also be stolen.

Unauthorized access/disclosure – Even if you obtain an employee’s information in the correct way, you still have to make sure that it is kept safe and not disclosed to anyone other than you or other authorized parties.
Improper disposal – Protected information needs to be disposed of properly – information could be illegally obtained if you don’t take reasonable measures such as shredding documents.

Being an employer means taking care of your employees in lots of different ways. If you offer them healthcare as one way of taking care of them, that’s great – but protecting their personal and private information needs to be another way that you look after them. The rules surrounding HIPAA may seem complicated on first look, but the most important thing to remember is that you need to safeguard any sensitive information entrusted to you. If you have any questions about how HIPAA affects your healthcare plan – or if you have any other questions about offering healthcare to your employees – EZ is here to help. Our knowledgeable agents can do everything from answer questions to provide fast, accurate quotes to sign you up for a great plan – and we’ll do it all for free. To get started with us, enter your zip code in the bar above. Or to speak with an agent directly, call 888-350-1890.

Small Business Group Health Insurance FAQ

Starting a small business is a great accomplishment! It takes a lot of hard work, and you probably have a to-do list a mile long. One very important thing on your list should be finding a great group health insurance plan. Offering health insurance to your employees leads to so many advantages for your business, like healthier, happier employees who are more likely to stay in their jobs, and tax breaks for you. There are many high-quality affordable plans to choose from, but you might be wondering where to begin, and you’ll probably have a lot of questions as you search for the right one for your business and your employees. That’s where EZ comes in: we’ve also got the answers to your most frequently asked questions and can give you a free quote to help you compare local group health insurance plans from all of the top carriers.

illustration of a woman with a headset on with her hand out and money floating over it — *An agent will be able to offer you exclusive deals and promotions from insurance companies.*

Should I use an agent or broker?

Both insurance brokers and insurance agents act as the middlemen between insurance buyers like you, and insurance companies. Using an insurance agent, like one of EZ’s, is the best option for small business owners looking to purchase a healthcare plan. Agents can expedite the buying process, they have specialized knowledge about the policies they sell, and they can keep you up-to-date on any changes to your plan. Our agents also have access to exclusive products from the top-rated insurance companies, which can save you more money than if you go it alone.

What is the minimum number of employees to get a group plan?

If you have 50 or more full-time employees, you are required to provide health insurance or you will be penalized under the employer mandate of the Affordable Care Act. You are eligible for a group plan as long as you have 2 full-time (or full-time equivalent) employees, including yourself. Full-time employees are considered those who work 30 hours or more a week.

The 2-employee rule is always true for tax-advantaged small business health insurance options program (SHOP) plans (although you will need 70% participation in your plan). If you’re looking into other group plans, some insurance companies may have different requirements. Ask one of EZ’s agents to check for you.

What is the average cost for a group health insurance plan?

Small business health insurance costs are determined by your location, number of employees, and how much you would like to contribute to your employees’ coverage. The average cost of annual premiums for employer-sponsored health insurance was $7,188 for individual coverage and $20,576 for family coverage in 2019. The average annual deductible amount for individual coverage was $1,655 for covered workers.

SHOP plans, as mentioned above, can offer some savings through the small business health insurance tax credit, if you have fewer than 25 full-time employees and meet certain requirements. Speak with an EZ agent about this possibility, or use our online tool to check fast, no-cost quotes for all available plans. We can help cut costs – but not benefits – by comparing multiple plan options.

How do I communicate the new benefits to my employees?

Simple, just ask your EZ agent! EZ’s agents are experienced in helping you communicate new benefits to your employees. Our agents will provide a Summary of Benefits Coverage (SBC) to participants and their beneficiaries before enrollment in the plan, at renewal of the plan, within 90 days of a Special Enrollment, and within 7 business days of a written request. They will also help you provide each employee covered under the plan a Summary of Material Modification (SMM) when there are changes made to their health benefits.

How much do I charge employees to be on the plan?

red "50%" sign — *Employers are required to contribute at least 50% of their employee’s health insurance premiums, but you can contribute more.*

Employers are required to contribute at least 50% of each employee’s health insurance premiums. On average, employers contribute approximately 82% of individual insurance premiums, and around 71% of family plan premiums. The more that you contribute to your employees’ premiums, the more likely employees are to enroll, and the more you will save – and don’t forget all of these contributions are tax-deductible!

You have options when it comes to plans and premium prices, so talk to an EZ agent about what’s best for you and your employees. For example, if you choose a plan with a low deductible, but higher premium, you may not be able to contribute more than 50%, and your employees might find it too expensive to enroll in your plan. In this case, you might want to look into a high deductible health plan, which would allow your employees to contribute to a health savings account (HSA). An EZ agent can help you determine how much you can afford to contribute, and other ways you can save!

Will offering health insurance help me attract better employees?

Businesses that offer health insurance tend to attract and recruit the best candidates. Most job seekers won’t even look twice at a posting if an employer does not offer health insurance – job seekers want to know that a prospective employer is willing to invest in them. Surveys show that 46% of job seekers said that healthcare was a deciding factor in taking a job, and that 60% of employees would take a job with lower pay but better benefits.

Will my employees be happier if they have health insurance?

Offering health insurance can mean having more loyal employees and a lower turnover rate. 83% of employees say health insurance is extremely important when deciding whether or not they should change jobs. Employees with health insurance are happier, less likely to leave their jobs, and healthier.

One survey found that 72% of employees said having more work benefits would increase job satisfaction. Knowing that they will be protected in case of an emergency, that their chronic conditions will be covered, and that they will not have to worry about large medical bills, means less stress for them and more productivity for you.

Will productivity go up if we offer health insurance?

Absolutely! In one recent study, 60% of employers said that offering health insurance led to higher productivity levels at their businesses. Not only will offering health insurance to employees lower their stress levels, but it will also keep them healthy – and healthier employees are less likely to take time off for being sick. When you invest in your employees, you’re boosting your bottom line.

What other benefits should I consider offering?

caucasian man laying in bed with the laptop on his lap with a doctor on the screen. — *Offering telemedicine to your employees is a great benefit that can help you save money.*

When choosing a plan, look at what “extra” benefits it offers – for example, telemedicine. This convenient option can actually save you thousands due to the reduced cost of healthcare claims from unnecessary visits to the doctor and reduced visits to the emergency room. It is more convenient (and less expensive) for employees to call and speak with a doctor to receive care.

You can also consider offering a workplace wellness program. These programs help keep healthcare costs down by giving incentives to employees to live healthier lives. These programs can include things like health screenings, programs to quit smoking, gym membership stipends, diet and weight loss programs, or diabetes management programs. To find out what extra benefits you can offer, talk to an EZ agent.

How will I know if my doctor and my employees’ doctors are in-network?

If you are looking for a plan that includes specific doctors, speak to an EZ agent to find a plan that includes the best network for you and your employees. Our agents can easily access any insurance company’s networks and included providers in minutes.

If you already have a plan, check your plan info to see if there’s a list of covered doctors. You can also call your doctor’s office, ask for their tax ID number, and then call your insurance carrier to find out if they are covered. Or you can avoid this long and annoying process by simply asking one of EZ’s agents to check for you!

EZ.Insure understands how time consuming and overwhelming finding a group health insurance plan for your small business can be. To make the process easier, we provide you with a personal agent who will answer all of your questions, compare plans, and provide you with free, instant, and accurate quotes. We do all the heavy lifting for you so that you can provide the best insurance for your employees, without breaking the bank. Let us help you save time and money. To get started, enter your zip code in the bar above, or to speak to a specialized agent within your area, call 888-998-2027.

Do You Have to Offer Insurance to Part-Time Employees?

If you’re running a small business, there’s a good chance you have more than one type of employee. You might have a few full-time workers, a few independent contractors, and some part-time employees. There are definitely advantages to hiring part-time workers: for example, flexible scheduling, having a few people on staff who are each specialized in different areas, and taking some of the stress off of full-time employees if their workload suddenly increases. Would you add “saving money on benefits” to that list? If you’re a small employer who chooses to offer healthcare to your full-time employees, you might wonder whether you also have to offer it to part-time employees, and if you don’t have to, whether you can – and should – offer it.

Part-Time Employees

clock drawn in chalk on a blackboard — *Under the rules set out by the Affordable Care Act (ACA), part-time employees are those who work less than 30 hours per week.*

First things first: what does being “part-time” actually mean? You might have your own definition for the purposes of your business, like someone who works fewer than 35 hours per week, but when it comes to healthcare, there is actually a legal definition of part-time. Under the rules set out by the Affordable Care Act (ACA), part-time employees are those who work less than 30 hours per week.

And now the answer to those basic questions above. First: do you have to offer healthcare to your part-time employees? No, you do not have to – even if you offer it to your full-time employees. The ACA only requires that employers with 50 or more full-time – or full-time equivalent – employees offer healthcare to those employees. Remember, your part-time employees count towards your number of full-time equivalent (FTE) employees, so be sure to do the following calculation:

Add up all the hours that your part-time (less than 30 hours per week) employees work on average each week
Divide the result by 30
Round down to the nearest number
Add that number to the number of full-time employees you have and that’s your FTE number

If that number is fewer than 50, then you are not required to offer healthcare to any of your employees.

Second: can you offer healthcare to part-time employees? Yes, you can, but there may be some barriers to offering it to part-time employees, and you must follow certain rules set out by the ACA.

The Rules

red prohibit sign — *Some insurance companies actually prohibit you from offering your insurance policy to part-time employees.*

If you do decide you want to offer healthcare to your part-time employees, there are some things you need to be aware of. First, check with your insurance carrier because:

Some insurance companies actually prohibit you from offering your insurance policy to part-time employees. Insurance companies make their own rules, and they may also vary on a state-by-state basis.
Most health insurance companies have a minimum participation rate for plans (this may vary by state, as well). Adding your part-time employees into the mix could mean changing your minimum participation rate percentage, so make sure that your part-time employees actually want to enroll in your plan before you offer it to them!

Next, if your insurance company gives you the go-ahead, then you need to make sure that you are complying with the ACA’s rules surrounding offering healthcare to part-time employees. You have to:

Be consistent. Just as the ACA requires that you offer the same benefits to all similarly situated full-time employees, the same applies to part-time employees. In other words, you can’t offer healthcare to one part-time employee, but not to another who works the same number of hours and does a similar job.
Clearly define your policy. If you are going to offer healthcare to part-time employees, you need to have a written policy that clearly states eligibility requirements. This is completely up to you, it just needs to be implemented consistently. For example, you could set a policy that allows employees to participate in your healthcare plan if they work a minimum of 20 hours per week – all employees who meet this minimum threshold would then be eligible for your plan.

The Pros and Cons

This brings us, finally, to whether you should offer part-time employees healthcare. Well, there are a few pros and one big con: the cost. Adding employees onto your healthcare plan will mean extra money out of your pocket, since you’ll be contributing to their premiums just as you would for full-time employees. But there are also advantages to offering healthcare to all of your employees, as well as ways to help offset the costs.

group of employees talking at a table. — *Advantages to offering healthcare is you will end up with happier, healthier, more productive employees*

The obvious advantages to offering healthcare are the personal reasons. You’ll end up with happier, healthier, more productive employees who are not worried about the possibility of being hit with a giant medical bill. In terms of your business, you’ll be able to attract high-quality staff if you offer this coveted benefit, and you’ll be more likely to retain them, which will save you on future recruitment.

Offering healthcare to your employees also comes with certain tax benefits. All of your healthcare-related expenses are tax deductible, so you can deduct every cent you spend on your employees’ premiums from your state and federal taxes. If you have fewer than 25 employees (making under a certain amount of money), you can also look into an ACA Small Business Health Options Program (SHOP) plan, which could qualify you for the small business healthcare tax credit. This provision of the ACA could save you up to 50% of your premium expenses.

In the end, it all comes down to what is right for you and your employees. You don’t need to offer part-time employees healthcare, but consider the benefits for your employees – and your business – of doing so, and calculate how much you’ll spend versus how much you’ll save on taxes and fewer sick days. If you’ve made up your mind to look for a plan – or if you need help deciding! – come to EZ. We’ll set you up with your very own agent who will go over all of your options, break everything down for you, and get you fast, accurate quotes – for free! Get started with us today by simply entering your zip code in the bar above, or you can speak to an agent by calling 888-998-2027.

What Happens to That “Use It or Lose It” FSA Money?

Offering any type of healthcare plan to your employees is beneficial to both of you, and not just because they help keep your employees healthy and productive. There are a lot of tax benefits to offering healthcare, especially if you include savings accounts like flexible spending accounts (FSAs).

FSAs, which you can offer alongside any type of healthcare plan (employees don’t even need to participate in the plan to opt into the FSA), allow employees to put money aside on a pre-tax basis and then use it for qualified medical expenses. This reduces your employees’ taxable incomes, as well as your payroll taxes. The downside for employees? The money in these accounts doesn’t roll over each year, so if they don’t use (most of) it, they lose it. The good news? That money reverts back to you, and you have a few options of what to do with it.

dollar bills in the ground growing — *Employees can then use the pre-tax money throughout the year on a wide variety of expenses,*

How FSAs Work

If employees choose to opt into your offered FSA, then they will contribute a certain amount of their paycheck to the account. They can then use that pre-tax money throughout the year on a wide variety of expenses, such as deductibles, copays, coinsurance, glasses, dental care, prescription and OTC medications, and even many common drugstore items. Employees’ annual contributions are taken out of their paychecks in installments, and they are treated as salary reductions for tax purposes (hence the tax benefits!). The reimbursements for the qualified expenses are also tax-free.

Both you and your employee can contribute to their FSA, but your employee’s contribution cannot exceed a certain amount. For 2020, that amount is $2,750. Whatever you choose to contribute is in addition to that amount and does not count towards their limit.

The “Use It or Lose it Rule”

FSAs take a bit of planning on an employee’s part. They need to choose their contribution amount during an annual enrollment period, and that amount cannot be changed during the year unless certain qualifying “change of status” events occur, such as change in marital status. 2020, however, has been a bit different: the IRS announced in May of this year that they will allow mid-year changes to FSA contributions, but this is most likely a temporary measure.

money rolled up in a rubber band on a white table. — *With an FSA money not used by employees doesn’t go to waste! A portion can roll over!*

If employees don’t end up using all of the money in their FSA accounts by the end of the year, then the balance generally reverts back to you, the employer. There are two exceptions to this “use it or lose it” rule:

Your FSA can allow a 2 ½ month grace period, meaning that (if your FSA operates on a calendar year basis, which most do) your employees will have until March 15th to use the funds
Your FSA can allow employees to roll over $500 of their unused balance into the next year

You can only offer one of these options to employees, and you are not actually required to offer either of them, but it is common practice to do so. If you do offer one of these options to your employees, and they still have more than $500 left in their account at the end of their year, or if they haven’t used up all of the money by March 15th, then that money reverts back to you. So what do you do with it?

What You Can Do with Forfeited Money

The IRS gives you a few options of what to with any unused FSA dollars. You can use it to:

Help with plan administration costs. You can choose to outsource the administration of your FSA for a cost of around $5/month/employee, and you can use the leftover funds to pay for it.
Reduce employee FSA salary reductions for the next year. For example, if an employee wants to contribute $500 to their next year’s FSA, you could allow them to contribute only $480 and use leftover funds to make up the other $20.

Add money to employees’ accounts. You can choose to use the money to offset any extra expenses incurred by employees in the next year. For example, if an employee contributes $1,000 to their next year’s FSA, but submits claims for $1,200, you can use leftover FSA money to cover that extra $200. This is generally not the most popular option, because it is only useful to employees if they spend more than they’ve put aside. They might also begin to expect this extra coverage every year.
Pay your employees in cash. If you choose to do this, you need to make sure that you are distributing the money in a “uniform” fashion, meaning you can’t just give the money back to the one or two employees who didn’t use their FSA money. You would also need to track down any former employees from that year and pay them their share. Remember, too, that the money you give them will be considered income, so it must be reported and will have taxes deducted from it.

Tax-advantaged healthcare benefits are basically a win for everyone involved, even with the small caveat of the FSA “use it or lose it” rule. You and your employees save on taxes, and any balance remaining in their account is never truly “lost” – you can take it and use it to continue helping them (or your business) with healthcare costs. We get it, this is all complicated stuff, so if you have questions about offering FSAs or any other type of group health benefit, we can help. Drop us a line and we’ll set you up with one (and only one) knowledgeable agent who will answer all of your questions, go over all of your options with you, and give you fast, accurate quotes when you’re ready for them. Ready to get started? Simply enter your zip code in the bar above, or to speak to an agent, call 888-998-2027.

The Opioid Epidemic: How Employers Can Be Part of the Solution

With the coronavirus pandemic dominating the news cycle, some of the focus has been taken off one of our country’s other major health crises: the epidemic of opioid addiction. This epidemic has claimed almost 600,000 lives over the past two decades, and it shows no signs of slowing down. In fact, the American Medical Association has recently said that it is “greatly concerned” that opioid overdoses seem to be rising in at least 30 states. It makes sense: stress levels have been high and many people have been feeling disconnected. Some people might also feel disconnected from their healthcare providers, and might be choosing the easiest option for dealing with chronic pain. Dr Mike Brumage, former director of the West Virginia office of drug control policy, puts it this way: “the opposite of addiction is not sobriety, the opposite of addiction is connection. Clearly, what we have lost with the pandemic is a loss of connection.”

Whatever the cause, opioid misuse is not something employers should ignore, whether or not they think it’s a problem in their workplace. You can make yourself a point of connection for an employee who might be struggling with addiction or who is dealing with chronic pain, and you can make your healthcare plan a part of the solution.

Treating Addiction

Opioid addiction is not someone else’s problem. It spans all socio-economic classes, genders, and cultures. It could very well reach into your workplace, if it hasn’t already. You would obviously want to help an employee who is struggling with addiction, not only for the sake of them and their family, but also for the sake of your business.

Whatever their job is, one employee who is abusing prescription painkillers can pose a physical risk to other employees, or a financial risk to your business if they make a mistake or are interacting with clients while under the influence. In fact, missed work days and lost productivity due to the abuse of prescription painkillers cost employers an estimated $25.6 billion a year. So it is in everyone’s best interest to provide care (or to prevent misuse, if possible, which we will discuss below) – and you can do this by simply offering an ACA-approved healthcare plan to your employees.

caucasian hands on a notebook while holding a pen — *All plans must cover behavioral health treatment, such as psychotherapy and counseling.*

Thanks to the Affordable Care Act (ACA), all healthcare plans have to cover 10 essential health benefits, and “mental and behavioral health services” is considered one of these essential benefits. Here’s what this means for your plan, and how it relates to substance abuse:

All plans must cover: behavioral health treatment, such as psychotherapy and counseling; mental and behavioral health inpatient services; and substance use disorder (commonly known as substance abuse) treatment.
Pre-existing mental and behavioral health conditions are covered, and spending limits aren’t allowed. This means that even if an employee was struggling with addiction before signing up for your plan, they will still be covered for it after signing up.
All plans have to provide “parity” of coverage, meaning that limits applied to mental health and substance abuse services can’t be more restrictive than limits applied to medical and surgical services. The rules have to be the same financially (for example, there can’t be a higher copay or deductible for mental health services), in terms of treatment (for example, there can’t be a limit on a number of mental health-related visits covered if there isn’t one for medical visits), and for how care is managed (for example, there can’t be a requirement to get authorization for treatment for one type of care and not the other).

Be very clear with your employees about what their options are when it comes to mental health services, and remember to make it clear that your workplace is a safe space and that employees should always take advantage of these services if they are needed.

Obstacles to Seeking Care

As long as you are offering your employees a quality healthcare plan (which you should be doing in any case!), then they are at least assured of basic care if they’re facing substance abuse issues. But the question is, are they accessing it? If not, why not?

Privacy concerns: Some employees may be reluctant to seek care because they’re not sure if their situation will be kept confidential. It should be made clear to employees that the Health Insurance Portability and Accountability Act of 1996 (HIPAA) means that there are very strict rules surrounding who can see an employee’s claims and how they can use that information. They may need to be reminded that any claims that they make will be kept secure, and any communication they have with an Employee Assistance Program, for example, is strictly confidential.
Find a plan where employees have access to a doctor including telehealth services.

Authorization requirements: Some employees may benefit from going to an inpatient treatment facility, but many plans require that they first seek treatment at an outpatient facility, which may be difficult for some people. Take a closer look at your plan: it might allow authorization by phone for a medical or surgical inpatient stay. If it does, then it must do so for a mental health or substance abuse inpatient admission, as well.
Access to a provider: As with seeking authorization, sometimes barriers to care are simply that it’s too difficult, inconvenient, or even costly to seek help. Again, look at your plan: does your network include options? Will employees have to go out-of-network, and will it cost them a lot to do so? Are there treatment facilities or clinics available in your area, and would an employee feel comfortable going to one (say, for example, that you are in a small town or rural area, and an employee might feel that everyone will know their business)? If this is an issue, look into a plan that includes expanded access to telemedicine as a way to encourage employees to seek help.

How You (and Your Healthcare Plan) Can Help Prevent Addiction

The old saying goes: “an ounce of prevention is worth a pound of cure.” Yes, all ACA-approved healthcare plans need to cover mental health and substance abuse treatment, but most people would agree that preventing addiction in the first place would be ideal. Consider this: Roughly 21-29%of patients prescribed opioids for chronic pain misuse them, and between 8-12%develop an opioid use disorder. What can employers do to stop their employees from becoming one of these statistics?

Education: You can educate your workforce on a variety of topics, such as: description of opioids and common brand and generic names, common risk factors for opioid misuse, reasons for opioid prescriptions (acute pain versus chronic pain), pain relief alternatives, and what to ask prescribers before filling an opioid prescription.

Policies: Have a clear, compassionate drug-free workplace policy, but also have a flexible medical leave policy, so employees don’t feel like they have to rush to come back to work after an injury or procedure. They might turn to stronger painkillers if they feel pressured to return to work, or they may end up taking these drugs more often or longer than they need to, which can lead to addiction.

Culture: Try to create a positive, low-stress work environment for your employees. Make sure to support your employees, encourage self-care, and show ways that they can prevent common or repetitive strain injuries. Consider adding a workplace wellness program in order to promote a culture of health and wellness.
Benefits: Covering essential mental health care is a great start in terms of preventing the psychological reasons for addiction, and in terms of treating addiction. But what about treating physical pain without using opioids? Unfortunately, some insurance companies have been slow to include alternative treatments in their health insurance policies, so it is up to you to look for a plan that allows employees to seek these types of therapies (think: acupuncture, chiropractors, and physical therapy) without having to rack up huge medical bills. To stop opioid use before it starts, you can also consider adding an Employee Assistance Program (EAP), which will include mental health-specific extras like counselling, or a pharmacy benefit management program, which can step in before an employee fills their first opioid prescription and offer advice and alternatives.

There’s a lot to consider when choosing a healthcare plan for your employees, especially if you’re looking to have the safest, most compassionate workplace that you can. It’s important to foster a positive work environment, but it is also important to find an insurance company that is willing to help keep employees from falling into addiction. EZ can help you in your search – we will sort through all the plans available to you, and find you one that will help you and your employees rest easy. Get started with us today for fast, accurate quotes: simply enter your zip code in the bar above, or you can call 888-998-2027.

High Deductible Health Plan? Make Sure Your Employees’ Is HSA-Qualified!

An increasing number of employers are jumping on the high deductible health plan bandwagon. In 2006, only around 6% of companies that offered healthcare plans offered High Deductible Health Plans, but in 2019 that number soared to 26%. There are definitely good reasons to consider offering one of these plans to your employees, but you do need to know that not all high deductible plans are the same. With some high deductible plans, you can offer your employees a Health Savings Account (HSA), which has tax advantages for them and for you. But first you need to make sure you’re choosing the right plan.

What Makes an HDHP HSA-Eligible?

person's hand holding a pen while checking off a checklist — *In order to offer an HSA, your high deductible health plan must meet certain criteria.*

It might seem like a small distinction, but not every high deductible plan is a High Deductible Health Plan (HDHP) with a capital “H.” The difference is that an HDHP not only has a high deductible, but it also meets certain criteria. If your plan meets this criteria then – and only then – can you offer an HSA alongside it. To be an HDHP, the plan must have:

A deductible that meets minimum requirements. A “high deductible” isn’t just a matter of opinion; each year, the IRS sets the minimum deductible amount for a plan to be considered HSA-eligible. For 2020, the deductible for an individual must be at least $1400, and for families, it must be at least $2800 for the plan to be an HSA-eligible HDHP.

A maximum out-of-pocket amount. Having a high deductible plan means having higher out-of-pocket expenses, but the good thing is that there is usually a limit to how much you have to fork out each year in deductibles and copays. To be an HSA-eligible HDHP, this out-of-pocket maximum must be below a certain amount. For 2020, that number is $6,900 for an individual and $13,800 for family.
No insurance coverage until the deductible is met. In order to take part in all of the advantages an HSA has to offer, you do have to give up some coverage. But don’t worry, there are some exclusions. Wellness and preventative care, which even includes things like help with weight loss and quitting smoking, as well as regular checkups and care resulting from accidents, can all be covered before the deductible is met in an HDHP with HSA.

These are the rules for offering an HSA alongside a high deductible plan, and there are also a few other rules surrounding contributing to an HSA to be aware of. In addition to being covered by an HDHP, you also cannot:

Have any other health coverage

Be enrolled in Medicare

Be claimed as a dependent on someone else’s tax return

Why Offer an HDHP with HSA?

Now that you know what makes a high deductible plan HSA-eligible, the next question is: why offer this type of plan to your employees? It all comes down to savings. Offering a healthcare plan to your employees is the right thing to do, and studies have shown that employees with healthcare are happier and more productive. But there’s no doubt that it’s expensive. Choosing a plan with a high deductible is one way to keep your costs down, because premiums on these plans are usually much lower.

Just look at this comparison: in 2019, the average employee contribution to a healthcare plan without a high deductible was around $6,200 for an individual and $14,700 for a family. For HSA-eligible HDHPs that number was around $5,200 and $14,000 respectively – a savings of $700 – $1,000.

Of course, HDHPs are not perfect. To some employees, especially lower income ones, the out-of-pocket expenses can feel like a burden. This is why it’s important to make sure the plan you choose is HSA-eligible. Having the HSA allows them to set aside money pre-tax to help pay for medical expenses that come up throughout the year; you can also help them out by contributing to their HSA (the maximum contribution allowed by both you and your employee combined is $3,550 for an individual and $7,100 for a family).

Offering an HSA alongside a HDHP (and contributing to it!) means that your employees will be more likely to enroll in your plan. It may also be the difference between them skipping out on preventative care or necessary treatments – possibly leading to poor health and more sick days in the future – and using their plan when they need it.

There’s a lot you need to know when you’re the boss. You’ve got to know your business, and also know what’s best for your employees – and sometimes that means reading up on things that aren’t your business – like health insurance. But don’t worry, you don’t have to go it alone! EZ can answer any questions you have, and can help you find the plan that works best for your employees and your business. There’s nothing we can’t answer, and we’ll never hassle you or charge you for our services. If it’s just quotes you’re after, stop by, give us a few seconds of your time, and be on your way. You’ve got enough to do! To get started with us, enter your zip code in the bar above. Or to speak with an agent directly, call 888-350-1890

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