Last updated on May 11th, 2022 at 10:00 pm
With the implementation of new Affordable Care Act health care regulations and procedures coming in 2015, the Independent Business Association of Wisconsin last week held an event called Healthcare 2015: Navigating the Maze.
“The new mandates kick in after Jan. 1, and this is the time companies are reviewing their plans for 2015,” said Steve Kohlmann, IBAW executive director. “Employee benefit issues can be highly complex and sifting through all that information takes time. Addressing the issue now would give employers time to get their questions answered before the first of the year.”
The presentation was made by Jim Mueller, chief executive officer of Mueller QAAS, an objective employee benefits consulting company in Waukesha. Some of the main points are as follows:
- Health insurance for employees is an employer’s second largest expense.
- The Affordable Care Act has changed the employee benefits industry by implementing more regulations, more government involvement and more expense.
- Large employers (100-plus full-time employees) will need to offer coverage to employees by Jan. 1 or face Pay or Play penalties.
- The ACA has led to increased transparency in providers and brokers, which results in better care, lower costs and more informed consumers.
- Plan transparency has also increased as Medicare Advantage plans are required to report data on five categories of quality and patient satisfaction. Businesses should use value-based insurance designs or directly incent employees to choose higher quality, lower cost providers.
- Public exchanges—government-run websites that allow individuals and small businesses to compare, choose and purchase private health care coverage—don’t deny applicants coverage. Plus, large claims are spread over a large population, and administrative costs are reduced or eliminated. The disadvantages of public exchanges are that people are resistant to change, the opportunity to apply ACA wellness incentives may be lost and some employees’ doctors may not participate in the exchange plans.
- Private exchanges—privately-run websites that allow individuals and small businesses to compare, choose and purchase private health care coverage—offer more employee choice and improved price and benefit transparency for employees. Total costs are still dependent on claims and market rates, however, and employees would need educated on the benefits and what suits their needs.
- Accountable Care Organizations—networks of physicians, hospitals and other health care providers who share responsibility for providing care to a group of patients—are advantageous for employers because they typically feature integrated delivery systems with electronic medical records. ACO-based health plans also often have significantly lower premiums.
- The ACA creates more reasons than ever to promote employee wellness. Health-contingent wellness programs allow businesses to reward or penalize participants up to 30 percent of the total cost of the premium. This results in healthier employees, fewer claims, increased productivity and reduced lost work time.
- Finally, on-site clinics at businesses increase employee productivity, provide immediate care for work-related injuries and reduce health care costs.
“One thing highlighted in the program is there are options available,” said attendee Ann Barry Hanneman, a principal at Waukesha-based Simandl Law Group S.C. “Consideration of those options is important and looking for what is most valuable to the employee group. People think their choices are quite limited, but one thing that I took away from the program was there are many components that need evaluation by business owners, particularly small business owners.”
Kohlmann advices business owners who did not attend the presentation to consult with their insurance providers and to get “brought up to speed” on the effects of the ACA on employee health benefits. If you are a business owner who has questions regarding employee health benefits and healthcare navigation, you may click here to learn more.