Your member number/ID numbers identifies you, the insured.

Your group number identifies your employer (assuming your coverage comes through your job).

Plan number tells the provider (doctor, hospital) which plan you have through your carrier.

PCP (Primary Care Physician).  The amount next to this indicates the copay fee per visit.  You may see a different copay amount on your card if you see a specialist.

Payer ID tells your doctor’s billing department which insurance company to route your claims to.

Did you know:

22% of employees are expected to respond to work email when they are not at work.

50% of employees check work email on the weekends.

46% check work email on sick days.

34% check work email while on vacation.

In recent cases, non-exempt employees have sued their employers for unpaid overtime compensation because the employer required them to check communication on their smart phone when not on duty.  The cases revolved around the question of whether the act of checking communications constitutes compensable work.

The Fair Labor Standards Act (FLSA) governs minimum wage and overtime.  It entitles employees to whom the law applies to receive overtime compensation for “time spent working” beyond the 40-hour workweek.  Both the minimum wage and overtime provisions of FLSA generally do not apply to workers in executive, administrative, professional and outside sales employees who are paid on a salary basis.  Requiring these “exempt” employees to check their smart phone would not subject employers to overtime claims.

As phone records are easily accessible, employees who use them off hours can provide solid evidence for their overtime claims.  To avoid claims for unpaid overtime, employers can limit use of company cell phones to exempt employees only, or limit their use by non-exempt employees to work hours only.

Lawmakers are once again pushing legislation in Congress that would require employers with 15 or more employees to provide workers with at least seven days of paid sick leave each calendar.  With Republicans now controlling the House, odds are strongly against passage of the “Healthy Families Act”.

The Denver Post reports “GettingUsCovered” is signing up a lower-than anticipated number of patients, but is spending a larger-than anticipated amount of money.   $90 million was given by the federal government to run the high-risk pool, expecting at least 4,000 patients to join.  Instead, just over 800 patients have taken the insurance since the program began a year ago.

Even though we have had an interim insurance commissioner, John Postolowski, Governor Hickenlooper just announced today that Rep. Jim Riesberg will be Colorado’s new Commissioner of Insurance beginning July 1.  John Postolowski took over the post December 1 when Marcy Morrison left the office. 

“Jim Riesberg has a distingished career in the insurance, human resources, and private sectors” says Hickenlooper.

Welcome aboard, Jim.

(MyHealthGuide Source: Milliman, Inc., 5/11/2011, www.milliman.com Seattle)

 Milliman, Inc., a premier global consulting and actuarial firm, released the results of the 2011 Milliman Medical Index, which measures the total cost of healthcare for a typical family of four covered by a preferred provider organization (PPO). The 2011 MMI cost is $19,393, an increase of 7.3% over 2010, which is the lowest annual rate of increase in more than a decade. Yet even though the rate of increase is the lowest in recent memory, the increase in total dollars–$1,319 in 2011–is the highest in the history of this study. “In 2002, American families had healthcare costs of $9,235, and those costs have now doubled in fewer than nine years,” said Lorraine Mayne, Milliman principal and consulting actuary. “As costs continue to grow–and even as the cost trend decelerates–the total cost of care for American families constitutes a larger and larger portion of the household budget.” Of the $1,319 total cost increase, employers bore $641 while employees shouldered the rest–$403 in payroll contributions and $275 in additional cost sharing. “As has been the case in four of the last five years, employees are paying a larger share of the cost increase than their employers,” said Scott Weltz, consulting actuary at Milliman. “That said, in absolute dollars, both employers and employees have shouldered approximately the same amount of additional costs since 2006, with employers absorbing $3,023 and employees absorbing $2,988.” In addition to looking at costs on a nationwide basis, the Milliman Medical Index also examines 14 geographic areas. “This year, six of the fourteen cities we studied exceeded $20,000 in total costs for a typical family of four,” said Milliman principal and consulting actuary Chris Girod. “But we still have several cities, Phoenix, Atlanta, and Seattle, with less than $19,000 in total costs for the typical family. These cost differences result from variation in local practice patterns and from differing costs for healthcare goods and services.” This years Milliman Medical Index also helps put healthcare reform changes in perspective, and includes various analyses of how healthcare reform is (or is not) contributing to the underlying cost of care. The report also looks at how healthcare reform changes may affect the typical family of four represented in this analysis.

Employer groups will be responsible for reporting to employees the total cost of their group health benefit plan coverage on 2012 W-2 forms, which is information employers must report to employees in January, 2013. 

Effective Date and Purpose

  • The guidance generally applies beginning with 2012 Forms W-2 that employers must provide to employees in January 2013. Forms W-2 provided to employees terminating during 2012 and requesting a Form W-2 prior to the end of the calendar year need not comply with the new requirements. This exception also applies to future years, until further IRS guidance is issued.
  • Employer-provided health coverage will remain non-taxable to employees (except for special situations, such as domestic partner or other non-dependent imputed income).
  • The purpose of the new W-2 information is to provide employees information on the cost of their health care coverage.
  • There are exceptions for certain tribal governments, churches and small employers (required to file fewer than 250 Forms W-2). Multiemployer plans are exempt from the reporting requirement until further guidance.

Scope of Health Plan

  • Employers can exclude the value of health reimbursement accounts and separate dental and vision plans when they report for 2012 – and future years – until the IRS issues further guidance.
  • Also excluded are health flexible spending accounts and HSAs. However, any employer contributions (not salary reduction) made to the health flexible spending account would be included.

We realize this is one more law that has moved ahead a year.  We at Trilogy Benefits want to keep you updated with the latest information; however, we do not want to boggle your already busy schedules with legislative mandates that are certain to change.  This ruling, in particular, is very important and affects all of us.  We will keep you posted as more legislation develops around employer mandates.

20% of employees use 80% of the claim dollars.  Studies have shown to manage wellness, not disease control.  In many cases it is about changing lifestyle habits. 

More to the point, abseentism vs. presentism.  Employees may “show up” to work, but really not be productive if there are health issues involved.

We want to employees to be healthy to work productively, be active in their communities, and live a healthy life.  But, how do employers become involved?  Do employers have an obligation to help their employees?  

Wellness program not only cut costs but can create and lead to big-picture strategies that directly affect the bottom line.  For every $1 the company invests, it sees a $1.50 to $2 return.

1)  Start with a wellness committee or team of employees who will make a difference in a Wellness Program.

2)  The first year, pick one healthy task to accomplish over a period of time whether it be purchasing pedometers for employees, stocking vending machines with healthy food, or participating in a Health Risk Assessment offered by most of the carriers.

3)  You could offer a gift card to employees who particpated in a health assessment, offer $100 to workers who attended a class on smoking cessation, diabetes management, depression, offer $5 for each pound lost.  

Start out small.  Employers with small budgets could start out with $25 per employee per year.  That’s $2,500 for 100 employees.

Let Trilogy Benefits assist with your Wellness Program ideas.  It will make a difference.

In today’s economic times, there are still lots of ways to reward employees without handing them money. We have shown you 51 ways:

1. Let the employee dump the one project they like least to you.

2. Use of the president’s office for a day.

3. The front parking spot.

4. A handwritten thank you note.

5. Name the conference room or lounge after them.

6. Inviting their spouse in for a lunch on the company.

7. A reserved parking spot.

8. A video game for the employee to give to their child.

9. A vacation day.

10. Brand-new desk, chair, or other piece of office furniture.

11. Bouquet of flowers.

12. Prepare a short video montage that celebrates the employee’s accomplishments.

13. A public thank you.

14. Send a birthday card to them at their home address.

15. Pay for them to take a fun class, such as cooking or skydiving.

16. Find something they like to collect, such as stamps or coins, and give them one for their collection.

17. Let them suggest a way they would like to be recognized.

18. Write a note to their family, sharing how important the person’s contribution to the company has been.

19. Keep the break room stocked with their favorite drink or snack.

20. Buy them tickets to a concert, show or other event.

21. Give them a small gift card from their favorite store.

22. Pick up a book or CD for them by their favorite author or artist.

23. Pick up the tab for them to have a family portrait taken.

24. Pay for their child to go to camp.

25. Buy a few extra boxes of Girl Scout Cookies from their daughter.

26. Give them a pair of movie tickets.

27. Help them with gas prices by giving them a gas card.

28. Provide them with a formal letter of appreciation for their personal file.

29. Create a “day pass” that they can turn in to take any day off, no questions asked.

30. Find a deal on a couple of three-day cruise tickets and set them up with a short vacation.

31. Allow them to be flexible with their hours.

32. Let them choose one day a week to work from home.

33. Have a birthday cake delivered to the office on their birthday.

34. Get each employee to write something positive about the person on a piece of paper, and give them the box of collected sayings, or frame them for the employee.

35. Start a company “Wall of Fame” and add them to it.

36. Find out what they are passionate about and give them a gift that relates to it.

37. Create and give them an award that they can keep and frame for a job well done.

38. Surprise them with an outdoor catered picnic.

39. Have a mobile car wash come to the business and clean their vehicle.

40. Get them a subscription to their favorite magazine.

41. Pay for a membership in a trade association of their choice.

42. Have a staff appreciation day once a month to provide them with a catered lunch.

43. Give them and their colleagues a catered breakfast.

44. Give them a new, improved job title.

45. Provide them with some one-on-one mentoring.

46. Institute a “playtime,” where employees can play games or shoot some baskets.

47. Host an annual award ceremony and give awards to employees for their contributions.

48. Celebrate the anniversary of their joining the company.

49. Allow them to dress casually on Fridays.

50. Have a massage therapist come to the office once a month and give a massage.

51. Create a relaxation room, where the employee (and other people you are rewarding) can go during the day, to read or even play a video game on their break.

Money may not always be the best way to recogize your employee’s accomplishments. Something to think about.

You have an employee who completed paperwork for the new plan year electing a deduction of $100 each pay period for 2011.  Now, she is standing in your office stating she made a mistake in completing the form.  What do we do now?

If it was clear a mistake was made and convincing evidence has been given to substantiate to the employer, IRS has informally commented that an employee’s election may be undone.  First, what is the proximity to the first payroll date after the new election is in force?  We recommend obtaining a signed statement from the employee describing the mistake.

One suggestion to reduce election mistakes is to provide employees with written confirmation of their elections after open enrollment and before the beginning of the new plan year.  Employees should be told to review their elections and to let the employer know before the plan year begins if there are corrections to be made.