Employee benefits

Look out! Open Enrollment Is Upon Us!

Never fear… WisMed is here

By Chris Noffke, GBDS – VP of Employee Benefits

November is coming and so too are your updated employee health plan costs… if the carriers are up to speed!

Regardless, it is time to start thinking about and planning for open enrollment. In addition to being prepared so that employees have the time, information, and support they need to select a plan that best fits their needs, here are some important changes you need to know;

  • 2021 affordability percentage is 9.83%, up from 9.78% (This applies to groups of 50 or more employees)
  • Out of Pocket Maximums for 2021: $8,550 for self-only coverage and $17,100 for Family
  • HDHP and HSA Limits for 2021 (see chart)

Compliance, compliance, compliance… talk about fun!

In all seriousness, here is a reminder of when to submit your ACA Disclosures and Notices:

  • Special Enrollment Notice: Initial Eligibility and each Open Enrollment and also must be in SPD (Summary Plan Description).
  • SBCs (Summary of Benefits and Coverage): Required 30 days prior to new plan. Must be provided during each annual enrollment. If an employee must enroll to continue coverage, the SBC must be provided when open enrollment materials are distributed.
  • CHIP Notice: Annually, before beginning of plan year. Recommend to include with Open Enrollment materials and upon initial eligibility.
  • Medicare Part D Creditability: Must be sent before October 15, regardless of your plan year.
  • Women’s Health and Cancer Rights Act (WHCRA): Annually & upon initial enrollment / Usually sent at Open Enrollment.

Market Updates

General opinion on this year’s premium increase range widely between 4 and 10 percent for group benefits.

As to trends in plan design in response to COVID, a survey conducted by Mercer in June found that 37 percent of employers do not anticipate adjusting benefits for 2021. It also found that 48 percent are taking a wait and see approach.

While waiting to see what plans will actually cost, I believe we need to be mindful of what’s almost certain to occur in 2021. Many plans have made gains this year because employees are deferring elective care, but, as COVID releases its grip, it will almost certainly result in a much higher than normal plan usage in 2021.

Some of you may have an opportunity to lower costs if you are willing to change insurance companies. But, look at any “gift horse” very carefully, you could be facing an even larger increase than normal next year if you switch to a company that is trying to grab marketing share.  If you are uncertain what to do, but find yourself in a situation where status quo means accepting a significant increase, we should talk.

And, if you would like to discuss how you can prepare now for what’s ahead, contact me.

Open Enrollment Safety

We will still be hosting town hall meetings but will be doing so with COVID-19 safety in mind. 

Please contact me to discuss arrangements for virtual enrollment meetings for your employees.

Chris Noffke

608.442.3734 direct

Chris.Noffke@wismedassure.org

Navigating Testing in a COVID Environment

By Chris Noffke, GBDS – VP of Employee Benefits

Navigating insurance benefits is complex and confusing for consumers and business owners alike. Today’s insurance landscape requires people seeking benefits to understand insurance terms like deductibles, coinsurance, out of pocket limits, annual out of pocket limits (yes this can be different caps) and many others.

On top of that, you now have to understand the ins and outs of preventative care coverages and COVID related no-cost, shared-cost coverages.

Currently most insurers are covering the COVID tests, antibody testing, and treatment with no cost share. But be aware, these 100% covered costs will eventually become the patient’s responsibility. Some testing may continue to be covered at no cost to the patient but you may be billed if you go outside of your network or don’t have an approved reason for testing.

We can begin to understand why by looking at the cost of one of these tests. A local PPO (preferred provider organization) reported that they have seen the cost of COVID Antibody testing (Codes 86328 and 86769) range from $23 – $1,023.92, which is one of the major issues with understanding your cost shares.

So, while this test may be covered based on current legislation, when will it no longer be covered? As of right now, there is a lot of speculation that once the “state of emergency” ends, you may see no cost end too.

Currently, to get an antibody test done, it needs to be ordered by a healthcare professional in an office visit, urgent care room or emergency room. Although there are some guidelines for how out of network visits will be covered, patients are sure to see costs shifted to them.

What does the future hold?

When I think about our healthcare future and how COVID-19 will impact the cost of care, it causes a significant sense of concern. With so many people avoiding seeing a physician during social distancing, we should anticipate a surge of chronic illnesses with higher than average claims costs. Staying home means those with anxiety, depression and obesity may be spending even more of their time on couches and this means less physical activities and socialization.

A recent report by Milliman – the highly respected risk management consulting firm – states, “We expect an increase in costs after the Pandemic due to deferred care and pent-up demand… The estimate of services deferred to 2021 is beyond the scope of this paper, but those costs are likely to be very significant.” The report says that ‘very significant’ is an understatement, as it speculates there will be at least $75 billion and as much as $575 billion in deferred care.

And that’s for non-COVID care! Another analysis, commissioned by America’s Health Insurance Plans, estimates that total costs of COVID-19 for commercially insured individuals could range from $44.6 billion to $438 billion over the next two years.

Arriving at a clear conclusion is impossible given the volatility of our times. But, what we can do is work together to protect each other while aggressively looking for ways we can collaborate to protect our healthcare future.

For a comprehensive look at COVID-19 related insurance coverage, check out this Health Affairs article by Katie Keith and take a look at Wismed Assure’s Covid-19 Updates page for added tools and resources.

It’s Time to Jump Start Your 2020 Employee Benefits Process

Open enrollment season is upon us. Here is a list you can use to ensure your employee benefit program for 2020 is implemented without a hitch.

Has your advisor: 

  1. Requested a census?
  2. Reviewed alternative carrier market options?
  3. Presented a plan level review of your benefits (i.e. deductibles)?
  4. Discussed Open Enrollment and your employee forms?
  5. Provided a Benefit Booklet for your employees?
  6. Updated your Summary Plan Description (SPD)?
  7. Reviewed the legally required group health plan notices for employees? *

If any item on this list causes you concern, or you have any questions about how to make your 2020 employee benefits plan the best ever, we can help.

Contact our director of group benefits, Chris Noffke, GBDS.

608.442.3734 direct

Chris.Noffke@wismedassure.org


Want more value from your 2020 medical benefit spend? Think ahead. Act soon.

Do you ever notice how the days seem to slip by faster and faster with each passing year?

Here we are approaching the final couple months of 2019 and it’s a shock to realize we’ll be entering a new decade. I can’t seem to adjust to typing 2020 on the applications. Before the rest of the year slips away completely, it is time to do some serious thinking about your medical benefit policies for next year.

Quoting and Timing

We see it every year— there is always a time crunch when quoting medical benefits mostly because the insurance companies do not make rates available to groups and agents until they absolutely need to. I believe insurance companies offer limited information on rates because it makes it difficult for clients to switch providers.

If you take action early… perhaps even right away, together we can put the pressure on the insurance companies. Additionally, we can reduce the time crunch by taking care of ancillary benefits like Dental, Disability, Life and Vision sooner because all quoting can be done months in advance of renewal. This will allow for more time to be spent toward working on medical benefits when the rates are available.

As a side note, I think it is unfortunate these benefits are called ancillary. Even though they might be seen as a luxury when rising premiums force people to make hard choices, they can be just as important as medical benefits… just ask the employee who needs dental work or has vision problems.

Notices and Enrollment Periods

Other important, time-sensitive things to think about now are your notices and enrollment periods. Open enrollment is the annual period of time when employees are able to make changes to their benefit selections. The only other time they can make changes is when they experience a Qualifying Life Event (QLE). Typically, groups need to provide a special notice to their employees to establish the time period for the upcoming open enrollment.

I am often asked to clarify which employees are eligible for open enrollment. The answer is simple for groups where all employees are working full time – 30 hours or more per week. However, for groups with employees who are working a variety of hours per week, it is a little more difficult. If you are concerned about getting it right, call me, I can help.

If you want to protect yourself, I recommend you consider setting up what is known as a Look Back Period. A Look Back Period helps you and your insurance advisor verify which employees qualify to have been part of the open enrollment process.

WisMed Assure Exclusive Programs – AHP, Delta Dental, MGIS

Most agencies only quote and spreadsheet for their clients which is why they are happy to work with any type of group or company. We’re the opposite. We are focused solely on health care companies which has helped us develop innovate and exclusive products that only WisMed Assure can offer. Some examples are the Association Health Plan, Delta Dental and income protection solutions from MGIS. If you shop for these elsewhere, you won’t get the discounts we offer.

A Little Faith Means Less Frustration

If, as the end of the year comes closer, you find yourself scratching your head with insurance questions, and feel frustrated due to not having access to the systems and services you need, think of us… have faith in us.  We are here to help you move the health care of Wisconsin forward and to be your financial partner for life.


Chris Noffke, GBDS

chris.noffke@wismedassure.org

608-442-3734