Category Archives: Health and wellness

How Will Obamacare Affect My Wellness Program?

Beginning in 2014, the Affordable Care Act (ACA) imposes “pay or play” requirements on large employers. Under these rules, large employers that do not offer health coverage to their full-time employees and their dependents, or that offer coverage that is either unaffordable or does not provide minimum value, may be subject to a penalty. This penalty is also referred to as a “shared responsibility payment.”

On May 3, 2013, the Internal Revenue Service (IRS) released a proposed rule on ACA’s minimum value and affordability requirements. This proposed rule includes guidance on how health reimbursement arrangements (HRAs) and wellness program incentives are counted in determining the affordability of employer-sponsored coverage.

The regulation is not final. However, employers may rely on the proposed regulation until final regulations or other applicable guidance is issued.

Background

The affordability of any health coverage offered by a large employer is a key point in determining whether the employer will be subject to a shared responsibility penalty. The coverage is considered affordable if the employee’s required contribution to the plan for self-only coverage does not exceed 9.5 percent of the employee’s household income for the taxable year.

“Household income” means the modified adjusted gross income of the employee and any members of the employee’s family, including a spouse and dependents. The IRS established three safe harbors for employers to use, which measure affordability based on the employee’s W-2 wages, the employee’s rate of pay or the federal poverty level for a single individual.

HRA contributions and wellness program incentives

The proposed regulation includes special rules for determining how HRAs and wellness program incentives are counted in determining the affordability of eligible employer-sponsored coverage. Employer contributions to health savings accounts (HSAs) do not affect the affordability of employer-sponsored coverage because HSA amounts generally may not be used to pay for health insurance premiums.

HRA Contributions

The proposed rule provides that amounts made newly available under an HRA that is integrated with an eligible employer-sponsored plan for the current plan year are taken into account only in determining affordability if the employee may either:

  • Use the amounts only for premiums; or
  • Choose to use the amounts for either premiums or cost sharing.

Treating amounts that may be used either for premiums or cost-sharing only toward affordability prevents double counting the HRA amounts when assessing minimum value and affordability of eligible employer-sponsored coverage.

Wellness Program Incentives

The proposed rule also contains clarification on affordability when premiums may be affected by wellness programs. Under the proposal, the affordability of an employer-sponsored plan is determined by assuming that each employee fails to satisfy the wellness program’s requirements, unless the wellness program is related to tobacco use. This means the affordability of a plan that charges a higher initial premium for tobacco users will be determined based on the premium charged to non-tobacco users, or tobacco users who complete the related wellness program, such as attending smoking cessation classes.

Transition relief is provided in the proposed rule for plan years beginning before Jan. 1, 2015. Under this relief, if an employee receives a premium tax credit because an employer-sponsored health plan is unaffordable or does not provide minimum value, but the employer coverage would have been affordable or provided minimum value had the employee satisfied the requirements of a nondiscriminatory wellness program that was in effect on May 3, 2013, the employer will not be subject to the employer mandate penalty.

The transition relief applies for rewards expressed as either a dollar amount or a fraction of the total required employee premium contribution. Also, any required employee contribution to premium determined based upon assumed satisfaction of the requirements of a wellness program under this transition relief may be applied to the use of an affordability safe harbor.

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Heat Related Illness: Stay Cool When Working in the Heat

If your job requires you to spend time working outside, it is important to take the weather into account for safety purposes. When it is hot outside, your body temperature can rise to dangerous levels. Normally your body cools itself through sweating, but in hot weather, sweating is not enough and the result can be a heat illness.

Staying Cool

Follow the suggestions below to stay cool when working in hot weather:

  • Wear loose, light-colored clothing and some type of hat.
  • Adapt to working in hot conditions gradually, especially if you must do any strenuous physical work.
  • Take breaks indoors or in the shade when possible.
  • Avoid overexerting yourself during peak temperature periods (midday).
  • Drink liquids frequently, even if you don’t feel thirsty – at least eight ounces every 20 to 30 minutes. Choose water, fruit juice or sports drinks and stay away from liquids containing caffeine, which can dehydrate you.

Recognizing the Symptoms

There are three forms of heat illness, each with its own distinct symptoms:

  • Heat Cramps – severe muscle spasms in the back, stomach, arms and legs, which are attributed to the loss of body salt and water during periods of heavy perspiration
  • Heat Exhaustion – heavy sweating, cool or pale skin, nausea, headache, weakness, vomiting and fast pulse
  • Heat Stroke – high body temperature, sweating stops, red and often dry skin, rapid breathing and pulse, headache, nausea, vomiting, diarrhea, seizures, confusion or unconsciousness

Providing Treatment

It is essential to treat heat illness as soon as possible. If you are feeling any of the above symptoms, inform a co-worker and ask for help. If you suspect that a fellow worker has a heat condition, follow these first-aid tips:

  • Heat Cramps – Move the victim to a cooler area and allow them to drink approximately six ounces of water every 15 minutes. Follow up with a medical examination.
  • Heat Exhaustion – Move the victim to a cooler area and keep them lying down with their legs slightly elevated. Cool their body by fanning and applying cool, wet towels. If conscious, allow the victim to drink approximately six ounces of water every 15 minutes. Follow up with a medical examination.
  • Heat Stroke – You or a bystander should immediately call an ambulance. Meanwhile, move the victim to a cooler area, remove their outer clothing, immerse them in cool water or apply cool, wet towels or cloths to the body. Do NOT give them liquids. If medical help is delayed, call the hospital for further instructions while waiting. Heat stroke is life-threatening, so it’s important to move quickly!

Safety Reminder

The risk of heat illness increases with age, poor diet, being overweight, insufficient liquid intake, poor physical condition and/or when taking medication. Never take salt tablets without your doctor’s approval.

Be aware of weather conditions when you will be working outside so that you can be prepared with appropriate clothing and beverages. If you are working outside and start to feel any adverse symptoms, inform your supervisor and take a break.

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Protect Your Business and Employees from Seasonal Flu

Each year, seasonal influenza has a marked impact on businesses and employers. Seasonal flu can cause increased absenteeism, decreased productivity and higher health care costs. As an employer, you are well-positioned to help keep your employees healthy and minimize the impact that influenza has on your business. The Centers for Disease Control and Prevention (CDC) recommends strategies for employers to help fight the flu.

Host a Flu Vaccination Clinic

One of the most important steps for preventing the flu is to get an annual flu vaccination. The CDC recommends that all people over the age of 6 months get a flu vaccine each year. Hosting an onsite flu vaccination clinic can help educate employees about the importance of vaccination, and make it easier for them to get vaccinated. The CDC offers these tips:

  • Consider getting employees vaccinated against flu as a business priority and create a goal aligned with this effort.
  • Identify a flu vaccination coordinator and/or team with defined roles and responsibilities. Determine if you will need to contract with an outside provider of flu vaccination services (such as a pharmacy or community immunizer).
  • Schedule the flu vaccination clinic to maximize employee participation. Flu season usually begins in the fall of each year.
  • Provide accessible flu vaccination in as many business locations as possible.
  • Provide a comfortable and convenient location for the flu vaccination clinic. 
  • Allow employees to get vaccinated during their normal work day.
  • Set an example by having managers and business leaders get vaccinated first.
  • Use incentives, such as offering the vaccine at no or low cost, providing refreshments at the clinic or holding a contest for participation percentage among departments.
  • Promote the flu vaccination clinic with posters, an article in the company newsletter or intranet, informational flyers and e-mails.
  • Set a participation goal to demonstrate to employees that participation is important.
  • Consider offering flu vaccination to employees’ families.

Educate Your Employees

If you choose not to provide an onsite flu vaccination clinic, you can still emphasize the importance of vaccination to your employees, and educate them about local opportunities to get vaccinated. In addition, educate employees about flu prevention strategies, including:

  • Covering nose and mouth when coughing or sneezing
  • Washing hands often with soap and water (or using alcohol-based hand sanitizer)
  • Avoiding close contact with sick people
  • Staying home from work when sick, and limiting contact with others

Ask your Texas Associates Insurors representative to provide you with employee educational materials regarding flu prevention, vaccination promotion and good hygiene. Also, consult the CDC seasonal flu toolkit for more information and resources: www.cdc.gov/flu/pdf/business/Toolkit_Seasonal_Flu_For_Businesses_and_Employers.pdf.