Not too long ago someone asked me for information on learning more about benefits. Luckily they were local and I was able to sit down and explain things in person and answer questions. However, I wanted to put together some information about online classes that are available to anyone that has an interest in learning more about the topic. After scouring the web, here is the list I’ve put together for you:

Free online benefit courses

Itunes U

In case you don’t know about it, the Itunes store actually has a section called iTunesU that has several audio and video courses on a variety of different topics. In order to find these classes (I couldn’t figure out a way to link them directly), simply search for them by name in the iTunes store search bar.

• Liberty University Online - Class: Human Resource Management #9 – Understanding Employee Benefits (7 minutes)
• NJIT School of Management – Class: Human Resource Management – Lecture #19 – Benefits (~1 hour)

Open Courses

These are a list of other college level courses that are available and cover various different aspects of health and benefits. I also threw in one on Program Evaluation to help anyone that is looking for ways to measure their wellness programs. These are full courses so they are typically several hours worth of content.

• The Changing Face of American Healthcare 
• Comparative Health Policy 
• Managed Care and Health Insurance
• Fundamentals of Program Evaluation 

Consultant Webinars

Many of the consulting and legal firms offer free webinars on the latest legal changes or other topics that are of interest to benefits professionals. You can generally sign up for their mailing lists and be notified of any upcoming webinars. You can check the websites of Towers Watson, Mercer, Aon Hewitt, Morgan Lewis, or any other largish broker or consulting firm for information about their offerings.

Paid Courses on Benefits

Other people are looking for more formal courses either to qualify for certification or to count toward PHR/SPHR recertification. Here are the two main providers of paid and certification eligible benefit courses.

International Foundation of Employee Benefit Plans

The IFEBP offers a Certified Employee Benefit Specialist (CEBS) designation with the successful completion of 8 courses and their associated tests. It is considered to be the primary certification for benefits professionals. Study materials cost about $200-$400 per class and an online study fee of $195/class. Additionally, IFEBP also offers other online and in class certification on a variety of benefit topics throughout the year. You do not need to be a member to access their classes, however they all do have fees associated with them.

World At Work

World At Work offers a Certified Benefits Professional (CBP) designation with the successful completion of 7 tests on various benefits related topics. There are associated classes that you can take to help you prepare for the test. The cost is $1,400 – $2,000/class and test or $1,000-$1,500 for self-study and test. In my opinion, the CBP courses offer a bit more depth than the CEBS courses in that they focus on managing plans rather than administration of plans, but that’s just one person’s opinion.

Hopefully these resources will help you learn a little bit more about the world of benefits. Please tell me of any other resources that might be available out there!

Ok….returning from my completely unplanned blogging hiatus and getting back to sharing some info…

Health

I haven’t made it all the way through the recent flurry of HHS, IRS, and DOL guidance, but  there will be a $5.25 per month surcharge on employer health plans in 2014 which drops to $3.33 in 2015 and phases out in 2017. The surcharge is meant to offset the cost of individuals with pre-existing conditions hitting the marketplace all at once in 2014.

For self-insured plans, don’t forget that the Patient Centered Outcome Research Institute (PCORI) fee needs to be paid this year. It’s $1 x the average number of lives covered under the plan. It’s $2/member for 2013 and then will go up by an amount that still needs to be determined in 2014. You have to file a Form 720 once a year before July 31 of the calendar year following the last day of the plan year.

Retirement

One of the new options that is coming after all of the fiscal cliff chaos is, is the ability to convert a traditional 401k into a Roth 401k. You might want to talk to your 401k administrator about it to get the details on how they are planning to handle this.

The UK is following the US in needing fee disclosures for their pension plans.

“The two words information and communication are often used interchangeably, but they signify quite different things. Information is giving out; communication is getting through.” - Sydney Harris

Let’s chat a bit today about open enrollment and how to effectively communicate benefits information. Frankly, other than the couple of people who are interested in getting out of their current health plan, the only people that care about open enrollment are the benefits professionals that have to deal with it. So your job in communicating about open enrollment is convincing people that not only that they should care but also that they should take some action.

6  Critical Areas of Focus

Identify key concepts.

Spend some time really thinking about what key messages you want your employees to take away with them. At a high level, list out your 3-5 main points that you are trying to get across. And actually think about it. You need to identify at least one compelling reason why your employees should care about open enrollment.

Consider your employee’s needs.

You have spent some portion of the year dealing with your employees’ questions about benefits. Use that information to start to sketch out a list of items that your employee’s want to know. And feel free to ask them what would be helpful. A quick 2 question survey might yield some great information. (Question 1 – Do you care about open enrollment? Question 2 – What is your top question about your benefits today?)  Do your employees just want to know what the cost increase is? Do they want more information about how to chose the right health insurance plan? Do they want specific information about their health needs? Figure out what information they need.

Determine what action you want people to take.

As a result of your open enrollment communications, what do you want people to do? Do you just want people to enroll? Do you want them to evaluate your plans? Do you want them to be aware of future cost changes? Regardless of what action you want them to undertake, you need to weave this into your message. There should always be a clear call to action in any open enrollment messaging.

Brainstorm on common objections to your message.

Spend the time to think through all of the objections that your employees might have to your message and create counterarguments. For example, if you think that employees will negatively react to high cost increases, then think about a way to acknowledge that concern, empathize with it, but the reasons why the costs will still go up.

Determine how to effectively reach your employees.

There are tons of ways to get messages to your employee population: email, videos, intranets, group meetings, 1:1 consultations, phone calls, flyers, etc. Think about yourself as an employee and think about the ways that have been most effective for you to receive information within the company and use those channels for your open enrollment messages in addition to some of the more traditional channels. Do your employees get most of their information through team meetings? If so, then educate your managers to be your evangelists or get invitations to team meetings for 10 minutes on the agenda. Is it through information conversations in the kitchen? Then get some key information leaders within the organization and spread the message through them. Use what works for your organization.

Make the next steps clear.

Nothing ruins any type of communication campaign quite a much as unclear next steps. Your employees should have a crystal clear understanding of exactly what their next steps should be, the time involved in those steps, and any due dates. Don’t bury the next steps – make them prominent in your messaging.

Have any good tips on open enrollment communication? Share what has worked for you in the comments! 

Often an employee will ask HR if it is worth it to cover themselves on the company’s insurance plan if they are also covered under their spouse’s plan. Many of us cannot easily answer this question – it’s time to change that and introduce you to this obscure benefits rule.

What is Coordination of Benefits (COB)?

Coordination of Benefits (COB) is essentially the way that insurance companies (and self-insured employers) can avoid paying more than 100% of a doctor’s charges. It was established as a method of ensuring that employees can’t profit from being double covered.

How does an insurance company know if you have other coverage?

Insurance companies ask that you tell them if you have multiple coverage. There is normally a form that they ask you to fill out. Other than that, they don’t really know if you have other coverage or not.

Which insurance pays first and which pays second?

This is where things get tricky and a lot of issues arise. Here’s how the rules go:

Yourself/Your Spouse

1. The plan that covers you as an active employee is your primary plan.
2. If your spouse also covers you, then you are secondary on your spouse’s plan.

Children of parents not separated or divorced

1. Birthday Rule – The plan covering the parent whose birth date (month and day – not the year) falls earlier in the year is the primary carrier. (No – I am not making this up – this really is the rule.
2. If both parents have the same birthday, the plan that has provided coverage longer is the primary carrier.

Children of separated or divorced parents

1. First, the plan of the parent with custody of the child;
2. Then, the plan of the parent not having custody of the child.
3. Sometimes though, there can be a court decree that says that one parent has to cover the child for insurance purposes. If you ever receive one of these, you’ll need to comply with the court order.

Medicare

Medicare has different rules than active insurance plans – mainly because they are trying to minimize as much cost to the federal government where ever possible.

1. If you are covered by Medicare and another active group health insurance plan, Medicare will always be secondary.
2. If you are covered by Medicare and a retiree medical plan, then Medicare will pay first.
3. There are other various situations which can vary based on employer size, amount of time enrolled in Medicare, and reason for qualifying for Medicare. For example, if you have end-stage renal disease, after 30 months, Medicare pays first but before that, a group health insurance plan pays first.  The rules get quite obscure when it comes to Medicare but the Centers for Medicare & Medicaid Services (CMS) have information available should a situation arise available here.

What is actually paid if you are covered by two insurance plans?

Less that you think is covered! You will never get covered for more than 100% of what the doctor’s allowed expense (also called reasonable & customary charge or negotiated rate).

Imagine this scenario…

You have a claim for $100. You are covered under 2 insurance plans. Your primary plan has a $50 deductible and then pays 80% of the charges. Your secondary plan has a $100 deductible and then pays 80% of the charges.

The claim would first get submitted to your primary plan and you would pay $50 as your deductible and then $10 as your coinsurance for a total of $60 (the plan would pay $40). Then you would submit the claim to your secondary insurance which would pay $0 since the deductible on that plan is $100. (However, the $100 would apply to your secondary plans deductible and any future charge would be covered at 80%)

After you’ve met the deductible, coordination of benefits starts getting a little more useful. If both plans pay 80% and you have a $1,000 bill, then your primary plan will pay $800 and your secondary plan will pay $200. Additionally, your secondary plan will store the difference of $600 ($800 – $200) in a credit account for you that can be used to offset any expenses during the plan year. However, in practice, I’ve not yet ever run into a case where anyone taps into this money.

How do my insurance company know when to reimburse me or coordinate my reimbursement between my two insurances?

They don’t do anything special for you. You have to handle all of the paperwork on your own. Once your primary insurance company has paid the bill, you need to forward your explanation of benefits (EOB) that you get from your primary insurance company and mail it in with a claim form to your secondary insurance company. It’s a lot of paperwork!

Is being double covered worth it?

It depends. If you are likely to hit the deductible on both plans then it’s worth it. If you aren’t, then you’re likely to get little benefit from being double covered. You can get your secondary plan to cover your copays, but depending on how much the secondary plan costs in employee contributions – it might not be worth it. The years it is definitely worth it are those in which you have a planned surgery, pregnancy or likely significant medical expenses. But take the time to calculate whether the amount you are likely to get back outweighs the cost of enrolling in the plan.

I’ve been listening to a lot of TedTalks recently and highly recommend listening to them on long roadtrips. Here are some of my favorite ones related to health care:

Atul Gawande: How do we heal Medicine?

Rebecca Onie What if our healthcare system kept us healthy?

Eric Dishman: Take health care off the mainframe

Ben Goldacre: Battling Bad Science

Ivan Oransky: Are we over-medicalized?