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10 benefit trends that are changing employer health plans

This isn’t your grandfather’s health insurance.

Health plans today are on a constant search of new ways to engage members in their healthcare, reduce medical costs and satisfy employers, who purchase for roughly half of U.S. residents.

From pay-to-sleep schemes to healthcare transparency, today’s plans are leveraging incentives, technology, improved access and consumerism. Here’s how:

  1. Rewards for healthy behaviors. Look for more plans that reward employees who lose weight, control blood pressure, monitor blood sugar and more. Atena is even paying its own employees to get enough shut-eye.
  2. Holistic care. The Affordable Care Act said insurance companies “shall not discriminate” against any state-licensed health provider, leading to more coverage for chiropractic, homeopathic and naturopathic care. With Americans spending nearly $34 billion out-of-pocket on complementary care, insurers are beginning to take note with coverage that even extends to acupuncture and massage.
  3. Total well-being programs. The latest take on wellness helps employees manage stress, improve resiliency and conquer financial challenges. The 2015 World at Work survey found that nearly 75 percent of employers will increase expenditures on well-being programs over the next two years.
  4. Fitbits® and more. Fast Company reports that employers nationwide are distributing Fitbits and other activity trackers to motivate healthy lifestyles and make it easier to report wellness participation. It’s the latest twist on reducing obesity, controlling blood sugar and helping people avoid chronic conditions.
  5. Mobile apps. Today, two-thirds of Americans have a smartphones and a growing percentage are “smart-phone dependent,” according to the Pew Research Center.
    Health plans are jumping on the mobile bandwagon with electronic ID cards, online claim statements, health trackers and text-messaging.
  6. Paperless explanation of benefits (EOBs). There’s a huge shift toward paperless recordkeeping, so savvy insurance companies are providing online EOBs. Now it’s time for doctors and hospitals to catch up: A Deloitte survey found that 70 percent of respondents prefer electronic medical bills, but 98 percent of providers still use paper billing systems.
  7. Retail-center healthcare. There are 5 million visits to retail health clinics each year, which shows they’re gaining credibility among consumers. Insurance companies are finally getting onboard. Four out of five visits to clinics at Walgreens and CVS were covered by insurance, according to Forbes.
  8. Many patients find they need a doctor outside of traditional office hours – whether it’s for a child’s middle-of-the-night ear infection or a rash that pops up during a road trip. Telemedicine options allow Skype-like interactions (or a simple phone call) with certified doctors, at a lower cost to consumers than a visit to the emergency room or an urgent care center.
  9. Comparison shopping. More and more insurers are broaching this taboo topic, according to Forbes. Cost-comparison tools on carriers’ websites let savvy members save on non-emergency care by driving across town: The cost of routine procedures could vary by a factor of nine within the same city.
  10. Expanded savings accounts. More than 9 million Americans have Health Savings Accounts (HSAs), and their tax-advantages are getting lots of press from presidential candidates Donald Trump and Ted Cruz. The biggest challenge is education: People are easily confused about how to contribute, how to access funds and what qualifies as eligible expenses, according to The New York Times.
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Presidential election promises to shake up ‘Obamacare.’ What to expect.

Presidential Candidates and Healthcare

The 2016 presidential election will mean changes to Affordable Care Act (ACA), and two candidates – on opposite sides of the issue – say they would eliminate employer-sponsored health benefits.

In general, the Democrats want to expand government-sponsored healthcare coverage, while Republican candidates are united in their determination to repeal “Obamacare.”

No matter who wins, you can expect employee benefit plans to undergo changes and last-minute rulings that create temporary chaos and confusion during the transition.

Here’s a snapshot of how candidates plan to improve the cost and quality of healthcare:

Hilary Clinton plans to build on the foundation set by the Affordable Care Act. An advocate for universal coverage for more than 20 years, Clinton has pledged to expand coverage for millions of Americans by:

  • Lowering premiums and out-of-pocket expenses for those buying coverage on the exchanges.
  • Encouraging Medicaid expansion with incentives to states, including a 100 percent match for three years.
  • Making enrollment easier with support from navigators and other outreach activities.
  • Supporting a “public option” in interested states.

Bernie Sanders is calling for “Medicare for all.” He wants to create a single-payor health plan, which he says will save the typical middle class family $5,000-plus, and save businesses $9,400 per employee annually.  Sanders’ plan includes:

  • Implementing a universal health plan for all medical care and treatment.
  • Eliminating provider networks— anyone could see any doctor.
  • Eliminating copays, deductibles and other out-of-pocket costs.
  • Paying for the plan with income-based health care premiums (6.2 percent from employers and 2.2 percent from households) along with changes to income tax, capital gains tax and estate taxes.

Senator Ted Cruz would have Congress repeal the Affordable Care Act. In 2013, before the law went into effect, he famously filibustered for an historic 21 hours in an effort to halt its implementation.  Cruz says he’ll make healthcare more personal, portable and affordable by:

  • Expanding the use of Health Savings Accounts to provide tax advantages.
  • Allowing individuals to purchase insurance across state lines to increase competition and drive down premiums.
  • De-linking health insurance from the workplace so Americans wouldn’t lose coverage if they change jobs or are laid off.

Ohio Governor John Kasich would repeal the Affordable Care Act.  His plan uses market-based principles to hold down costs and improve health by:

  • Expanding Medicaid.
  • Placing more emphasis on patient-centered primary care, with added incentives for providers.
  • Encouraging episode-based payments and other forms of payment reform.
  • Allowing states to control insurance market regulations.

Donald Trump also wants to repeal the Affordable Care Act, bringing “free market reforms” to the healthcare industry. Trump’s plan includes:

  • Eliminating the individual mandate.
  • Allowing health insurance sales across state lines.
  • Allowing individuals to deduct health insurance premium payments on their tax returns.
  • Expanding the use of Health Savings Accounts.
  • Requiring price transparency for doctors and healthcare organizations.
  • Providing Medicaid block-grants to states.
  • Driving down prescription drug prices by allowing consumers to buy drugs from other countries.
  • Whether this becomes a tornado or a tsunami in the world of employer benefits depends largely on which candidate is elected, how much cooperation comes from Congress, and the inevitable challenges and decisions at the Supreme Court level.