Regulatory Impact on Health Plan Design and Benefits Structure

When drafting a health plan design for employees, it’s important to first look at the regulatory impact on benefits.

Perhaps the most pressing issue employers considering onsite clinics are facing right now is the so-called “Cadillac tax” under the Affordable Care Act. Last February, the IRS released a notice suggesting the cost of care received through onsite clinics must be counted in the ACA’s excise tax, also known as the Cadillac tax, calculations.

Considering Regulations in Health Plan Design

Scheduled to take effect in 2018, the “Cadillac Tax” is a 40% non-deductible excise tax on employer-sponsored health coverage that provides high-cost benefits. The tax is 40% of the cost of health coverage that exceeds predetermined threshold amounts. Though final regulations have not yet been issued, for planning purposes, the thresholds for high-cost plans are currently $10,200 for individual coverage, and $27,500 for family coverage.

We’ve joined the National Association of Worksite Health Centers in opposing this classification of onsite health centers as part of a benefits plan. Larry Boress, the NAWHC’s executive director, told Employee Benefits News that the challenge is convincing the IRS that onsite health centers are medical settings, not benefit programs per se.

Boress argues that the federal government is not going to be taxing physician offices, hospitals or retail clinics, and onsite health centers provide the same types of services.

Boress also argues that employers should not be penalized for expanding access to primary care, one of the primary goals of the ACA. If anything, they should be offered a tax credit, he believes. “We find anywhere from 40% to 60% of people who go to onsite clinics don’t have a doctor at all and so [clinics are] tremendously improving access” not only in rural communities but in metropolitan areas as well, he says.

Aside from the Cadillac tax, we generally can’t give much opinion when it comes to regulatory issues. That’s typically left to an employer’s ERISA attorneys, consultants and accountants.

However, during implementation we will work with employers to go over regulations pertaining to licensing clinicians and providing services. We advise our clients to do the same as each state has different regulations.

For example, in Texas neither MDs nor NPs or PAs can dispense our model of prepackaged pharmaceuticals.

Before setting a health plan design, it’s important to research these and other regulations.

Tips for Backing the Health Advocates in Your Office

For many industries, word of mouth can be one of the strongest influencers in gaining participation and driving results. When we feel good about a program, service, or product we are likely to share our experience with others.

Why Health Advocates are Essential to Wellness Program Success

Likewise, motivating advocates of a health program can be hugely valuable for increased participation and driving success of the program overall. Employees who are motivated and armed to share their experience with their peers are likely to offer highly personal, authentic information to new participants – resulting in greater education, awareness, and action.

Paired with standing outreach and communication – advertising positive experiences through company communications or events is an effective solution for spreading the good word. Provide a supportive system for ambassadors to submit their stories to the program committee for ease of review. Including a valuable incentive in return for shared stories is also favorable for encouraging participation.

Marathon Health supports this initiative through our Healthy Like Me program in which participants are entered to receive a cash prize in return for sharing their story. Stories can easily be shared through company and clinic communications. To learn more about Healthy Like Me click here.

Additionally, giving ambassadors a role in the preparation or recruitment for company wellness programs such as fitness events and weight loss challenges not only helps them to feel good about their support, but will provide further opportunities for the individual to actively continue their own wellness journey. Begin by inviting ambassadors to join the planning committee, incentivize a referral program as part of the sign up or recruitment process, or include their story during outreach.

Maintaining support for advocates of a health program can make a valuable impact on building a culture of health for your company internally. The benefits of this effort will likely reveal themselves externally as well. With the help of ambassadors, a strong health initiative is easily extended by reputation and direct association with friends, family and community over time.


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