The Real Cost of Employee Benefits: Compliance Risks, Rising Expenses, and How to Fix Both

Good afternoon and welcome to the real cost of employee benefits, compliance risks, rising expenses, and how to fix both. Thanks for joining us today. I'm

both. Thanks for joining us today. I'm

Jennifer Barry, GTM's HR consultant practice leader, and I'm so pleased to be joined today by Keith Dolan, the senior benefits manager with the GTM Insurance Agency.

A couple of housekeeping tips before we get started. Feel free to use the

get started. Feel free to use the question functionality to ask your questions during today's presentation.

We'll address as many questions as possible at the end of the presentation.

If we don't get to your question, we'll be sure to follow up with you tomorrow.

Also, you'll receive an email later today with a link to watch a video recording as well as a PDF version of this presentation.

So, let's get started and talk about what today's webinar will cover. I

intend to review benefits compliance from an HR perspective during today's presentation.

During my career, I've worked with many clients of all sizes and in many industries and advised them about all areas of benefits compliance, including

benefits enrollment, ACA compliance, COBRA administration, ORISA audits, and have managed state and federal compliance notices for such clients. I

will kick off the presentation touching on many of these benefits compliance topics and then Keith will dive into the biggest drivers behind rising health care costs and what you can do to

mitigate them while still maintaining employee value.

With over 30 years of experience in the benefits industry at agencies and large health insurance carriers, Keith leads the GTM insurance agency's employee

benefits practice, assisting clients with benefits design, implementation, compliance, and education.

Thank you, Keith, for joining me for today's presentation.

So, let's get started.

Today's HR leaders face mounting pressures when they are trying to determine whether to offer employee benefits and if so, how they can afford

to do so. When an employer does decide to offer employee benefits and especially health insurance, it is important that they recognize that their job is not done just by making the

offer.

The significant regulatory environment around benefits and regular changes to those rules require constant review and investigation.

Further and most significant as of recent years is that benefit costs continue their upward trajectory.

It is often difficult to offer the comprehensive coverage that employees and their families need while also meeting internal budgetary constraints.

It has become a decision employers can no longer take lightly and one that has significant impact on their ability to attract and retain talent.

With that said, during this presentation, we will discuss the following.

How to master benefits compliance fundamentals and avoid costly penalties related to those compliance requirements.

Next, how to implement strategies that reduce employer expenses without sacrificing the level of coverage employees need and expect.

And finally, how to create a communication and educational strategy for employer provided benefits that will help engage the workforce and ask them

to take accountability for their own health care and other benefits.

Let's start with a discussion about benefits compliance. Understanding and

benefits compliance. Understanding and meeting your employer obligations is the bedrock of effective benefits administration.

Non-compliance can result in significant penalties, legal exposure, and reputational damage.

It is important that employers understand that securing the right health plan and other employee benefits is not where their obligation ends. It

is important that employers communicate with and educate employees in advance of their open enrollment so that they are prepared to select their benefits, understand their options, and most

importantly get the information they need in a timely fashion.

With that said, employers should do the following to ensure a successful open enrollment.

First, you should start early and communicate clearly.

Communications about the plan should be sent to eligible employees at least four to six weeks in advance of enrollment if possible. We realize right now carriers

possible. We realize right now carriers are being late with some of their information. So keeping as close to that

information. So keeping as close to that timeline will be most ideal for employer or employers and employees.

These communications should use simple language to explain the benefits, any changes from the previous year and any deadlines related to open enrollment. It

is helpful to have information provided to employees both in writing. This is so they can share it with their other family members who may also be covered as well as to have someone available to

answer questions about those benefits.

We recommend sharing benefits communications via email, posting to your benefits platform or HRIS system, provided printing printed materials, and

even utilizing text messages. It's

almost impossible to overcommunicate about benefits in advance of open enrollment.

Next, you should educate employees on their options. With that said, it's

their options. With that said, it's highly recommended that you host live or recorded webinars with Q&A sessions, provide decision support tools or

calculators to help employees compare plans, and share real life scenarios to illustrate how different plans work.

Next, it's important that employers highlight what's new or changed. With

that said, employers should clearly outline new benefits, cost, and contribution changes, if any, or policy updates. It's often helpful to use

updates. It's often helpful to use comparison charts to show differences from the previous year.

Next, make it easy to enroll. We highly

encourage you to utilize electronic enrollment for both recordkeeping and compliance purposes. Employers should

compliance purposes. Employers should ensure the enrollment platform is userfriendly, mobile accessible, and well tested. Employers should also

well tested. Employers should also provide step-by-step guides or video walkthroughs.

Providing live support or chat options during peak enrollment times is also helpful, causing fewer delays at employee decision making and enrollment.

Finally, it's important to document employee elections accurately. If you

are utilizing electronic enrollment via BL Ben admin platform or payroll platform, you likely already have this covered. Be sure to provide elections

covered. Be sure to provide elections and declinations of benefits to the carriers in a timely fashion so that employees can seek medical and other treatment under their new coverage. Be

sure to upload elections and benefit deductions in your payroll system so that employee contributions are available to pay for their coverage.

This is particularly important when employees elect to contribute additional dollars to flexible benefit plans.

Provide required benefit notices, including many state and federal notices and plan documents that must be provided annually. Employers can be penalized

annually. Employers can be penalized hundreds of dollars a day if they do not provide these notices. More to come on this later in the webinar.

Generally speaking, an employee is tied into their benefit elections for an entire plan year. Making changes to coverage usually occurs during open enrollment or if an employee or a

covered family member experiences a qualifying event or under specific circumstances and even if that must occur within a very tight window in

order to be in compliance.

So what is a qualifying event or qualifying life event?

According to the IRS, HIPPA, and ORISA rules, employees may make mid-year changes to their benefits only if they experience a qualifying event. Some

examples of these events include marriage or divor divorce, birth or adoption of a child, death of a dependent, loss or gain of other health coverage, including Medicaid and CHIP

coverage for children. And employees

typically have 30 days from the date of this event to request changes. And some

changes do allow for 60 days, but as you can see, it's a really tight window.

Regardless, please note that after plans begin, changes are generally not allowed unless there is one of these qualifying events or unless there is a clear and

convincing evidence of a mistake. For

example, if an employee enrolls in a dependent care coverage plan and that employee does not have any eligible dependent, there would be clear and convincing evidence to remove that person from that plan. You could take

care of it at that time.

>> [snorts] >> This timing makes it critical for employers to track enrollments and process enrollments and changes in a timely fashion. It's important to

timely fashion. It's important to document when and why changes to enrollment occur and also be sure to monitor coverage by carefully reviewing plan billing each month. Although the

value an employer brings to employee benefits occurs partly due to offering health and other coverage pre-tax, if an employer decides to allow employees to pay for their benefits with post- tax

dollars, they have may have more flexibility to make changes midyear depending on the plan. This may sound like a useful loophole for employers that want to provide more flexibility.

However, it is often a missed opportunity to provide provide more value to employees.

So on to the affordable care act which has obviously been in the news a lot lately. Affordable care act compliance

lately. Affordable care act compliance is very broad area of employee benefits compliance that is important to understand when deciding whether to

offer health insurance and if so how the employee and employer contribution to such insurance will be handled. There

are significant IRS penalties for not providing coverage or providing unaffordable coverage when a qualified employer is required to offer coverage

pursuant to the Affordable Care Act. So,

let's discuss some of the particulars.

The Affordable Care Act or ACA mainly applies to applicable large employers or ALES.

An applicable large employer or AL is a business with 50 or more full-time employees or full-time equivalents.

Please note, however, that part-time employees may qualify as a full-time equivalent for purposes of the ACA, which makes tracking hours very important.

Although we could do an hours long webinar just on the ACA alone, I want to provide some of the basics of the ACA regulatory requirements. First, the ACA

regulatory requirements. First, the ACA requires ALES to provide affordable coverage that meets other guidelines to all full-time and full-time eligible employees.

Affordability is a guideline provided by the IRS regulations.

If you are an AL, you must generally offer coverage that meets ACA guidelines to at least 95% of your full-time employees. The plans that are compliant

employees. The plans that are compliant under the ACA must generally cover at least 60% of health care costs at the very least providing minimum value to employees and their covered dependence.

And most importantly, the coverage offered by employers must be affordable.

That means that the employees share of at least one plan offer does not exceed a certain percentage of their household income.

In addition to offers of coverage and health insurance compliance, there are also reporting requirements under the ACA.

It's [clears throat] important to ensure accurate tracking of health plan offers and acceptance or decline from eligible employees. It is also important that

employees. It is also important that eligible employers track employee hours so that they ensure that those that qualify are made compliant offers of

coverage. Bottom line, the ACA comes

coverage. Bottom line, the ACA comes with a lot of compliance and if the rules are not followed correctly comes with a lot of penalties for employers.

For example, you could face penalties if you don't offer coverage at all if the coverage that you do offer is not affordable or does not meet minimum

value. And there are other ways for

value. And there are other ways for reporting penalties.

Penalties are calculated based on the number of full-time employees and can be in the thousands of dollars per year.

This is significant area of compliance, so we recommend seeking counsel from your benefits advisor, HR consultant, or broker to ensure you're managing your

offers of health coverage correctly.

Employers offering health insurance also have specific responsibilities under COBRA to ensure compliance and protect employees

rights to continued coverage.

Federal COBRA applies to employers with 20 or more employees who offer group health plans.

Please note, however, that there are state mini COBRA requirements.

[clears throat] Excuse me. Excuse me for one second.

that often require employers with any number of employees starting at one employee to offer continuation coverage.

New York is one of these states.

Both apply to employers who offer health benefits. It covers medical, dental,

benefits. It covers medical, dental, vision, and certain wellness programs that provide medical care. Employers

must offer COBRA and or state continuation coverage when an employee or their dependent loses coverage due to a number of qualifying reasons including

job loss, reduction of hours, divorce, or death. It also applies when

or death. It also applies when dependents lose coverage under a parents plan, which typically occurs at age 26.

COBRA has other requirements, including notification requirements. First,

notification requirements. First, employers are required to provide an initial COBRA notice, also called the general notice, to employees when they first become covered under a group

health plan.

It must be provided within 90 days of the employee or dependent becoming covered under the group health plan.

Employers must also notify the plan administrator within 30 days of a qualifying event. The administrator then

qualifying event. The administrator then has 14 days to notify the employee or dependent of their COBRA rights. If the

employer is also the plan administrator, they have a total of 44 days to send the notice.

Recordkeeping is also important for COBRA compliance. Employers must

COBRA compliance. Employers must maintain accurate records of notices, elections, and payments. Failure to

provide timely notice can result in penalties of up to $110 a day and potential lawsuits. Cobra complaints

potential lawsuits. Cobra complaints must also be reported on form 5500 if applicable.

[snorts] Earlier we discussed that employers are responsible providing plan documents as well as many state and federal notices in order to be compliant and avoid

penalties. Orisa is a federal law that

penalties. Orisa is a federal law that sets rules for how employers must manage employee benefit plans.

It applies to retirement plans, health plans, and some other employer offered benefits.

Orisa is about protecting employees and making sure they get the benefits they were promised. For employers, it's about

were promised. For employers, it's about avoiding penalties, building trust, running benefits programs responsibly.

It doesn't force employers to offer benefits like the Affordable Care Act, but if they do, employers must follow Orisa's rules. So, what do employers

Orisa's rules. So, what do employers need to do to stay compliant with Orisa?

If you offer benefits, you must provide a written plan document that explains how each benefit works, who is eligible, what's covered, and how it's funded. One

of those plan documents that must be provided is a summary plan description or SPD, which is a simplified version of the plan that an employee can easily

understand. It must be provided to

understand. It must be provided to participants within 90 days of joining the plan. Employers must provide other

the plan. Employers must provide other plan documentation including Cobra notices as pre previously discussed, HIPPA privacy notices, Medicare notices,

and children's health coverage notices amongst others. Employers must also act

amongst others. Employers must also act as a fiduciary. With that said, employers must ensure the plan assets are safeguarded. They must also manage

are safeguarded. They must also manage the plan in the best interest of employees. That means choosing good

employees. That means choosing good service providers, keeping fees reasonable, and avoiding conflicts of interest. If you have a larger plan,

interest. If you have a larger plan, Orisa requires you to also file a form 5500 each year with the Department of Labor and IRS.

Finally, employers are generally required to keep organized records related to the plans they offer. These

documents and any formal filings needed as well as provide document should be there for an audit. Often employers

utilize WAP plans to meet many of Orisa's documentation requirements.

If employers do not comply with Orisa, they can face fines upwards of hundreds of dollars per day per employee. They

can also face legal trouble. For

example, if an employer does not provide an SPD, the fine is up to $195 per day per employee. If eligible employers do

per employee. If eligible employers do not file a form 5500, the penalty is upwards of $2,500 per day.

In addition to what we've already covered, there are other areas of risk and compliance, including mental health parody, HIPPA privacy, and state mandates. With that said, it's important

mandates. With that said, it's important that employers and especially multi-state employers work with their HR and benefit advisors to ensure they maintain compliance in these additional

areas and jurisdictions.

Mental health parody is an area of great concern recently. In fact, its

concern recently. In fact, its enforcement is intensifying.

Mental health parody ensures that mental health benefits match medical and surgical coverage, meaning mental health is placed on equal footing with other health care needs and services. HIPPO

privacy ensures that employee health data remains confidential. It is

important that employers ensure their vendors have strict personal health information guidelines and do not breach these protocols. As we already noted,

these protocols. As we already noted, many areas of compliance not only come from federal law, but also state requirements, including paid leave, sick and safe leave, mini cobra, and

reporting.

It's important to consult with experts on multi-state benefit administration.

In order to get this right now, on to open enrollment and benefits administration.

Successful open enrollment requires coordinated planning, clear communication, and meticulous execution.

The quality of your enrollment process directly impacts employer satisfaction, employee satisfaction, data accuracy, and downstream administrative efficiency.

Successful open enrollment is directly tied to employee satisfaction, maintaining compliance, and accurate recordkeeping. With that said, it is

recordkeeping. With that said, it is important for employers to do the following to ensure a positive open enrollment experience. First, you should

enrollment experience. First, you should develop a communication strategy. As

briefly discussed earlier, there should be a multi-channel approach to communicating plan details and enrollment details to eligible employees. This includes using email,

employees. This includes using email, meetings, videos, and printed materials to communicate with employees. Some of

these materials will ensure your compliance as noted earlier.

Next, employers should provide some sort of education and/or support so that employees can make the right decision on benefits for themselves and their families. Employers can employ the use

families. Employers can employ the use of cost calculators, provided personalized recommendations, provide plan comparison models, and other advisement. There is nothing more

advisement. There is nothing more stressful to employees than making sure they select the right plans for their family. Going a step further than just

family. Going a step further than just offering great employee benefits, employers should help alleviate stress of choice by offering support and guidance throughout the process.

Benefits often include alignment internally with multiple departments within an organization. Often HR,

payroll, finance, and external vendors need to coordinate benefits, enrollment, and payment for the plans offered. It is

important to work together with these constituents to be sure that clear timelines are established, that data exchange protocols, if any, are established and tested, and that there

are outlets for employees who may have challenges or technical issues. [snorts]

Although employers offer benefits due to many factors, compliance, recruiting and retention, and also just to do the right thing, they do want to make sure they are reconciling their benefits, costs,

deductions made, and payments to carriers so that they are not over or underpaying for anything. It's important

part of keeping the bottom line. Regular

reconciliation pro protects against overpayments underpayments and compliance issues. The most important

compliance issues. The most important part of benefits reconciliation is for employers benefits or the HR team to audit carrier bills against your records

monthly and not just at renewal.

This type of audit ensures that terminated employees are not still on the bill after their termination date and that new hires are added to the plan and thus the billing at the right time.

It also helps to recognize whether the right employees and dependents are actually covered and the correct deductions are being taken for that coverage.

Automation in this area certainly reduces manual errors and frees H and HR and benefit staff up for other strategic work. The automation can set up systemic

work. The automation can set up systemic audit schedules and document your findings. It can also help communicate

findings. It can also help communicate directly with carriers to ensure fewer errors.

Benefits are only valuable when employees understand and use them appropriately. Effective engagement

appropriately. Effective engagement drives smarter healthcare decisions, reduces unnecessary costs, and improves satisfaction and retention.

Communication and education are the most valuable tool tools for all aspects of employee benefits. It provides ease of

employee benefits. It provides ease of understanding and enrollment, meets compliance requirements for documentation, and ensures that employers are in alignment with the

costs and expectations of the benefits they are offering.

Better benefits understanding correlates with appropriate use of those benefits.

For example, knowing where to go when you need medical attention, whether it be to your regular doctor, urgent care, or an emergency room. It also leads to

increased preventative care utilization.

Employees who understand the value of their benefits and that their employer cares are more likely to remain with their employer. Employee benefits are a

their employer. Employee benefits are a big part of employee recruitment and retention, saving employers a lot of time and money over the course of many years. Comprehensive benefits

years. Comprehensive benefits communication can increase overall job satisfaction scores even without changing benefit offerings.

Now, I'd like to turn it over to Keith Dolan to talk about why health care costs keep rising and what we can do to help alleviate this for employers.

Keith, >> thank you, Jen.

Seems like a simple question. Why

healthcare costs keep rising? I wish I had a simple answer. Um it's a complex uh problem that needs a solution and and

quickly understanding the forces driving healthcare cost increases is essential for developing effective migration strategies. These aren't

migration strategies. These aren't temporary fluctuations. They're

temporary fluctuations. They're structural pressures reshaping the benefit landscape.

You have economic pressures.

Medical inflation continues to outpace general inflation.

We have both provider and carrier consolidation that is limiting competition and increasing cost and limiting negotiating power uh by those who purchase the plans employers and

it's driving up reimbursement rates across the board. We're still feeling the pandemic aftermath.

Um in healthcare the pandemic a aftermath was delayed u because there was such delayed care during the pandemic. Combine that with the ramp up

pandemic. Combine that with the ramp up of deferred care and deferred uh surgeries, we're really just reaching the point where we're just starting to

outpace where we were precoid and some of the deferred care has deteriorated and increased the acuity and the severity of the conditions that our population are affected by.

We have an evolving workforce.

expectations of employees have never been higher both in asking employers to provide choice but also the comprehensiveness of the coverages that

we offer. As Jen had referred to,

we offer. As Jen had referred to, communication and education of the benefits that you as employers offer is critical. Not only for the appreciation

critical. Not only for the appreciation from the staff that you provide the coverage to, but also so that proper utilization occurs and that they all of

the coverages that are offered work in concert and in sync to minimize cost and increase satisfaction going forward.

Another large area of cost increase is in the pharmaceutical space. There have

been a number of breakthrough drugs that have been wonderful in treatment for specific conditions. But these come at

specific conditions. But these come at very high cost that needs to be spread across the population that affects that actually provides the coverage to a very

few. Um so in concept you know health

few. Um so in concept you know health insurance is built on the premise of the law of large numbers and spreading the

cost amongst many. The issue is that the cost for specific care that affects the few have out outpaced from an escalation standpoint the cost of the many. When I

first got into this industry, you know, we used to have an 8020 rule. And what

that said was that 20% of your population drove 80% of your cost. That

rule has escalated uh in today's world to now it's a 955 rule where 5% of your population is driving 95% of your cost.

And it becomes harder and harder to spread that cost across the larger population.

Understanding your cost drivers is important. We have a diverse population

important. We have a diverse population on this webinar, so I want to sort of address both populations. As a small employer under 100 employees in New York

State, you're in a community rated program for the most part. That's really

the the the market that's available to you. That market's cost is based on the

you. That market's cost is based on the population as a whole. So, you're rated on a geographical basis. Um, so the plans that you purchase with a carrier

are filed with New York State Department of Financial Services and you would pay the same thing, same rate for a plan as an employer next door if they purchase

the same plan from the same carrier. So

understanding what drives your cost is a little different and the focus needs to be on utilization and execution of effectively utilizing the plan uh for

your employees so that they appreciate the benefit and finding the right plans at the right price point. As a large employer you're actually cost is actually derived

by the utilization at a higher level. Um

so once you reach 100 employees your specific utilization as an organization affects your rate going forward. So

there it is critical to understand what your high-c cost claimments and condition categories are. Understanding

your pharmacy utilization patterns and where there are opportunities to drive cost savings. Making sure your

cost savings. Making sure your population is accessing the correct care from the correct vehicle. What I mean by this is taking advantage of tele medicine opportunities for routine care

and keeping folks out of the emergency room and urgent care centers and understanding how taking care of your preventative care lowers cost in your long term

cost reduction strategies that work.

Plan design optimization is critical when we're talking about plan design.

As folks continue to migrate to more and more consumer-directed health plans, meaning plans that have higher deductibles and cost shares may be HSA qualified or mitigated with a health

health reimbursement account. It's

important that you continually assess the correct deductible and out-of-pocket maximum attachment points and utilize

vehicles like HSAs or HASS to mitigate the employees exposure. Another method

for mitigating those exposures is offering additional benefits that act specifically to address some of those cost shares, whether it be a hospital

indemnity plan, an accident policy, or a critical illness coverage. These are

methods that employees can use in concert with an HSA to mitigate the exposure to both deductibles and out-of- pocket maximums.

Additionally, employers that are in the large group space should look at their network strategies and look to determine whether narrower networks may fit their

population to drive care to the lowest most optimal providers or do you need a more comprehensive package because of the national scale of your employment.

Self-funding has become more and more popular in the large group space. This

has provided a number of employers the ability to control their health care spend. Obviously, they're acting as the

spend. Obviously, they're acting as the insurance company when you become self-insured. Uh, and it's important

self-insured. Uh, and it's important that you understand the risks in doing that to both the volatility as well as as well as the financial liquidity on a

month-to-month basis.

That said, you are in now in control of your healthcare spend. So your

flexibility in design, network utilization and cost transparency increases. You can negotiate on your

increases. You can negotiate on your behalf on the pharmacy spend utilizing different pharmacy solutions and pharmacy benefit managers to optimize

your pharmacy spend and receive the lowest net cost.

In a self-insured environment, stop-loss insurance is critical to providing catastrophic protection to the plan.

Stop-loss insurance is designed to both provide incident or in coverage for an individual claim over a maximum as well as what we call aggregate which is on

the total spend of the organization.

But managing your stop-loss insuranceances is critical to managing the overall uh performance of your self-funded plan as stop-loss insurance

premiums increase dramatically and need to be marketed properly.

Which leads us into smarter vendor and program management. Overall, the the

program management. Overall, the the health care space and the benefit space in general has become more complex.

There are more point solutions.

There are more coverages that are integrated into the overall healthcare experience. And it's important that they

experience. And it's important that they are chose and integrate to provide a seamless integration to your employees as well as explained thoroughly so your

employees know how to utilize them at their most efficient nature. Virtual

care expansion has been a wonderful way to lower the out-ofpocket cost and the overall costs of your health care program. There are a number of virtual

program. There are a number of virtual solutions both in the primary care space as well in the mental health space that have increased access to care both in

rural and in white areas, white out areas that networks have previously been unable to provide providers. So provider

gaps are closed through these virtual solutions as well as increasing care in the mental health space for those that may have otherwise not seek care uh

because of stigmatisms and concerns.

Contract optimization is critical. We

need to make sure that you're receiving the lowest net cost of care at the highest efficiency. And so managing

highest efficiency. And so managing value and cost is important when you when determining what the best networks are. And as I mentioned, your overall

are. And as I mentioned, your overall importance of integrating all of the coverages and all of the vendors you use will create the most seamless and

efficient process for your employees.

Trends and takeaways.

So, as we end this webinar, we'd like to provide you with some emerging trends for the 2025 and beyond.

First, employers should expect some evolution in the current legislation.

For example, there may be continued ACA refinements, potential flexible spending expansion and evolving Orisa interpretation. In addition, mental

interpretation. In addition, mental health parity, as discussed earlier, the enforcement of mental health parody will likely advance, creating intensified

enforcement, fines, and penalties.

Next, uh technology integration will continue to improve. Um predictive

analytics and AI, as they are in many other areas, will likely transform benefits management by helping to forecast costs, identifying intervention opportunities, and personalizing

recommendations.

Personalization will continue to improve. The days of sort of a one-sizefits-all program are no longer in existence, and it's critical that we continue to provide the

actual solutions that a diverse workforce needs.

So, on to our action plan. What should

you do? Um, first and foremost, audit audit your compliance processes. As you

do other areas of your organization, make sure that you are in compliance with what is required around benefits offering um and benefits enrollment and benefits

requirements. Um update your plan

requirements. Um update your plan documents. Make sure that you are

documents. Make sure that you are working in concert with the carriers as well as your broker and make sure you understand exactly what you're responsible for and getting these

documents to your employees and eligible employees in a timely fashion.

You should also train your team, the team that's working with employees around the benefits area. Um, it's

always helpful to have them updated on some of the things that are going on.

It's important for them to be able to communicate the differences about the plans. It's important for them to be

plans. It's important for them to be able to communicate what's different from prior years. So, it's worth taking the time to train your team in advance of offering employee benefits.

>> Conduct claims analysis. If your costs are driven by your utilization, identifying your specific cost drivers before renewal and making sure that any

large claimments that may not apply going forward are taken out of the renewal calculations is critical to driving your costs down.

Evaluate plan designs. Looking at

alternative plan designs than sort of what what we've always had is important in continuing to migrate employees to the most optimal utilization of their

healthcare spend dollars while receiving the most efficient quality care that they can.

And lastly, audit your dependence. You

want to make sure that your plans are only covering those that you intend to cover. Uh any unnecessary coverage could

cover. Uh any unnecessary coverage could receive.

Before we get to our questions, just a brief word on benefit design and administrative services.

When thinking about benefit design, you want to streamline your process.

Obviously, the goal of all this is to reduce costs while providing the most comprehensive benefit to your employees.

And that is done by constantly evaluating the that that you're offering the correct plans to your population based on their needs of of the workforce.

We want to look for ways to drive efficiency. Uh as Jen mentioned,

efficiency. Uh as Jen mentioned, technology and AI is increasingly changing the dynamic in how we're administering benefit plans. Making sure

that we're leveraging technology to provide the optimal experience to your employees is critical.

We want to create ecstatic employees, making sure that we're constantly updating the benefits portfolio with the benefits that they're looking for, whether that be things like pet

insurance or other voluntary lifestyle benefits that increase the overall experience of your employees will increase retention and attraction of quality employees for you.

access to HR and benefits experts.

Leaning into the experts in in your area or advisors will continually keep you at the top of the game when it comes to offering your benefits package. This

environment changes constantly and should be updated year-over-year and continue to have a plan that starts well in advance of your renewal period.

Automate where you can. As we mentioned, technology from an open enrollment onboarding and benefits reconciliation will drive as much efficiency as you

possibly can in your program.

So, um, as a reminder, as we get into the questions, you can submit questions using the questions box that's part of the webinar console. uh we'll get to as many as we can during the time remaining

and if we don't get to your question we will absolutely follow up with you within the next day. So we did receive a few questions in advance. So we're going to start off with those and then I will

see if we have any additional questions coming in. So the first one I see is

coming in. So the first one I see is what are some incentives to encourage employees aged 65 and older to use Medicare rather than employer insurance?

Um, employers generally should not incentivize employees age 65 or over to drop or not enroll in employer provided group health coverage and instead

incentivize them to enroll in Medicare.

Should absolutely not do this, especially if the employer has 20 or more employees under the Medicare secondary payer rules, which again would take a whole other webinar to go through

those. Um but their rules that the

those. Um but their rules that the employer's group health plan must remain the primary payer for active employees age 65 or over. Employers cannot offer

financial or other incentives to encourage employees to drop their group health plan in exchange for Medicare.

Employees have the right to choose between staying on the employer plan or enrolling in Medicare. But the employer must not pressure or otherwise incentivize even for small employers under 20.

Although the pay structure is different between the employer plan and Medicare, employers still cannot force or incentivize Medicare enrollment. In

addition to the secondary payer rules, it's also could lead to other claims of discrimination based on age, which is a protected class. So, we would highly

protected class. So, we would highly recommend that um none of you out there are trying to encourage employees age 65 or older to enroll in Medicare over

their employer provided plan. Um

I see that we have another question. Um

are small employers required to offer health insurance and other employee benefits to all employees? Um well that it's it's often a choice but once we get

up to that 50 full-time employee mark um there are some obligation as we discussed earlier under the affordable care act um those employers with fewer

than 50 FTEEs are not required by law to offer health insurance or other employee benefits. Um, you should offer coverage

benefits. Um, you should offer coverage following the ACA guidelines if you are above that 50 mark, but otherwise employers may be flexible in what they choose to offer employees and how much

they want to contribute to employees.

Please note that employee benefits, especially health insurance, is one of the biggest recruiting and retention tools an employer can use. And it's

highly recommended that most employers try to determine an avenue in which they could offer health insurance at the very least or other employee benefits uh so long as it meets budgetary um

requirements internally.

Um next question. With all of the documentation and notice requirements discussed today, what is the best way to be sure that employees get everything they need and that employers are

compliant? Um, so I think we discussed a

compliant? Um, so I think we discussed a number of the items that employers are responsible for. Um, but like I said, I

responsible for. Um, but like I said, I think earlier, first and foremost, you should discuss with your benefits broker um or anyone who you're working with regarding benefits administration,

whether it be that that be your broker or HR consultant. You should determine which items they may be taking care of on your behalf. Um, you should also create a compliance calendar and track

deadlines and distribution for notices and make sure you're coordinating that with that additional um, outside help if you have it. Um, it's very important

that certain notices um, be received by employees, especially those that are enrolled in certain plans um, usually at least annually.

Um, but we, you know, generally speaking, I would recommend that you put together a state and federal notice packet that can contain many of the notices that are required. And I usually

recommend providing those to employees um, in line with the open enrollment process. It is it's timely. It meets

process. It is it's timely. It meets

compliance deadlines and um, if you do it annually, you will not forget to include that as part of your process. Um

don't forget however that there are certain other notices for example the the Cobra general notice or that initial notice that you give to employees um

which must be provided within 90 days of the employee independent becoming covered under the group health plan. So

having a calendar is probably the most critical piece of that but making sure that you coordinate efforts and make them a regular part of your benefits timeline is the best recommendation.

Um, I see another question here. Um,

what are common employee benefits that can be offered for all employees? So,

you know, as Keith mentioned, you know, health insurance is certainly rising and we don't often provide benefits for all employees, including part-time employees. But what we're seeing for

employees. But what we're seeing for more for recruiting and retention are that many employers of all sizes are choosing to offer wellness programs, which is usually some combination with

their health plans or otherwise, or other programs to get employees invested in their own personal health journey.

That could be as simple as signing up to be part of a race as part of your organization or tracking your certain uh health programs and projects um in order

to earn points for prizes. Um another

popular benefit is an employee assistance plan. Um this is something

assistance plan. Um this is something that provides great value to employees at a somewhat minimal cost for employers. It provides everyday

employers. It provides everyday consulting for employees on a number of areas in their life, including employment financial legal and wellness. And it's provided by an

wellness. And it's provided by an outside vendor who can assist employees in better managing some of life's everyday challenges. And of course, we

everyday challenges. And of course, we know people that have healthy home lives generally are more productive at work.

So, it's often, you know, a great uh incentive for employers to pro provide this type of plan. Um, Trevor, are there any other questions that have come up that we should get to now?

>> Uh, no other questions, Jen. I think

we've covered everything.

>> All right.

So, um, with no more questions, that's all the time we have. Thank you for joining me, Keith, and for sharing your expertise.

If any of you on the webinar have any additional questions about benefits compliance, feel free to contact me directly. If you're interested in

directly. If you're interested in learning more about GTM's HR or benefit services, you can contact Keto Delgado.

Our contact information is up on the screen. Um, once again, thanks for

screen. Um, once again, thanks for joining us and be sure to look out for that email with a link to the video recording and a PDF version of today's presentation. Have a great rest of your

presentation. Have a great rest of your day. Thank you. Bye now.

day. Thank you. Bye now.