By Joshua Weinstein
Who doesn’t want to pay half for their health plan? What if it came with lower out-of-pocket costs if you were to get ill or injured? On top of that, you can use any provider of your choice! Too good to be true? Well, you know the saying. It probably is. Welcome to the world of alternative health plan arrangements.
Since passage of the Affordable Care Act (ACA) in 2010, health plans have changed. Categories of “Essential Health Benefits” were defined, and dollar-based maximums were prohibited. Denying coverage or claims because of pre-existing conditions was banned. Preventive care had to be covered “in full”, and the list of changes goes on. As a result of these mandates and consumer protections, rates, in general, rose. While most Americans receive their medical coverage through their employers, others get it through governmental plans, such as Medicare or Medicaid. Many are eligible for and receive subsidies to afford individual and family plans on the newly created Marketplaces, which sell Qualified Health Plans that meet these law’s requirements. However, some Americans fall through the gaps and don’t have access to affordable health coverage. Enter alternative plans.
Even prior to the ACA, health sharing plans existed. They are not health insurance, though. In these arrangements, members share each other’s health care costs. To cover these costs, members pay a monthly share amount (similar to paying a health insurance premium) and must pay for their own expenses up to a certain amount (similar to a deductible). After members pay their personal responsibilities, any remaining expenses are split between other members. Many health care cost-sharing arrangements offer different membership options to fit the needs of both individuals and families. Unlike the ACA compliant plans mentioned above, sharing plans are not subject to the law’s requirements. For example, they may deny membership to those who smoke, have a pre-existing condition or live a certain lifestyle. So, there’s lots of fine print to see what’s “shared” in the event of a covered illness or injury.
In the case of sharing plans, new entrants to the market have begun connecting sharing plans with limited supplement plans and they are being proposed to employers as ways to cover employees’ healthcare expenses for less money. Many are sponsored by associations of small businesses that were formed for the purpose of promoting and selling these arrangements. After reviewing a few of the designs, they don’t cover lengthy bouts with chronic conditions. For example, one only covers four months of medications and has a limited chemotherapy benefit. They usually do not provide preventive benefits, behavioral health, or rehabilitative therapies. What’s more is that the dreaded pre-existing condition exclusions and waiting periods are rampant throughout the plan documentation. They are marketing to look like traditional arrangements, and the Alaska Division of Insurance is actively investigating some of these programs for multiple reasons. Again, they are comprised of little, if any, insurance. That implies the companies sponsoring them have no fiscal requirements, regulations to follow, or other statutory appeal review obligations if a claim isn’t covered.
Other alternative health arrangements include short-term medical plans, “skinny plans”, mini-med plans, MEC plans, supplemental benefit plans, and more. There are ways to provide health benefits outside of the confines of the ACA, but the purchaser should be informed about what is or isn’t covered.
In closing, talking with a licensed health benefits consultant about your situation may yield surprising results. You may find that there are regulated, comprehensive insurance options in your reach. On the other hand, if ACA-regulated coverage isn’t an option for you, due to your budget, beliefs, or interests, I suggest diligence in checking the fine print and scouring the internet for reviews of how the specific alternative plans have performed for other purchasers. Going into one of these plans with reasonable expectations and “eyes wide open” is the best advice I can offer.
By Bailey Penrose
My first job out of college involved an office full what felt like an endless maze of cubicles. This particular company had a fun little slogan for employee promotion, “working toward the light”, as the high-ranking employees got actual offices that were cream carpeted, lit with warm yellow light, and located next to the windows. As a lowly intern, my cubical was about 5 rows in from a window and I was one of the lucky ones – at least I had a tantalizing glimpse of daylight bouncing off the ceiling along with the fluorescent strip lighting. My manager, who was tall enough to see over the cubicle walls, would stand and crane his neck to give me periodic weather updates out of pity for my diminutive size.
A couple of things to learn from this anecdote: 1) it pays to be aware of commonly used phrases in your company as they give a good glimpse of the company culture, the good AND the bad, 2) office environment does factor in to employee satisfaction as well as productivity.
Let’s dive into the first issue, phrases that are used in-company that hint at culture. “Working toward the light” started as a joke, even the executives who had achieved the pinnacle of interior lighting used it when meeting new employees. What the management team may not have realized is that the jokiness of the phrase did not last and instead started to draw attention to a perceived inter-office class system. That sounds dramatic, but the saying had stopped implicitly sounding like “work hard and you too can achieve this really awesome office space” and instead started sounding like “management doesn’t care and won’t even give me a fricken’ lamp”. The phrase had become a kernel of contention and no one in the C-Suite was having a light-bulb moment. (Sorry, I couldn’t resist.)
Culture expresses itself in attitudes and behaviors that are reinforced on a daily basis. Because culture is an ongoing thing that happens constantly it’s really hard to call out flashpoints. Companies should focus on culture markers (shared values, goals, and language) as a way to gauge employee engagement, and ultimately the bottom line. Communication and trust are essential to course correcting. Employees want to feel like their employer hears them and know that they won’t be penalized for voicing a concern. A positive office culture is a major driver in successful organizations.
Let’s look at the second issue, office environment and its effect on employees. I think everyone understands that it’s not feasible or cost-effective for a company to remodel their entire office plan so that all employees get a window, a standing desk, a top-of-the-line air purifier, what-have-you. However, there have been studies that show correlation between light and an employee’s productivity (please reference the articles listed below). Small efforts on a company’s part to improve their employee’s workspace will go a long way to fostering good will internally as well as driving up productivity thanks to focused employees. Some options may include the employer reimbursing $20 for a desk lamp or HappyLight, setting up a communal computer station where employees could stand to work when they wanted, or ensuring that at least one conference/lunch/break room had access to natural light. Effort, small or large, can be rewarded in big ways.
The Lifecycle of an EEOC Charge
August 22, 2019 | 10:00 AM – 11:00 AM AKDT
The EEOC charge is the first step in an employee’s march towards litigation. Responding to charges with an organized and thoughtful approach can significantly minimize employer liability. This webinar will review the lifecycle of the EEOC charge from the most common charge allegations to the most common administrative hurdles to the right to sue letter and everything in between.
Here is the registration link- The Lifecycle of an EEOC Charge
By Natasha Kwachka
Have you ever pondered why we, as people, respond or react to certain scenarios in the way that we do? What compels one to respond positively or negatively? What is the driving force behind a meltdown or calmly working your way through a tough situation? I believe we all have so many reasons that cause us to respond or react to different stresses and pressures. How do we respond versus react? Where does the strength come from to slow down and think through a response before you react in a poor manner?
More than I would like to admit, I can think of a time or two that I personally had a full on meltdown at the world around me. Lashing out at the driver in front of me for pumping the breaks last minute. Becoming frustrated as my kids take their time getting into the car knowing that we are already 30 minutes late. These are some of the smaller frustrations. It was my reactions to common day-to-day life events that caused me to take a look inward.
Over the past two years I have spent some time focusing on why I react poorly and why don’t I change that behavior? Change is tough, it takes practice and dedication. Programming your brain can feel like your lost in a maze, it is and always will be a work in progress. We as people will likely never fully master this. We all have breaking points that bring out the worst. What we can master though is our due diligence to slow down and think. In doing so, I have witnessed a change in how I interact with my colleagues and my family. Slowing down, looking inward, has made this thing called life much easier. My best thoughts are put forth and the negative thoughts are laid to rest. Most of the time, let’s be honest, this is truly a work in progress. Reacting is triggered from our subconscious mind, therefore not allowing you time to process, the reaction becomes instinctual. Responding allows you to take control of the next step. Take a moment, think through the pros and cons and thoughtfully plan your response, there is power in your words.
Today I encourage you to stop collect your thoughts, process your feelings before any response is given. Get up and walk the hall at work after finding out you have re-do that report you recreated 5 different times this week alone. Ask yourself what your desired outcome would be to anything coming your way? Empower and challenge yourself to connect with your higher purpose in all you do. Slow down and discover the power in your response. Let this be a challenge to find the greatness you have within and to give the world around you the best you. That you that brings to the table those amazing ideas, thoughts and strategic responses.