What President Biden’s Vaccine Mandate Means for Employers
This article is from RISQ Consulting’s Zywave client portal, a resource available to all RISQ Consulting clients. Please contact your Benefits Consultant or Account Executive for more information or for help setting up your own login.
President Joe Biden’s administration is continuing its efforts to curb the COVID-19 pandemic and the spread of the deadly coronavirus Delta variant. Recently, the White House ordered all federal workers and contractors to get vaccinated against COVID-19. Now, the government is imposing a similar requirement on private employers. The move is estimated to affect over 80 million private-sector workers.
The Occupational Safety and Health Administration (OSHA) has been tasked with drafting an emergency temporary standard (ETS) and will announce more specifics in the coming weeks. Soon, employers with 100 or more employees will need to adapt their vaccine policies to comply with these new rules.
This article discusses this latest vaccination mandate, including its scope and how it may affect employers.
Note: This is a developing issue. Information will be updated here and in subsequent resources as more details are released.
Rule Overview
Soon, employers with 100 or more employees (measured companywide, not by location) will need to enforce one of the following:
- Require employees to get vaccinated against COVID-19
- Require unvaccinated employees to produce evidence of a negative COVID-19 test each week
This flexibility allows employers to choose how strictly they want to enforce a vaccine mandate. In other words, some employers may decide to make vaccination a condition of employment; others may only require negative COVID-19 tests.
What’s Known About the Upcoming Rule
OSHA is tasked with drafting the new rule. As such, there will be few details available before OSHA publishes a definitive ETS. Meanwhile, the only pertinent information has come from short government briefings.
Here’s what’s known about the upcoming rule, keeping in mind these particulars may change in time:
- The rule will only apply to employers with 100 or more employees, measured companywide.
- Employers will be able to decide if they want to adopt a strict, mandatory vaccination policy or allow testing as an alternative.
- Employers must provide paid leave to receive and recover from vaccinations.
- Remote employees not working in contact with others will be exempt from the ETS (unless they come into the workplace).
Again, all aspects of this upcoming rule are subject to modification as OSHA continues to work on the details. The above information is provided to help employers understand how the government is proceeding in this area.
What’s Unknown About the Upcoming Rule
Much is still unknown about the upcoming vaccine requirement, and it will remain as such until OSHA publishes the ETS. Here are just some of the questions that remain to be answered:
- When will the ETS begin being enforced?
- What qualifies as proof of vaccination or a negative COVID-19 test?
- Who must pay for weekly testing?
- What specific penalties will there be for noncompliance?
- Will the mandates apply to part-time workers?
- Will there be new guidance on how employers should handle accommodations for employees seeking an exemption?
- Must paid leave be provided for employees’ COVID-19 testing, as it is for vaccinations?
As the list illustrates, there are many unknown factors at this time. Employers will need to stay tuned for updates from OSHA as they come; however, that employers can take action in the meantime.
Expected Enforcement Timetable
The vaccination mandate will come in two primary waves:
- An ETS with comprehensive details and actionable steps
- A permanent OSHA standard with all aspects fleshed out
First, OSHA will publish its ETS that will include important details and enforcement guidelines. This is expected to come in the weeks ahead; however, an actual release date is uncertain. Once issued, the ETS will take immediate effect in states where federal OSHA has jurisdiction. In states where the federal government does not have jurisdiction over workplace safety, state agencies will have to either adopt the ETS or develop their own ETS within 30 days that is “at least as effective.”
An ETS can only remain in effect for six months. After that time, it must be replaced by a permanent standard, which must undergo a formal rule-making process involving a notice-and-comment period to allow stakeholders to submit feedback. This process follows the usual procedure for adopting a permanent standard except that a final ruling should be made within six months from that date OSHA publishes the ETS in the Federal Register.
In summation, employers can expect the ETS sometime within the year, but its specifics may ultimately change as the standard is finalized.
What Employers Can Do Now
While many details are still unknown, the primary vaccination or testing requirement is definite. As such, employers can at least prepare for this aspect of the mandate. Here are some actions employers can consider when preparing for the upcoming requirement:
- Determine whether COVID-19 vaccination will be required as a condition of employment or if weekly negative testing will be an alternative.
- Consider how to handle accommodation requests for those seeking vaccination exemptions.
- Start planning an employee communication campaign to educate workers about vaccine policy changes.
- Think about the systems needed to adequately track employee vaccination statuses and confidentially secure the data.
- Plan for potential staffing shortages or scheduling changes to afford employees time to get vaccinated.
- Consider whether partitions or spaced-out workstations will be utilized
This list is nonexhaustive, as certain considerations will be unique to individual employers.
Though the ETS will almost certainly face multiple legal challenges, employers should not count on the rule being entirely struck down and should begin preparing to comply as soon as possible.
Conclusion
The specifics of this latest vaccine mandate are still being drafted, so its rules may seem like a distant concern; however, these requirements will take effect quickly once they’re announced. Employers will need to act swiftly when the time comes to ensure compliance. Taking proactive steps now can help save employers from a scramble at the end of the year.
Reach out to RISQ Consulting to discuss how this new rule may affect your business. In the meantime, stay tuned for updates as this situation develops.
- Published in Blog
Zodiac Signs in the Workplace
By Taylor Brouillet-Stock, Account Specialist
Have you ever had an instance when you didn’t get along with a coworker? Well, maybe it was because they’re a Taurus and you’re an Aries! Just kidding, that’s not entirely how astrology works. Astrology has become a contentious topic of discussion as its popularity has grown over the years. People often wonder, does astrology somehow control our fate? Or is this just a bunch of bologna? Whether you believe in astrology or think it’s straight up nonsense, it can be a very interesting topic to learn about and can invite us to learn more about ourselves and others (like the people we work with). Plus, it’s just plain FUN!
Check out below what your zodiac sign is along with a few strengths, weaknesses, and general overview of each sign in the workplace.
Aries (March 21-April 20)
- Strengths: Courageous, confident, determined, passionate, energetic
- Weaknesses: Impatient, short-tempered, impulsive
- In the workplace: Aries are the first of the zodiac, therefore, they have a desire to be first at everything and are natural born leaders who are fiercely competitive. In the workplace, they are often gamechangers and are a great force. However, it can be important for this sun sign to remember to be patient and to not overstep boundaries.
Taurus (April 21-May 21)
- Strengths: Patient, reliable, responsible, practical
- Weaknesses: Stubborn, possessive, greedy
- In the workplace: People born under this sun sign are often known as “the rock of the workplace”. They value their security and stability and are known for being dependable and reliable in the workplace. You can typically count on a Taurus to be unfazed by potential emotional turmoil that may easily cloud other’s vision.
Gemini (May 22-June 21)
- Strengths: Curious, adaptable, versatile, intellectual
- Weaknesses: Inconsistent, indecisive, superficial
- In the workplace: Geminis have been known to be “the most delightful to work with”. This sun sign is ruled by Mercury, so they value communication. The symbol of Gemini is the “twins”, which can make them seem “superficial” at times as they may act different in different surroundings. However, it’s important to keep in mind that this sign is very adaptable to its surroundings and can vibe with anyone.
Cancer (June 22-July 22)
- Strengths: Loyal, sympathetic, persuasive, imaginative
- Weaknesses: Manipulative, pessimistic, clingy
- In the workplace: Cancers are very much in tune with their own emotions, as well as other’s emotions which can make them a very caring co-worker. The symbol for Cancer is a crab, which reflects how Cancers can sometimes be very guarded (like how a crab’s shell provides protection) which makes it hard to let their true personality shine through.
Leo (July 23-August 21)
- Strengths: Generous, humorous, cheerful, creative
- Weaknesses: Arrogant, bossy, inflexible
- In the workplace: Leos are often known as the “king of the office jungle” as their symbol is the lion. Leos thrive on the energy of others and have the ability to bring their own enthusiasm to the workplace. Leos are ruled by the Sun, so they are the center of their own universe which can make it quite easy to bruise a Leo’s ego.
Virgo (August 22-September 23)
- Strengths: Analytical, hardworking, practical, diligent
- Weaknesses: Shy, overly critical of self and others, perfectionist
- In the workplace: Virgos are known as the “diligent, silent soldiers” in the workplace. They are intelligent, however they typically over-think, over-worry, and over-work themselves. In addition, Virgos can sometimes come off as very critical of others.
Libra (September 24-October 23)
- Strengths: Cooperative, fair-minded, diplomatic, easygoing
- Weaknesses: Avoids confrontations, indecisive, holds a grudge
- In the workplace: The symbol for Libra is the scales and because of this, Libras value justice and balance. They are often known as the “unifying force of justice” in the workplace as they are usually unbothered by others and are known to be unbiased and very fair. However, at times, a Libra’s confidence in their judgment can be overpowering and can end up clouding their judgment.
Scorpio (October 24-November 22)
- Strengths: Brave, passionate, resourceful, determined
- Weaknesses: Jealous, secretive, distrusting
- In the workplace: Just like a scorpion (the symbol for this sun sign) Scorpios are the people at work that you don’t want to mess with. However, on the plus side, they can accomplish anything due to their drive, determination, passion, and their resourcefulness.
Sagittarius (November 23-December 22)
- Strengths: Generous, idealistic, optimistic, straightforward
- Weaknesses: Impatient, careless, irresponsible
- In the workplace: Sagittarians have been known to be a “ray of sunshine in a windowless office”. They are often very optimistic and adventurous. However, there are times when this sun sign takes things too far and can get caught up pursuing a good time.
Capricorn (December 23-January 20)
- Strengths: Responsible, disciplined, practical, careful
- Weaknesses: Pessimistic, know-it-all, unforgiving
- In the workplace: Capricorns are often very efficient and helpful in the workplace. You can count on them to be responsible and practical. Capricorns value stability and order which is often reflected in their work. At times, Capricorns may come off as a know-it-all, however they just might actually know it all.
Aquarius (January 21-February 19)
- Strengths: Independent, humanitarian, original, progressive
- Weaknesses: Avoids emotional expression, temperamental, uncompromising
- In the workplace: Aquarians are known as one of the most “good-natured of the bunch”. Due to their independence and originality, they often isolate themselves and they have sometimes been known to set double standards.
Pisces (February 20-March 20)
- Strengths: Compassionate, artistic, gentle, wise, intuitive
- Weaknesses: Overly trusting, fearful, desire to escape reality
- In the workplace: Pisces are the “babies” of the zodiac signs and are often a “mix” of all zodiac signs. This makes Pisces very intuitive of others which can them more aware of how other people are feeling. Like Cancer, this makes for a very caring and emotionally intelligent co-worker.
So, what does all this mean? Well, that’s for you to decide! It Of course, this is a very general overview of each zodiac sign, and it may not reflect exactly who you are as a person. If you want to learn more, I suggest doing more research into your sun sign (and possibly your entire birth chart, but that’s a whole different conversation).
Whether you believe any of this to be true or not, it’s always beneficial to seek a greater understanding of our strengths, weaknesses, and how we may act in the workplace. It can also help to understand our coworkers better, which may help to create better relationships with those people. Let’s be honest, if you’re going to spend 40 hours a week with people, don’t you want to get along with them? Even if they are a Taurus and you’re an Aries…
Websites used:
https://www.monster.com/career-advice/article/astrology-sign-work-life
- Published in Blog
Are You Prepared? Tsunamis.
This article is from RISQ Consulting’s Zywave client portal, a resource available to all RISQ Consulting clients. Please contact your Benefits Consultant or Account Executive for more information or for help setting up your own login.
Tsunamis, also known as seismic sea waves (mistakenly called “tidal waves”), are a series of enormous waves created by an underwater disturbance—such as an earthquake, volcanic eruption or meteorite. A tsunami can move hundreds of miles per hour in the open ocean and smash into land with waves as high as 100 feet or more.
From the area where the tsunami originates, waves travel outward in all directions. As the wave approaches the shore, it builds in height. The coastline and ocean floor landscape will influence the size of the wave. There may be more than one wave, and succeeding waves may be larger than the ones before. That is why a small tsunami at one beach can be a giant wave a few miles away.
All tsunamis can be dangerous, even though they may not damage every coastline they strike. A tsunami can strike anywhere along most of the U.S. coastline. The most destructive tsunamis have occurred along the coasts of California, Oregon, Washington, Alaska and Hawaii.
Earthquake-induced movement of the ocean floor most often causes tsunamis. If a major earthquake or landslide occurs close to shore, the first wave in a series could reach the beach in a few minutes, even before a warning is issued. Areas are at greater risk if they are less than 25 feet above sea level and within a mile of the shoreline.
Drowning is the most common cause of death associated with a tsunami. Tsunami waves and the receding water are very destructive to structures in the run-up zone (the area where waves come onshore). Other hazards include flooding, contamination of drinking water and fires from gas lines or ruptured tanks. Review the following guidance to properly prepare for and respond to a tsunami.
Know the Terms
Familiarize yourself with these terms to help identify a tsunami hazard:
- Warning—A tsunami warning is issued when a tsunami with the potential to cause widespread flooding is imminent or expected. Warnings alert the public that dangerous coastal flooding accompanied by powerful currents is possible and may continue for several hours after it arrives. Warnings also alert emergency management officials to take action for the entire tsunami hazard zone. Appropriate actions local officials should take may include evacuating low-lying coastal areas and repositioning ships to deep waters while there is time to safely do so. Warnings may be updated, adjusted geographically, downgraded or canceled. To provide the earliest possible alert, initial warnings are normally based only on seismic information.
- Advisory—A tsunami advisory is issued when a tsunami that can cause strong currents or waves dangerous to those in or very near the water is imminent or expected. The threat may last for several hours after initial arrival, but significant flooding is not expected for areas under an advisory. Appropriate actions for local officials to take may include closing beaches, evacuating harbors and marinas, and repositioning ships to deep waters while there is time to safely do so. Advisories are normally updated to continue the advisory, expand/reduce affected areas, upgrade to a warning or cancel the advisory.
- Watch—A tsunami watch is issued to alert emergency management officials and the public of a tsunami event that may later affect the watch area. The watch area may be upgraded to a warning or advisory—or canceled—based on updated information and analysis. Therefore, emergency management officials and the public should prepare to take action. Watches are normally issued based on seismic information without confirmation that a destructive tsunami is underway.
- Information statement—A tsunami information statement is issued to inform emergency management officials and the public that an earthquake has occurred, or that a tsunami warning, watch or advisory has been issued for another section of the ocean. In most cases, information statements are issued to indicate there is no threat of a destructive tsunami and to prevent unnecessary evacuations. An information statement may, in appropriate situations, caution about the possibility of destructive local tsunamis. Information statements may be re-issued with additional information, though normally these messages are not updated. However, a watch, advisory or warning may be issued for the area, if necessary, after analysis and updated information becomes available.
Before a Tsunami
The following are things you can do to protect yourself, your family and your property from a tsunami:
- Build an emergency kit and develop a family communications plan. Share these resources with all members for your household.
- Talk to everyone in your household about what to do if a tsunami occurs. Create and practice an evacuation plan for your family. Be able to follow your escape route at night and during inclement weather. You should be able to reach your safe location on foot within 15 minutes. Practicing your plan makes the response more of a reaction, thus requiring less thinking during an actual emergency.
- Know your community’s warning systems and disaster plans, including evacuation routes.
- Know how high above sea level your street is, as well as how far from the coast or other high-risk waters your street is located. Evacuation orders may be based on these numbers.
- If you are a tourist, familiarize yourself with local tsunami evacuation procedures. You may be able to safely evacuate to the third floor or higher in reinforced concrete structures.
- If an earthquake occurs and you are in a coastal area, turn on the radio, watch the television or check your phone to find out whether there is a tsunami warning.
During a Tsunami
- Follow any evacuation orders issued by authorities. Take your animals with you.
- If the school evacuation plan requires you to, pick your children up from school or from another location. Be aware that telephone lines during a tsunami watch or warning may be overloaded, and routes to and from schools may be jammed.
- Move inland to higher ground immediately. Pick areas 100 feet above sea level or go as far as 2 miles inland, away from the coastline. If you cannot get this high or far, go as high or far as you can. Every foot inland or upward may make a difference.
- Stay away from the beach. Never go down to the beach to watch a tsunami come in. If you can see the wave, you are too close to escape it. If the water is noticeably receding away from the shoreline, move away immediately. This is nature’s tsunami warning.
- Always prioritize saving yourself, not your possessions.
- Remember to help your neighbors who may require special assistance—such as infants, elderly people and individuals with access or functional needs.
After a Tsunami
- Return home only after local officials tell you it is safe. Tsunami waves may continue for hours. Do not assume that after one wave the danger is over—the next wave may be larger than the first one.
- Go to a designated public shelter if you have been told to evacuate or you feel it is unsafe to remain within your home.
- Avoid disaster areas. Your presence might interfere with emergency response operations and put you at further risk from floods.
- Stay away from debris in the water—it may pose a safety hazard to people or pets.
- Check yourself for injuries and get first aid as needed before helping other injured or trapped individuals.
- If someone needs to be rescued, call professionals with the right equipment to help. Many people have been killed or injured trying to rescue others.
- Help people who require special assistance, such as infants, elderly people, those without transportation, people with access and functional needs and large families who may need additional help.
- Use a National Oceanic and Atmospheric Administration Weather Radio, a Coast Guard radio station or a local radio or television station for the latest updates.
- Stay out of any building that has water around it. Floodwater can cause floors to crack or walls to collapse.
- Use caution when re-entering buildings or homes. Tsunami-driven floodwater may have damaged buildings where you least expect it. Carefully watch every step you take.
- To avoid injury, wear protective clothing and be cautious when cleaning up after a tsunami.
RISQ Consulting is committed to helping you and your loved ones stay safe when disaster strikes. For additional risk management guidance, contact us today.
- Published in Blog
Expectation vs. Reality – The Digitization Dilemma
By Andrew Kupperman, Employer Services and Workforce Technology Consultant
When an Employee starts working with an Employer, there are a variety of different expectations that go into forming that Employee/Employer relationship. For example, the Employer is going to expect the Employee to show up to their job and do the work asked of them. Correspondingly, the Employee is going to expect to be compensated for the work that was asked of them. These are the basic expectations at the heart of every Employee/Employer relationship, but they set a very important tone for all other expectations derived from this ongoing relationship.
Additional relationship building expectations include the Employer providing the Employee the tools, resources, and training to be able to do the work that is asked of them. In many organizations, one tool in particular – technology – often creates friction in the Employee/Employer relationship. There are a lot of reasons why this occurs.
CAPABILITIES
Workplace technologies don’t typically have comparable capabilities to the technology we all use daily in our personal lives. In fact, when looking at some capabilities in workplace technology, you could probably go back 5, 10, or even 15 years to see those capabilities being released for personal use. Don’t get me wrong, I know there are thousands (yes thousands) of technology vendors trying to close this gap for workplace technology, but because these gaps still exist, there is a gap that exists in what the Employee expects from their Employer, which can strain the relationship. This is especially true for younger workers just entering the workforce.
BRIGHT SHINY OBJECT SYNDROME
More often than I’d personally like to see, organizations decide to purchase and implement new technology just because of a cool demo someone saw. A word to the wise: the demo isn’t how your organization is going to receive that technology out of the gate – it needs to be built and implemented in order to eventually get there.
If you’ve ever seen Jason Averbook speak (the CEO and Founder of Leapgen, an organization that consults around workforce technology with Fortune 500 and very large global organizations as well as a thought leader in workforce technology space), he often discusses the difference between implementing technology and an organization successfully digitizing its processes. He uses a formula to describe that the digital equation for success includes 20% organizational mindset about digitizing, 25% of the people (ie: Employees) involved in using technology, 45% of understanding and aligning processes, and only 10% of the actual technology system, which is just the tool being used.
I know organizations want to be able to adopt and use technology like we do in our personal lives. But most organizations are big, clunky, and slow moving, so it’s hard to just try out a new technology tool and then scrap it a few days later because you don’t like it (like we do with apps on our phone). In most organizations, operating in such a manner would be fiscally irresponsible and cost them tens of thousands of dollars annually, if not more.
OWNERSHIP
Lastly, an organization leadership often owns the technology selection, implementation, and workflow processes. Again, there is an expectation in the Employee/Employer relationship here, as the Employer provides the Employee with the technology. There will be times that the leadership delegates these components to different areas of the business (for example when looking at finance, HR, or operational technologies). However, in doing so, they unknowingly create silos within the organization and don’t strategically think about how adopting these new technologies can impact other areas of a business.
An even more unfortunate scenario is when only one or two of those components are delegated (maybe the implementation or workflow processes). By not including key stakeholders in the selection process, an organization opens itself up in failing to meet the goals set out for adopting that technology. I understand and agree that the leadership often needs to be involved from a budgetary standpoint, but by not looping in those stakeholders to help select the technology they’ll be working in, it can be like forcing people to use those bloatware apps that come preinstalled on your new smartphone… but that no one ever end up using. This too can strain in the Employee/Employer relationship.
SOLUTION
There are definitely other reasons why the expectations around workplace technology can create friction, but the crux of the issue (at least as I see it), involves Employers not being strategic enough in considering the people and processes currently involved when they first set out to adopt new technology. They naively expect an instant and miraculous return on investment from their Employees who are using that technology. Employers need to remember that most people are innately change adverse, and not considering them when forcing change upon them is more likely to end in poor experiences for everyone.
The solution seems simple. Employers should find ways to involve and empower their Employees when it comes to providing technology to them. If Employers can find a way to give Employees the opportunity to be involved in selection and allow them to experiment with technology like they do in their personal lives (if the Employer’s budgetary needs are considered), this will create buy in and will lead to success when meeting organizational goals relative to adopting new technology. It is a bit of a mind shift based on the expectations as part of the predicated Employee/Employer relationship, but by creating the ownership and accountability for Employees, you’re also creating more ENGAGED Employees.
- Published in Blog
Ring-Ring, Your Future Career Calling
By Tiffany Stock, Director of Marketing & Client Relations | Employee Benefits Consultant | Partner
I know it may be hard to believe, but there isn’t a never-ending flow of resumes and applications coming in for people looking to get their foot in the door to start a career in insurance. In my almost 14 years in this industry, I can say I have only met one person who said they knew they wanted to work in insurance when they were growing up – I know, again, hard to believe [insert sarcastic face here]. I mean, I went through a few phases and thought I wanted to be a doctor, a graphic artist, or work in advertising – but never once did I think I’d work for an insurance brokerage and consulting firm.
Back in 2008, I had just had my second daughter and was working for an advertising and consulting firm. It was a small agency owned by a husband and wife, which was perfect for that time in my life. Being a small agency, I had my hands in a little bit of everything and got to meet a lot of people. But once I had two young children at home, I started to feel like if I was going to be away from them for forty+ hours per week, then I needed a job with more of a career path, room for growth, and new opportunities to learn. I hate to say it, but I was BORED. So, I updated my resume and started surfing the internet looking for open positions (I know that statement just dated me😊).
I came across an ad on Craigslist for an administrative position, no company name shown, and it was posted by a staffing agency saying something like, “Are you looking for a new career? Do you like creating presentations and working with a team? Opportunities for growth…” you get the picture. So, I submitted by resume and got through a few rounds of interviews, one of them ended up being a lunch interview at Pizza Plaza! Well, I got the job! I remember many times in the first few years, the then President of the company would check in with me to make sure I wasn’t “bored.” And I can say, there is not one time since I started in this industry where boredom has set in!
There are many different types of insurance, so I’m going to narrow down the focus to where my experience and opinions lie, in the Employee Benefits realm. Think of all the types of benefits you might look to an employer to provide you with (or at least provide access to). All types of insurance are highly regulated, and employee benefits is no exception. Both from the state and federal level, Health & Human Services, Department of Labor, Internal Revenue Service, State Divisions of Insurance, etc. all have a part in the rules and regulations surrounding the benefits you can get from your employer. There is so much to learn and just when you think you may have “mastered” something, a new piece of legislation gets passed, or a new product is introduced – there are never-ending learning opportunities in this field. And if you find a particular type of product or program that interests you, there is plenty of room to become a “specialist” in that topic.
You get to meet A LOT of different people, from local family-owned business owners, to boards of directors, people representing all sectors of our economy, from Presidents and CEOs, down to entry-level staff. At the end of the day, my job is to help employers know what their options are and help them evaluate those options to ensure those benefits align with their goals and objectives. Then, I facilitate making sure that their employees know what is available to them and be there as a resource to help them make the most of it.
One of the best things about my job is when I know I have helped someone. Insurance is a tool to help with financial protection. In the case of health or life insurance, you hope people never have to use it, but if they do or think they may, I hope I’ve made sure all my clients and their employees know we are here to help them navigate those difficult times.
It’s not all great, but I’m not sure of any job that doesn’t have its fair share of ups and downs. Let’s get real, it can be tough working in an industry that is so highly regulated, especially in a state that has some of the highest healthcare costs in the country. Things don’t always go the way we want or the way we hope, so during those times it’s so important to make sure you have a great work-family. Having an awesome team that supports you and an employer that has your back is crucial when those tough times come along. When I think of my team and the traits that make us successful, like being intellectually curious, self-motivated, a team player, and always looking for ways to make things better, the sky is the limit.
So, if you know of someone looking for a new career path, send them our way. Retirement is still in the distant future for me, but there is no better time than now to start looking for the person who can fill my shoes when that time comes. It may not be the career most kids dream of, but it certainly enables me to live the life most adults dream of!
- Published in Blog
What You Need to Know About the Biden-Harris Administration’s Actions to Prevent Surprise Billing
This article is from RISQ Consulting’s Zywave client portal, a resource available to all RISQ Consulting clients. Please contact your Benefits Consultant or Account Executive for more information or for help setting up your own login.
On July 1, 2021, the Biden-Harris Administration, through the U.S. Departments of Health and Human Services (HHS), Labor, and the Treasury, as well as the Office of Personnel Management, issued “Requirements Related to Surprise Billing; Part I,” an interim final rule with comment period that will restrict surprise billing for patients in job-based and individual health plans and who get emergency care, non-emergency care from out-of-network providers at in-network facilities, and air ambulance services from out-of-network providers.
This first rule implements several important requirements for group health plans, group and individual health insurance issuers, carriers under the Federal Employees Health Benefits (FEHB) Program, health care providers and facilities, and providers of air ambulance services.
What is a surprise medical bill?
When a person with a group health plan or health insurance coverage gets care from an out-of-network provider, their health plan or issuer usually does not cover the entire out-of-network cost, leaving them with higher costs than if they had been seen by an in-network provider. In many cases, the out-of-network provider can bill the person for the difference between the billed charge and the amount paid by their plan or insurance, unless prohibited by state law. This is known as “balance billing.” An unexpected balance bill is called a surprise bill.
This rule protects patients from surprise bills under certain circumstances.
Who will benefit from this rule?
These surprise billing protections apply to you if you get your coverage through your employer (including a federal, state or local government) or through the federal Marketplaces, state-based Marketplaces or directly through an individual market health insurance issuer.
The rule does not apply to people with coverage through programs such as Medicare, Medicaid, Indian Health Services, Veterans Affairs Health Care or TRICARE. These programs already prohibit balance billing.
Who is affected by surprise bills?
Surprise medical bills and balance bills affect many Americans, particularly when people with health insurance unknowingly get medical care from a provider or facility outside their health plan’s network. This can be very common in emergency situations, where people usually go (or are taken) to the nearest emergency department without considering their health plan’s network.
An in-network hospital still might have out-of-network providers, and patients in emergency situations may have little or no choice when it comes to who provides their care.
For non-emergency care, an individual might choose an in-network facility or an in-network provider but not know that a provider involved in their care (for example, an anesthesiologist or radiologist) is an out-of-network provider.
How does this rule help?
If your health plan provides or covers any benefits for emergency services, this rule requires emergency services to be covered:
- Without any prior authorization (meaning you do not need to get approval beforehand)
- Regardless of whether a provider or facility is in-network
This rule also protects people from excessive out-of-pocket costs by limiting cost sharing for out-of-network services to in-network levels, requiring cost sharing for these services to count toward any in-network deductibles and out-of-pocket maximums, and prohibiting balance billing under certain circumstances. Cost sharing is what you pay out of your own pocket when you have insurance, such as deductibles, coinsurance and copayments when you get medical care.
The protections in this rule apply to most emergency services, air ambulance services from out-of-network providers and non-emergency care from out-of-network providers at certain in-network facilities, including in-network hospitals and ambulatory surgical centers.
Additionally, this rule requires certain health care providers and facilities to furnish patients with a one-page notice on:
- The requirements and prohibitions applicable to the provider or facility regarding balance billing
- Any applicable state balance billing prohibitions or limitations
- How to contact appropriate state and federal agencies if the patient believes the provider or facility has violated the requirements described in the notice
This information must be publicly available from the provider or facility, too.
When does the rule take effect?
Consumer protections in the rule will take effect beginning on Jan. 1, 2022.
The regulations are generally applicable to group health plans and health insurance issuers for plan years beginning on or after Jan. 1, 2022, and to FEHB program carriers for contract years beginning on or after Jan. 1, 2022. They are applicable to providers and facilities beginning on Jan. 1, 2022.
- Published in Blog