Consumer-Driven Health Care

Foundation Publication Search Results

These summaries were compiled from Foundation Publications Search, a database of articles, research reports and books published by the International Foundation and the International Society of Certified Employee Benefit Specialists.


Washington Update: IRS Issues 2018 Annual Limits for HDHPs and HSAs.
Benefits Magazine; v54 no9 p 65 Sep 2017; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : On May 4, 2017, the Internal Revenue Service (IRS) released Revenue Procedure 2017-37, which sets the 2018 inflation adjusted amounts for contributions to health savings accounts (HSAs) and minimum deductibles and maximum out-of-pocket limits for high deductible health plans (HDHPs).
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You Asked, We Answered: Health Savings Accounts.
Lucey, Jennifer; Benefits Magazine; v54 no8 p 14 Aug 2017; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : Answers to frequently asked questions about health savings accounts (HSAs).
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Telehealth Benefits on the Rise Despite Low Employee Utilization.
Mazur, Lisa Schmitz; NewsBriefs; v35 pp 8-11 3rd Qtr 2017; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : Telehealth services are expected to become more common, but employees need to know the benefits exist and how to access them. Besides improving their education efforts, plan sponsors must be aware of state and federal legal and compliance issues.
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Telehealth Benefits on the Rise Despite Low Employee Utilization.
Mazur, Lisa Schmitz; Benefits Magazine; v54 no2 pp 14-18 Feb 2017; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : Telehealth services are expected to become more common, but employees need to know the benefits exist and how to access them. Besides improving their education efforts, plan sponsors must be aware of state and federal legal and compliance issues.
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Health Savings Accounts: An Emerging Cornerstone of the Health-Wealth Bridge?
Steinberg, Allen T.; Benefits Quarterly; v32 no4 pp 24-28 4th Qtr 2016; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : Several trends may help make health savings accounts (HSAs) a ubiquitous part of Americans' financial planning. When one looks at the totality of factors, it is easy to see how HSAs can become a vital connection between active and retiree health care needs and between retirement income and retiree medical needs. However, it is also easy to see the clouds over the horizon that could stall HSA growth in coming years. This article discusses both.
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The HSA in Your Future: Defined Contribution Retiree Medical Coverage.
Towarnicky, Jack M.; Benefits Quarterly; v32 no4 pp 29-37 4th Qtr 2016; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : This article shares one plan sponsor's journey to help employees accumulate assets to fund medical costs--while employed and after retirement. It documents a 30-plus-year retiree health insurance transition from a defined benefit to a defined contribution structure and culminating in a full-replacement defined contribution structure using HSA-qualifying high-deductible health plans (HDHPs) and then redeploying/repurposing the HSA to incorporate a savings incentive for retiree medical costs.
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Workplace Financial Wellness Programs Help Employees Manage Health Care Changes.
Meyer, Cynthia; Smith, Michael C.; Benefits Quarterly; v32 no4 pp 20-23 4th Qtr 2016; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : Employers and employees are navigating major changes in health insurance benefits, including the move to high-deductible health plans in conjunction with health savings accounts (HSAs). The HSA offers unique benefits that could prove instrumental in helping workers both navigate current health care expenses and build a nest egg for much larger health care costs in retirement. Yet employees often don't understand the HSA and how to best use it. How can employers help employees make wise benefit choices that work for their personal financial circumstances?
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Evaluating the Investment Potential of HSAs in Benefit Programs.
LaFleur, James; Magner, Liana; Domaszewicz, Sander; Benefits Quarterly; v32 no3 pp 17-20 3rd Qtr 2016; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : Despite its complexities, the health savings account (HSA) is a powerful and growing element of the U.S. financial landscape. In the future, employers will likely be expected to provide tax-advantaged savings programs for employees' current and future medical expenses. This article discusses investment lineup issues that must be addressed in order to optimize HSAs to help participants achieve successful outcomes. Plan sponsors at the forefront of addressing these issues (and perhaps others) will be in a better position to help their employees maximize both the health benefits and the wealth benefits provided for a secure retirement.
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Looking Under the Hood: Top Five Open Issues for the Cadillac Tax.
Stover, Richard; Laderman, Leslye; Benefits Quarterly; v31 no1 pp 22-25 1st Qtr 2015; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : The Affordable Care Act's 40 percent excise tax on generous health benefits, dubbed the Cadillac tax, starts in 2018. Key questions revolve around its application to employee health savings account contributions, dental and vision plans, employee assistance plans, onsite clinics and expatriate plans. The tax is based on the aggregate cost of coverage, including employer and employee contributions, determined in a similar way to COBRA rates. The tax applies beyond coverage cost thresholds that vary by age and gender, with different effects according to workforce demographics. The Cadillac tax is to be paid by coverage providers, i.e. the insurer of insured plans, employer for health savings account contributions and plan administrator for self-funded plans, creating potentially complex allocations. Responsibility may fall to insurers but ultimately be borne by the employer through grossed up charges to cover the tax.
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65th Birthday: Impact on HSAs.
Johnson, Whitney R.; Benefits Magazine; v51 no11 pp 28-34 Nov 2014; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : An employee reaching age 65 gains additional benefits through a health savings account (HSA) but may not make further HSA contributions once he or she starts Medicare. Applying for Social Security automatically enrolls the individual in Medicare Part A. Those not enrolled in Medicare continue to be eligible for an HSA. It is possible to reverse the Medicare enrollment and reestablish HSA eligibility. Starting on the 65th birthday an individual can use HSA funds to pay medical costs such as health insurance or Medicare premiums for the individual and for a spouse under age 65 without tax or penalty. When an employee turns age 65, HSA payroll deferrals and employer HSA contributions for a spouse must stop even if the spouse is still eligible. Rules governing HSAs interact with Medicare and Social Security and gain added complexity for those turning age 65.
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Does Your Health Plan Span the Generations?
Lapoff, Cindy; Benefits Magazine; v51 no10 pp 34-39 Oct 2014; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : The needs of group health plan members differ dramatically by age. Younger employees tend to be healthier, have few dependents and be less willing to spend on benefits, while older workers typically have more coverage needs within their budget limits. Plans should offer care options geared to various life stages, while holding costs down. They must be attuned to regulatory requirements pertaining to plan cost, benefit coverage and access. For some employees plans offered on insurance exchanges may be a better fit than employer-sponsored plans. Plan trustees can modify the design to allow for greater member choice, involving base benefits and the option for members to supplement basic coverage. Offering coverage through a private insurance exchange is an option. Consumer driven plans paired with health savings accounts or health reimbursement arrangements may also suit individual needs.
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CDHPs: As Enrollment Goes Up, a Time to Tune Up.
Domaszewicz, Sander; Savan, Jay; Benefits Quarterly; v30 no3 pp 19-23 3rd Qtr 2014; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : According to Mercer's 2013 National Survey of Employer-Sponsored Health Plans, the coming of the Affordable Care Act (ACA) has increased employer and employee interest in consumer driven health plans (CDHPs). The ACA has had a significant impact on CDHPs that include health flexible spending accounts. Department of Labor guidance requires health reimbursement accounts (HRAs) to meet Public Health Services Act rules that are at odds with many existing HRA designs. Health savings accounts, a key component of most CDHPs, are largely unaffected by the ACA. Employers need to communicate the benefits of CDHPs to employees and give them the proper tools to manage their health spending.
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HSA Growth and the Associated Opportunities/Challenges Presented by Pharmacy Benefits.
Fay, Maureen; Malley, John; Benefits Quarterly; v30 no3 pp 8-15 3rd Qtr 2014; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : In 2014, 11 percent of employees were covered under a health savings account (HSA) and nine percent were covered under a health reimbursement account (HRA), compared to two percent combined under both in 2006, according to a 2013 Kaiser Family Foundation survey. Research by America's Health Insurance Plans shows that the percentage of HSA participants in large employer group plans went from 16 to 62 between 2005 and 2013, while the percentage in individual plans decreased from 54 to 13. A 2013 Devenir survey shows HSA assets grew from $1.6 billion in 2006 to $29.4 billion in 2013. Reasons for these increases include need for improved cost control, rising health care costs and cost implications of the Affordable Care Act. Managers and employers are focusing on promoting consumerism and behavior change to control health care costs. Pharmacy benefits present opportunities and challenges for CDHP growth. While consumerism appears to have reduced pharmacy plan spending, research suggests this is due to lack of utilization. A trend counteracting pharmacy cost reductions is the increased use of specialty drugs.
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Pharmacy and Consumer-Directed Accounts.
Klavohn, Travis; Kalman, Robert; Benefits Quarterly; v30 no3 pp 16-18 3rd Qtr 2014; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : In order for consumer-directed pharmacy benefit programs to be effective, employers must make informed choices. The pharmacy benefit market in 2014 is open to negotiation on nearly every term, and wise employers are shifting to three-tier copay systems that incentivize employees to purchase lower-cost drugs. Plan designs integrated with high-deductible health plans (HDHPs) offer the best cost management for employers, and the health savings accounts associated with HDHPs are consistently ranked by employees as one of their most valuable benefits. Employees must be informed to make the right choices too. A 2013 Buck Consultants survey finds that employees in consumer directed health accounts are more efficient when they get the rewards of informed decision making and have the resources to make informed decisions. The vast majority of transactions involving consumer-directed accounts come from debit cards.
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Finding the Right Spending Account for Public Plans.
Erickson, Reed; Peterson, Marlo; Benefits Magazine; v51 no5 pp 38-43 May 2014; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : Adoption of consumer driven health plans with medical spending accounts is rising, with 59 percent of employers sponsoring some variety in 2013, according to Towers Watson and the National Business Group on Health. With six types of account options available for governmental entities, employers must understand the differences while considering their goals, financial needs and workforce characteristics as well as the requirements of GASB Statement 45. Among the factors to consider are the degree of control over accounts the organization wants, union involvement, retiree coverage, necessary flexibility and funding possibilities. A table lays out the pros and cons of a notional health reimbursement arrangement (HRA), a funded HRA, a funded 501(c)(9), a voluntary employees' beneficiary association, a 115 funded governmental trust as an HRA, a health savings account and a flexible spending account.
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The Power of Two: The Dual Savings Path of HSAs for Health Care Both Now and in Retirement.
Wise, Christi Rager; Newsbriefs; v32 pp 12-14 1st Qtr 2014; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : Analysis of 121,000 Fidelity health savings accounts (HSAs) finds that in 2011 HSA holders deferred more in their 401(k) plans than the average defined contribution (DC) plan participant. Those who save in their HSA are likely to save in their DC accounts as well, with DC assets 62 percent higher than those of HSA spenders. Even spenders had an average of $2,300 in their HSA account at the end of 2012. Over time, more HSA participants are becoming spenders, but average contributions remain constant and average balances continue to grow.
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401(k) 101: Augmenting the Plan's Role in Your Benefits Package.
Wayne, Mark; Benefits Magazine; v49 no8 p 32-36 Aug 2012; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : The presentation of fee information to employees, the result of disclosure rules effective in summer 2012, provides an excellent opportunity to raise the profile of 401(k) plans. As a key part of a total benefits package, 401(k) plans can be used more effectively for attracting and retaining employees. Employer matching contributions and payment schedules can be used creatively, linking collective performance with earning incentives. Timing raises, bonuses and profit sharing payments to coincide with open enrollment increases the focus on 401(k) plans and can stimulate higher employee participation and contribution rates. Regular visits by plan consultants and financial professionals can be scheduled for maximum advantage, and employees should be encouraged to think about rebalancing the split of money going to 401(k) plans and health savings accounts. The critical importance of frequent and engaging communication remains constant.
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HSA Programs for Groups: Employer Versus Employee Responsibilities.
Johnson, Whitney R.; Benefits Quarterly; v28 no3 pp 43-51 3rd Qtr 2012; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : Employers and employees of a group health plan with a health savings account (HSA) have shared compliance responsibilities. Employers wanting to allow employees to make pretax deferrals to an HSA need to establish Section 125, or cafeteria, plans, which generally do not require an IRS filing. The most complicated compliance issue for employers is comparability testing, a process similar to 401(k) plan nondiscrimination testing involving a long and complex set of rules. Small business owners have additional rules, based on the type of small business, for contributions to themselves. HSA money must be held by an approved HSA custodian, who tracks distributions and deposits. Individual HSA owners must substantiate the use to which they put their distributions, determine their own eligibility, ensure their contributions do not go over the federal limit, manage their own HSA balances and pay taxes on their HSAs.
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Overcoming Employee Objections to HSAs.
Johnson, Whitney R.; Benefits Magazine; v49 no2 pp 24-28 Feb 2012; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : A combination of a high-deductible health plan (HDHP) and a health savings account (HSA) is generally less expensive than traditional health insurance, gives employees more ownership over their health care money and allows for more cost sharing options, but many employees have objections. To those who say they cannot afford an HSA, employers should note that the HSA program is generally the least expensive option available and is often too expensive only when compared to an unrealistic or unsustainable plan. Those who do not want the responsibility of HSA management should be advised that they can control what level of services and spending they want. Objections that the tax savings of an HSA will not help an individual can be countered by explaining that payroll taxes, not just income taxes, are lowered by HSA contributions. Participants who balk at learning new rules should be aware that the benefits of an HSA plan make it worth the effort of learning the rules.
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The Impact of Health Reform on HSAs.
Johnson, Whitney R.; Benefits Quarterly; v27 no3 pp 45-52 3rd Qtr 2011; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : The Patient Protection and Affordable Care Act (PPACA) directly changes two aspects of health savings accounts (HSAs), eliminating their use for over-the-counter drugs and doubling the early withdrawal penalty. A number of provisions of the PPACA affect HSAs indirectly. The PPACA does not consider anything that does not support preventive care to be a health plan, so high-deductible health plans (HDHPs) attached to HSAs must include compatible definitions or insurers will stop offering them. HDHPs are also likely to have lower medical loss ratios (MLRs), the proportion of insurance premiums used for qualifying medical expenses, than other health plans, meaning they may not meet the PPACA's minimum MLR requirement. The question of whether HDHPs and, by extension, HSAs can be included in the health care exchanges created by the PPACA is unanswered as of July 2011.
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Sizing Up Health Care Reform: What Small and Midsize Companies Need to Know.
Miraglia, Dorothy L.; Benefits Magazine; v48 no2 pp 30-35 Feb 2011; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : With little HR support, small and midsized companies face a heavy administrative burden under the Patient Protection and Affordable Care Act. They must decide about offering health insurance, meet pressing deadlines and consider the pros and cons of grandfathering. Extra reporting requirements take effect in 2011 and 2012. Those sponsoring flexible spending accounts, health reimbursement arrangements and health savings accounts must be aware of changing coverage for over-the-counter drugs. Starting in 2012 employers must provide a summary of benefits and coverage explanation and detail the aggregate cost of health insurance on each employee's W-2 form. Further requirements and penalties take effect in 2014, including vouchers to purchase individual insurance.
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Prospects for Account-Based Health Plans Under the Patient Protection and Affordable Care Act.
McDevitt, Roland D.; Savan, Jay; Benefits Quarterly; v27 no1 pp 21-25 1st Qtr 2011; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : Health savings accounts and health reimbursement arrangements have been shown to lower costs and engage health care consumers. Yet there is concern the Patient Protection and Affordable Care Act (PPACA) will undermine the use and effectiveness of these account-based strategies and raise employer costs through mandated benefits. The PPACA requires minimum essential coverage and includes standards for member cost sharing, minimum actuarial value and minimum employer contributions. These requirements are all compatible with account-based plans. The plans also offer advantages over flexible spending arrangements, strong tax protection, opportunity for retiree medical savings and broad support for a consumerist approach to health care.
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Avoiding a Head-on Collision With the Cadillac Tax.
McSweeney, David; Ermer, David; Niehus, Barbara P.; Benefits & Compensation Digest; v47 no10 pp 1, 11-15 Oct 2010; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : The Patient Protection and Affordable Care Act (PPACA) has introduced the Cadillac tax, effective January 2018, on premiums above set thresholds for individual or family plans. The premium is the total of all employer and employee contributions for medical coverage, health savings accounts, health reimbursement arrangements and worksite clinics. Additional PPACA provisions will make the Cadillac tax very difficult to avoid. Plans can work to minimize the impact of the Cadillac tax by understanding their health care costs, monitoring paid claims, continuing cost-management efforts, considering self-funding, reexamining contribution structures, ensuring dental and vision plans stand apart from general health plans and making sure retiree plans are managed properly.
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Best Practices in Communicating Health Care Payment Card Programs.
Pourfallah, Stacy; Benefits & Compensation Digest; v47 no8 pp 24-27 Aug 2010; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : Health care payment cards simplify using flexible spending accounts, health savings accounts and health reimbursement arrangements. Similar to debit cards, they draw on funds in the personal health accounts, using pretax dollars to pay for qualified services and products. Substantiation is automatic, avoiding the need to submit paperwork and get reimbursement. For employers, the cards lower the administrative burden and provide valuable benefit utilization information. Communication to employees about the payment card program is key before, during and after enrollment. Special attention should be paid to points often misunderstood, such as covered expenses and use-it-or-lose-it provisions.
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Health Savings Accounts: Back to the Future.
Klug, Kathy; Chianese, Lois; Benefits Quarterly; v26 no1 pp 12-23 1st Qtr 2010; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : December 8, 2009 was the sixth anniversary of the health savings account (HSA). In the six years since their creation, adoption of HSAs has been surprisingly robust, beating out medical savings accounts and 401(k) plans. HSAs offer the ability to make pretax contributions, grow assets tax free and receive tax free distributions for qualified medical expenses. Unlike other individual account plans, HSAs are true accounts owned by participants, and unlike a 401(k) account an HSA allows for tax-advantaged withdrawals. While six years is not sufficient time to declare the HSA a success, the performance of HSAs indicates they still have the potential to increase health care cost savings.
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