Tag: HRAs

September 15 to October 15 is National Hispanic Heritage Month

National Hispanic Heritage Month is the period from September 15 to October 15 in the United States, when people recognize the contributions of Hispanic and Latino Americans to the United States and celebrate the group’s heritage and culture.

Started as Hispanic Heritage Week by president Lyndon Johnson in 1968, September 15 was chosen as the starting point for the celebration because it is the anniversary of independence of five Latin American countries: Costa Rica, El Salvador, Guatemala, Honduras and Nicaragua. All declared independence in 1821. In addition, Mexico, Chile and Belize celebrate their independence days on September 16, September 18, and September 21, respectively.

As a Minority Business Enterprise (MBE), one of our core beliefs as a company has always been to celebrate diversity and inclusion. Sterling Administration supports our Spanish-speaking Employer Clients and Members with services including a Spanish language option for our full-service website, online enrollment, educational materials, forms, and customer service.

¿Habla Español?
Nuestro compromiso con los latinos no es simplemente hablarles en español, sino realmente entender y hablar su mismo idioma. Aprende más.

Are you an Industry Partner with clients looking for a solution in Spanish?
Contact us today to learn more.

For Members: Carrier (EOB) Integration with Your Sterling Account For Claims Payment

Claims payment from an HSA, FSA or HRA account can be set up using our carrier (EOB) integration service for all HSA, FSA and HRA member clients. Set up requires you to have an online Sterling account and an online account with your health plan carrier. The service is available for most major carriers. Check here to make sure your health plan carrier is supported.

Once set up, you can:

  • Manage medical claims information all in one place.
  • Access your HSA, HRA or FSA to identify available balances and choose to pay providers or reimburse expenses already paid.
  • Pay right away or select a future payment date.
  • Choose the amount of payment or reimbursement up to what the claim allows.
  • Link to a dependent’s EOB information within HIPAA requirements.
  • Electronically keep records of receipts and other documentation related to medical claims, payments and reimbursements in a secure, HIPAA compliant database.

For instructions on setting up and using the service, please view or download the Sterling Carrier Integration Guide. Contact Sterling customer service at 800-617-4729 or customer.service@sterlingadministration.com for more information or help with the set up.

Consumer Driven Health Plans Help Consumers & Employers

Consumer driven health plans (CDHPs) help millions of American workers and their employers reduce healthcare expenses by shifting behaviors, rather than shifting costs. This trend continues to be validated in healthcare studies and by Sterling clients. With CDHPs, the evidence is clear that employee health utilization and employer healthcare premiums are reduced.

A long-time Sterling client, the Northern California Teamsters Trust, achieved these results with HSA plans (2013 data):

  • Medical costs were $861 per employee per year under the HSA plan vs. $1,076 under the traditional plan.
  • Drug costs were $62 per employee per year under the HSA plan vs. $154 under the traditional plan.

A recent Strategic Benefits—Health Care Survey (January 22, 2015), found that 19% of respondents offering employee coverage said CDHPs – including plans with health savings accounts (HSAs) and health reimbursement arrangements (HRAs) – are the most effective way of controlling the rising cost of health coverage.

Similarly, the Eighth Annual Cigna Choice Fund Experience Study (April 23, 2014) compared the claims experience of over 3.6 million Cigna customers enrolled in a CDHP, a traditional PPO or HMO health plan. The study found that people covered by CDHPs are more likely to “own” their health and health spending, resulting in improved total medical expenses by 12%. CDHP healthcare consumers:

  • Are more engaged – Nearly 50% are more likely to complete a health risk assessment and those with chronic illnesses are up to 41% more likely to participate in disease management.
  • Are more likely to manage their health benefits – 75% of CDHP customers use online tools to manage their health benefits and access information on care cost, quality and procedures.
  • Demonstrate lower health risks – Employers that transitioned to offering only a CDHP option had 14% more low-risk individuals and 28% fewer high-risk individuals compared to those in a traditional plan.
  • Reduce total medical costs – The CDHP medical cost trend was 12% lower than traditional plans during the first year. Employers did not shift out-of-pocket health expenses to employees in order to achieve reductions.

Both the Northern California Teamsters Trust and LA Mission, another Sterling client, discuss the advantages they realize with CDHP plans and Sterling HSAs. Go to the Sterling YouTube channel to hear in their own words how HSAs benefit their organizations:

Learn more about CDHP plans or call 800-617-4729. Our full suite of products includes HSA, HRA, FSA, POP, COBRA, ERISA Wrap, Form 5500 Filing and ACA compliance services.

Little Known Impact of Healthcare Reform: PCORI Fees

by Chris Bettner, Sterling Executive Vice President of Business Development

The Internal Revenue Service (IRS) issued a final rule on fees on health insurance policies and self-insured plans for the Patient-Centered Outcomes Research Trust Fund. The Patient Protection and Affordable Care Act (PPACA) established PCORI to promote evidence based medicine by sharing comparative data and effectiveness through research findings.  This is the funding mechanism for the research.

To fund PCORI, PPACA imposes a fee on employers who sponsor self-insured health plans and insurers providing fully insured health coverage as well.  For each policy or plan year ending on or after Oct. 1, 2012, and before Oct. 1, 2019, the first payment is due by July 31, 2013. Each year following, the fee will be due no later than July 31 following the last day of the plan year. The fee must be reported on Form 720, completed by the employer with the fee attached.

The fee is $1.00 per plan participant for the first plan year ending after Sept. 30, 2012, and $2.00 per plan participant in succeeding years.  For policy or plan years ending after Oct. 1, 2014, the fee will be increased based on increases in the projected per capita amount of national health expenditures.

The final rule clarifies that the fee required by the employer is based on the average number of lives covered under the plan during the plan year. There are several ways to calculate this.

If an employer sponsors more than one self-insured arrangement they are treated as a single plan for calculation purposes as long as the plans have the same plan year.  An example of this is a self-insured health plan and a self-insured Health Reimbursement Arrangement (HRA) attached to that health plan.

In the event that the employer has a fully insured health plan with a self-funded HRA, the fee applies to the HRA population.  Remember that the health plan will be paying the fee on the fully insured health plan side.  The employer is still required to calculate and pay for the HRA side.

This same ruling applies to employers who provide health plan coverage to a retiree population.

COBRA and other continuation coverage must also be included in the calculation.

The following plans are subject to the PCORI fee:

  • Medical plans
  • Prescription drug plans
  • Self-insured dental or visions plans (if provided without a separate election or premium charge)
  • HRAs
  • Retiree-only health plans

Excepted or Exempt Plans:

  • Self-insured dental or vision plans (if separate coverage elections and employee contributions)
  • Expatriate coverage for employees working outside the US
  • HSAs
  • Most FSAs
  • EAPs, Wellness programs, and disease management programs (that do not provide a significant benefit)

The employer can aggregate all plans that are self-insured and pay the fee once on all overlapping plan lives.  The employer must pay these fees outside of the plan, not using plan assets.

A consideration for employers who do not wish to pay the fee twice on a fully insured medical plan (the fee is added into the premium by the carrier) and again for a self-funded HRA may want to consider moving to a plan design that is HSA (Health Savings Account) compatible as HSAs are exempt from the fee. Learn more about HSAs.

Learn more about Sterling’s PCORI Fee Calculation Services.

About Chris Bettner
With over 30 years of experience in healthcare sales and management with health insurance carriers, Chris Bettner serves as executive vice president of Business Development for Sterling Health Services and was a co-founder of the company in 2004. Prior to joining Sterling, Chris was Vice President of Sales for Blue Shield of California. She held similar positions at Lifeguard, FHP, Independence Blue Cross and MetLife. Chris is also a national spokesperson on HSAs and consumer directed healthcare programs. Connect with Chris Bettner on LinkedIn.