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  • Pennsylvania lawmakers have been working diligently to pass a bill that would expand coverage of medical procedures for chronically ill patients. While the bill mainly applies to private insurers, it would do the following for individuals in Pennsylvania:

    • Remove prior authorization for emergency care
    • Standardize timelines for insurers to approve or deny a request for treatment
    • Guarantee that doctors can request that plans cover medications without a patient first trying a cheaper drug

    Ultimately, the bill would allow medical providers more time on caring for patients as opposed to fighting with insurance companies. The patients will receive more clarity and flexibility when deciding on their treatment options.

    The current proposal passed the Republican-controlled state Senate in June. The bill is now waiting for the state House to vote, then the state Senate must approve the changes before taking additional measures.

    Diving Deeper Into The Bill

    The proposal aims to change two fundamental aspects of American health care which include:

    • Prior authorization
    • Step therapy

    Prior authorization is a process used by insurance companies to determine if a prescribed product or service will be covered. Step therapy means trying less expensive options prior to “stepping up” to drugs that cost more. Both ensure that medically sound and cost-effective medications are prescribed appropriately. However, the bill would not completely eliminate either practice. Instead, it would require insurers to offer exemptions for both along with creating a standardized process for doctors to apply for approval or request an exemption.

    To accomplish this, the bill would:

    • Establish standardized electronic forms for the application
    • Set a statutory deadline for responding to requests
    • Require insurers to provide written notification explaining the denial
    • Allow the state Insurance Department to review the decision

    In addition, this bill would allow physicians to dispute an insurer’s decision directly with a doctor employed by the insurer rather than an individual who may not have a medical degree. The goal of the bill is to create a new and more effective process for prior authorization of medical services which will keep everything consistent and transparent.

    What Now?

    While individuals in Pennsylvania wait for a further notice regarding this proposal, it’s important to understand alternative solutions. This proposal still must pass through multiple stages for it to become a law. Partner with GMS to ensure your employees are covered under any circumstance. When you partner with GMS, it’s possible to reduce your health insurance costs while still providing top-tier coverage. GMS changes the approach to increase affordable options by giving small businesses the buying power of a large corporation. Contact us today to learn more.

  • Inflation continues to rise, increasing health insurance premiums for Americans. Employer-sponsored insurance (ESI) is the largest source of health insurance coverage in the United States. Employer health insurance premiums have continued to rise quicker than wages and inflation.

    According to The Los Angeles Times, two in five adults enrolled in employer-sponsored coverage find it difficult to afford health care and insurance costs. Commercial rates for hospital care are averaging 224 percent of Medicare rates.

    The Cost Of Employer-Sponsored Insurance

    According to a recent analysis from the Kaiser Family Foundation, in 2021, the average ESI premium for single coverage was $7,739 per year, and the average ESI premium for family coverage was $22,221 per year. Additionally, with those plans, the average deductible for single coverage was $1,669, and the average aggregate deductible for family coverage was $4,705.

    To combat the increasing costs of ESI, it’s vital to take immediate action to bring down costs. As an employer, it can be challenging to negotiate prices on plans. However, many consider the option of joining other firms to combine buying power to obtain fair provider prices.

    Those with lower incomes may find it increasingly challenging to keep up with the ESI rates. In 2020, the Commonwealth Fund survey defined the word, “underinsured” as being covered by a plan with high out-of-pocket costs, the findings were that one-fourth of working-age adults in employer plans were underinsured.

    How GMS Can Help

    A partnership with GMS allows you to provide the best healthcare benefits to your employees. When it comes to medical coverage, this is a necessity for your employees. As the economy fluctuates, your health insurance pricing cannot. With GMS, we give small businesses the buying power of a large corporation. GMS represents over 40,000 worksite employees, allowing businesses to receive a lower rate. Retake control of this essential benefit, and contact GMS today!

  • While the benefits open enrollment period is quickly approaching, it’s essential to have a step-by-step plan in place to ensure a smooth enrollment experience. Open enrollment is the annual window where employees may enroll or make changes to their healthcare benefits package. 

    As a business owner, implementing an effective plan is important for your employees. Continue reading to learn simple steps to improve your open enrollment process for 2023. 

    1. Reflect On Previous Open Enrollment Periods

    Before the upcoming open enrollment period, reflect on last year’s wins and losses. Typically, business owners should sit down right after the enrollment period ends to reflect on the ups and downs and prepare for the following year. Being open about the mistakes made and how to improve the internal process provides significant value to employees and ultimately creates a smoother experience. The following are the most common mistakes that occur during the open enrollment period: 

    • Missing the deadline
    • Defaulting to last year’s plan
    • Over or under-insuring
    • Passing up tax-free savings
    • Assuming all employees should be on one plan
    • Ignoring add-ons

    If any of these mistakes occurred last year, what would you do differently to prevent them from happening again? When you partner with a PEO like GMS, we take on this entire process, so you don’t make the same mistakes. Your designated benefits account manager sits with you and your employees to ensure everyone understands the plan. 

    2. Have A Strategy In Place

    Having a strategic plan in place before open enrollment is the key to success. You may ask yourself, how can I change the way I approach open enrollment to ensure a successful one? Starting early is the most important way to create an efficient and positive employee experience. Creating a renewal timeline halfway through the benefits fiscal year will allow your employees to stay on track ahead of the renewal deadline. 

    Rules and regulations constantly change, especially in the healthcare industry. Ensure you stay up to date with the changing regulations, so you know exactly what you’re getting into before open enrollment begins. In addition, if you have any significant benefit changes, your employees need to know as soon as possible. Be sure to explain the previous plan, what the new plan entails, and any changes they need to be aware of so it’s not a surprise when the enrollment time comes.

    3. Ensure Your Employees Understand Benefit Details

    With the number of benefits available, it can be confusing for your employees to determine which package best fits their needs. In addition, offering a quality benefits package is one of the best ways to retain and attract top talent, which is why it’s more important than ever to explain your benefits plan accordingly.

    Did you know, nearly a third of employees don’t think their employer’s benefits communications are easy to understand? When you outsource your benefits functions to a PEO such as GMS, you are provided with experts who guide you and your employees on how to best utilize their plans, maintain compliance, and stay on top of Affordable Care Act regulations. In addition to a dedicated benefits specialist who is there to help you through the open enrollment period, you also gain access to a team of experts who train your employees on how their plan works and answer difficult coverage questions.

    4. Outline Employee Vs. Employer Costs

    When deciding on a benefits package, employees care about price. As an employer, it’s essential to consider how much the employee will have to pay with your plan. In addition, showing the plan’s overall value will provide them with additional information to help with their decision. They want to see what they will get from the benefits package to ensure they are covered accordingly and receive the best possible option. Ensure you are transparent about the cost upfront, so they have all the necessary information before entering the open enrollment period.

    5. Work With A PEO To Develop And Implement Your Benefits Strategy

    The most effective way to ensure a smooth and positive enrollment period for your employees is by partnering with a PEO like GMS. At GMS, our benefits outsourcing services allow your company to offer competitive, cost-effective benefits while you focus on what you do best – running your business. GMS helps small businesses offer customized health insurance tailored to your needs. Our experts manage everything from benefits enrollment to ongoing plan education through our proprietary technology and dedicated customer support. The following are the benefits of partnering with a PEO for employee benefits administration:

    • Saves you money
    • Saves you time
    • Simplifies employee management

    Set Yourself Up For Success, Partner With GMS

    Your benefits package is one of the best ways to attract and retain top talent. Your open enrollment period needs to be effective and positive for your employees. When you partner with GMS, your employees will experience an easy and seamless process. We offer flexibility, control of premiums, access to data and networks, and overall options that you can’t find elsewhere. Make your employees happy and partner with GMS today. Contact us here.

  • When individuals buy life insurance, there are various reasons they buy it. Ultimately, making the decision to buy life insurance provides financial security for yourself and your loved ones. A question that probably crosses your mind is the importance of life insurance. Do I really need it? Continue reading to learn more about the importance of life insurance.

    What Is Life Insurance?

    Life insurance is a contract between an insurer and a policy owner. The insurer pays into a plan and assigns beneficiaries to the account. When the insured dies, in exchange for the premiums paid, the life insurance plan guarantees the beneficiaries will be paid out. Buying life insurance protects your spouse and children from the potentially devastating financial losses that could result if something happened to you. It helps pay off debts, living expenses, and medical or other final expenses. Two in three individuals in the U.S. buy life insurance.

    Steps In The Life Insurance Buying Process

    Anyone considering buying life insurance may get overwhelmed by the different policies available. Life insurance is typically a much longer process compared to other insurance policy-buying processes. However, purchasing life insurance doesn’t have to be complicated. Below, you will find four steps that will simplify the life insurance buying process.

    1. Determine your goals
    2. Determine how much insurance you need to meet your goals over time and determine what you can afford to pay
    3. Research the available plans for life insurance that can help meet your needs
    4. Choose the type of insurance policy that best meets your needs

    Reasons To Buy Life Insurance

    Individuals buy life insurance for a variety of reasons. Ultimately, a life insurance policy provides individuals with lasting peace of mind by assuring them that they have left behind a legacy. The most common reasons for buying life insurance include the following:

    • Guaranteed protection
    • Replaces income
    • Tax-free benefit
    • Guaranteed cash value growth
    • Dividend potential

    How GMS Comes Into Play

    Life insurance is one of those things that just about everyone needs but far too few people have it. When your life changes and priorities shift, the right life insurance policy can provide you with options for protection and growth. Luckily, GMS now provides employers and individuals with life and disability insurance at a lower monthly rate. Do you want to feel secure and protected? Contact us today to learn how you can get covered now.

  • The Federal government recently passed the Inflation Reduction Act, which states that prescription drug prices cannot increase more than the current inflation rate. This will have a sweeping effect on those under Medicare who have been paying thousands of dollars for prescription drugs.

    Tens of thousands of Arizonans will gain health care coverage under the Inflation Reduction Act. The act’s expansion will improve health outcomes, save lives, improve financial security, and narrow disparities and access to care.

    Cutting Prescription Drug Costs

    One of the major declarations the bill makes is capping the Medicare beneficiary’s out-of-pocket costs in Part D to $2,000. Arizonans will no longer pay more than $2,000 on prescription medications. An additional benefit is capping insulin copays at $35 per month. This will help roughly 63,000 people who live in the state.

    The act will also help those with low incomes by providing extra help to pay for prescription drugs. It expands eligibility for full Part D low-income subsidies, known as Extra Help. Roughly 8,100 Arizona Medicare beneficiaries received partial Extra Help and due to the act, they could receive full Extra Help benefits. Individuals under Medicare Part D must pay for a portion of vaccines out of pocket. This legislation will make sure there are no out-of-pocket costs for Part D constituents which will affect 88,000 individuals.

    Lowering Health Insurance Premiums And Expanding Coverage

    About 200,000 Arizonans with marketplace coverage are saving an average of $830 per year from the American Rescue Plan (ARP) subsidies that the Inflation Reduction Act would continue. Among those benefiting, small business owners and those that are self-employed will benefit the most due to their usage of the Affordable Care Act. In addition, it benefits middle-income individuals who have retired or don’t have health insurance through their companies.

    The Benefits Of Partnering With GMS

    With the Inflation Reduction Act being passed by Congress, GMS can manage the complexities. It will ensure that small businesses are optimizing their gains and participating in the act. Our RX specialists can help you navigate how this can help you and your business and ensure your premiums are as low as possible. We offer flexibility, control of premiums, access to data and networks, and overall options that you can’t find elsewhere. Contact GMS today.

  • On September 30th, 2022, California Governor Newsom signed Senate Bill (SB) 951, which will increase the wage replacement rate for lower wage earners under the state Paid Family Leave Program (PFL) and State Disability Insurance (SDI) programs. A similar bill was vetoed last year.

    PFL provides short-term wage replacement benefits to eligible California workers. You may be eligible for PFL if you cannot work, resulting in lost wages and time off work for family leave. California’s SDI program provides short-term disability insurance to individuals who are unable to work due to non-work-related illness or injury, pregnancy, or childbirth.

    What The New Bill Means

    Beginning in 2025, individuals who earn 70 percent or less than the state’s average wage are eligible for 90 percent of their regular wages under the PFL and SDI programs. Currently, workers who earn low wages may be eligible for 70 percent of their regular wages under the programs.

    Governor Newsom expressed, “My administration has been a strong advocate for expanding access to DI and PFL programs, and I am proud of the progress we have made in collaboration with the Legislature… SB 951 will create significant new costs not included in the 2021 Budget Act and would result in higher disability contributions paid by employees.”

    Additional Steps

    Whether your organization lacks an HR department or HR team or needs a resource to make more informed decisions about benefits management, GMS can help. Our benefits outsourcing services allow your business to offer competitive, cost-effective benefits while you focus on what you do best, running your business. In addition, while laws and regulations are constantly changing, our team of experts ensures you stay compliant. Should a new law be enforced in the state you run your business operations, we create a strategic plan on how you can begin implementing it within your workplace. Want to learn more about how GMS can help you and your business? Contact us today.

  • The California legislature passed Assembly Bill (AB) 1949, requiring California employers to offer employees five days of bereavement leave. Five days would be provided to each employee each time they lose a:

    • Spouse
    • Child
    • Parent
    • Sibling
    • Grandparent
    • Grandchild
    • Domestic partner
    • Parent-in-law

    While bereavement leaves may be unpaid, employees may choose to use their accrued vacation, sick leave, or other paid time off options, such as personal days. If California Governor Newsom signs the bill, it would be the third state to mandate this type of time off, alongside Oregon, Maryland, and Pennsylvania. While there have been previous versions of a similar bill, this year’s version has bipartisan support, meaning opposing political parties have found common ground through compromise.

    Understanding AB 1949

    AB 1949 would cover all public employers and private businesses that have at least five employees in California. Full-time and part-time employees are eligible for this bereavement leave if they have worked for the business for at least 30 days. Employers can request documentation providing evidence of the family member’s death. These documents include a death certificate, published obituary, or other written verification of death, burial, or memorial services. However, all information must be made confidential. In addition, when employees take bereavement leave, it must be completed within three months of the date of death. The days of leave do not have to be consecutive.

    What This Means For Small Business Owners

    While many employers currently give bereavement time to employees, this bill would formalize this benefit in California. If you are a small business owner in California, it’s vital to look at your current policy and determine if it’s being implemented properly. If Governor Newsom signs the bill and employers fail to comply with the new law, they’d have to pay past and future:

    • Lost income and benefits
    • Emotional distress damages
    • Punitive damages

    It’s important to note that AB 1949 is separate from time off under the California Family Rights Act (CFRA). The CFRA authorizes eligible employees to take up to 12 weeks of paid or unpaid job-protected leave during a 12-month period.

    The Benefits Of Partnering With A PEO

    As a business owner, you understand the importance of staying compliant with laws and regulations. In addition, providing your employees with a competitive benefits package sets you apart from competitors and allows you to attract and retain quality talent. Partnering with GMS ensures you are compliant and attracting and retaining quality talent. Our team of experts works with you through the constant law changes, so you don’t have to worry about that added stress and time. Contact us today to get started.

  • On August 12th, 2022, the Inflation Reduction Act went into effect. As inflation continues to rise throughout the United States, the act calls for a significant reduction in prescription drug pricing. Various implications come along with the new federal drug price as it moves across healthcare systems.

    Three Provisions

    A recent webinar panel discussed three major changes in prescription drug pricing:

    1. Price negotiation – This allows the government to regulate certain drugs under Medicare and the Drug Price Negotiation. This pushes the government to establish a maximum fair price (MFP) for certain prescription drugs. As a result, H.R. 3 requires the Secretary to consider research and development costs, market data, production and distribution costs, and therapeutic alternatives. 
    2. Inflation penalties – Pharmaceutical manufacturers must pay rebates on drugs covered by Medicare Part B and Part D if the drug price rises faster than the inflation rate. 
    3. Medicare Part D – This creates a $200,000 out-of-pocket cap on Part D prescription drug spending. 

    Industries Affected

    Due to the creation of this revision, there are five key sectors of the healthcare system that are affected, including: 

    • Drug manufacturers 
    • Payers
    • Providers
    • State Medicaid agencies
    • Patients

    Deduction Of Manufacturer’s Revenue

    Drug manufacturers not subject to negotiation will see a decrease in revenue as others choose to decrease their prices. Due to inflation caps, price increases will be limited. A significant benefit of these regulatory changes will be a smaller out-of-pocket cost for consumers.

    Medicare Part D Cap

    The regulations have established that Part D beneficiary premiums are capped for 2024 through 2029. In addition, there will be an annual beneficiary cost-sharing cap effective in 2025. This will also eliminate catastrophic beneficiary cost-sharing for 2023 and 2024. The negotiated drug prices and inflationary rebates may reduce Medicare Advantage plan costs for Part B drugs.

    The Impact GMS Has On Your Business

    As a business owner, you want to ensure that your benefits plan continues to get you the lowest rates. When you partner with GMS, you gain access to an Rx Specialist who can support you and your employees find the most cost-effective option. Additionally, we offer control of premiums, access to data and networks, and options you can’t find elsewhere. Learn more today!

  • As the third quarter comes to an end, that means it’s time to start thinking about open enrollment. Open enrollment is the annual period when individuals can begin enrolling in a health insurance plan for the upcoming calendar year. Your employees may choose to add or drop health insurance, allowing them to make changes to their coverage. As a small business owner, this time of year can become overwhelming. Open enrollment for 2023 runs from November 1st, 2022, to January 15th, 2023.

    Due to recent changes, signing up for benefit plans during the open enrollment period has transitioned into a more digitalized process. Not only does this help you as an employer, but it also streamlines the process, making it less stressful for your employees. As open enrollment approaches, it’s crucial to increase engagement from year to year for your program to be successful.

    Raising Engagement During Open Enrollment

    Make an impact with your employees during the open enrollment period and drive engagement to an all-time high with the following advice:

    • Clearly communicate dates to your employees
    • Create engaging benefit planning meetings for all employees
    • Ask your employees what they want
    • Provide simple and engaging resources
    • Continue the benefit conversation 
    • Put emphasis on creating goals and tracking progress

    Understanding what your employees want and need is the key to successful open enrollment. By taking a continuous and proactive approach throughout the year, you can ensure that your employees know the resources and support available.

    Stress No More

    Benefits are complex making it easy for employees to become overwhelmed by the information they need to make informed decisions. When you partner with GMS, we take on the burdens of the open enrollment period so you can focus on other aspects of your business. Your designated benefits account manager works diligently with you and your employees to provide the best benefit plans while also educating your employees. You gain access to a team of experts who can train employees on how their plan works and answer difficult coverage questions. We get it. Health insurance is complicated. Let us provide guidance on how to utilize your plans best, maintain compliance, and stay on top of the Affordable Care Act regulations. Contact us today.

  • It’s important to make a name for yourself in business. However, having other people use your small business’ name or sensitive information is less than ideal.

    According to PwC’s 2022 Global Economic Crime and Fraud Survey, 46% of organizations experienced some form of fraud in the last two years. Business identity theft is a serious issue for both small businesses and their employees. Find out how identity theft can impact your business and how you can protect yourself in the future.

    How Does Identity Theft Affect Businesses?

    Identity thieves can target your business in several ways – by attacking your company directly or targeting your employees. While one method is a more direct attack on your business, both forms of theft will end up hurting your business and costing you time and money.

    Examples of business identity theft

    There are multiple ways that fraudsters can use your business’ identity against you. Corporate identity theft scams include:

    • Fake invoices
    • Phishing emails
    • Fake social media accounts
    • Lookalike websites
    • Tax information abuse
    • Trademark ransom

    All of these forms of fraud are used to gain access to something – your back account, personal information, and more. Stolen money and information are just the beginning for the problem. Business identity theft can lead to credit score drops, IRS audit penalties, and a hit to your company’s reputation.

    Examples of employee identity theft

    There are several different ways that identity theft can wreak havoc on your employees’ personal lives.

    • Stolen debit cards, credit cards, or checks
    • Fraudulent change of address
    • Social security number fraud
    • Passport abuse
    • Drivers license misuse
    • Hacked email accounts

    It’s also important that attacks against your employees can impact your business in multiple ways. The most obvious issue is the personal toll that identity theft takes on your workers. According to Allstate, it can take up to 200 hours to resolve identity theft. That’s a lot of time and energy, and your employees may need to take time off to deal with the fallout caused by identity theft.

    There’s also the emotional impact of identity theft. The Identity Theft Resource Center reports that 86.7% of identity theft victims felt stressed, 90% couldn’t sleep properly, and 36.7% suffered from panic attacks. That level of emotional distress will distract your employees and most likely impact work performance, which is why safeguarding them from these issues can directly benefit your business.

    A phone with strong password protection, one way how to protect your business from identity theft.

    How To Prevent Identity Theft At Your Business

    Identify theft can happen to anyone, from a single person to a major corporation. However, that doesn’t mean you can’t take measures to prevent identity theft. Use the following measures to defend your business and employees from future identity theft attacks.

    Add extra security measures

    Protect your business by making it harder for fraudsters to access your information. One of the most common ways for people to steal a business’ or an employee’s identity is to access their private accounts – emails, social media accounts, and more. The following steps can help secure these accounts and shield them from intruders:

    • Use multi-factor authentication to log into accounts
    • Regularly change login information
    • Set password policies to dictate password strength and prevent password duplication across platforms
    • Store sensitive login information with a secure password management system

    Keep any software or computer systems up to date

    Outdated software and other tools can be targets for identity theft attempts. Make sure your business has an updated firewall, anti-virus software, anti-malware software, and pop-up blockers. Any other online tools that you use, such as customer relationship management software, should be as up-to-date as possible. If you have any virtual private networks (VPNs), double check that they were implemented correctly for any individuals accessing information offsite.

    Train employees

    The more prepared your employees are to spot potential identity theft attacks, the better. Conduct cybersecurity training to educate your employees about what to look out for during and outside of work. Teach employees how to spot phishing emails, scam texts, and other attempts.

    You should also highlight standard security protocols and best practices such as your password policies, how to set up multi-factor authentication, and more. Finally, let them know how to report questionable messages and other warning signs so that you and the rest of your business can stay safe.

    Offer identity theft protection benefits

    While you can take measures internally to defend against data breaches, there’s only so much that you can do to prevent identity theft outside of your business. Your employees are still at risk for data security attacks and stolen identities can still have major impacts on your employees’ personal lives and production on the job.

    Offering identity theft protection benefits can help safeguard your employees. These benefits can help protect your employee’s finances, social media accounts, and more during attacks. Identity theft protection also helps employees limit potential damage and quickly resolve the situation.

    What To Do If Your Business Identity Is Stolen

    Despite your best efforts, there are times when your business may be a victim of identity theft. The good news is that there are additional steps you can take if someone has stolen sensitive data and personal information from your business. The IRS recommends taking the following actions if your business information is compromised:

    • Contact the IRS as soon as you believe someone is using your Employer Identification Number.
    • File a police report with the local police department.
    • Review and reconcile any account statements as soon as you receive them.
    • Review all business registration information online and look for suspicious activity in bank accounts, online accounts, and any other pertinent sources.
    • Contact one of the three credit reporting companies – Equifax, Experian, or TransUnion – to place a 90-day fraud alert on your credit reports. Once you contact one company, it must tell the other two to do the same.
    • Request a credit freeze from each of the three reporting companies.
    • Close any accounts that may have been compromised or tampered with during or after the attack.
    • File a complaint with the Federal Trade Commission.
    • Stay on alert for suspicious activity and conduct regular business credit reviews every year.

    Protect Your Business From Identity Theft

    Between on-site safety and online security, it’s vital to make your small business as safe as possible. That’s why GMS helps employers protect themselves and their employees from identity theft.

    Our goal is to make your small business simpler, safer, and stronger. In addition to providing expert payroll, benefits administration, and other HR management services, we provide clients access to GMS Connect. This cutting edge software allows users to securely access all their employee data online. We can also help you offer additional benefits such as identity theft protection to protect your employees and enhance your benefits package.

    Contact GMS today to talk to one of our experts about how GMS can save you time and protect your business through benefits administration and other services.