Request a call Login

  • Dealing with health insurance is one of the biggest challenges for a small business owner. Between the cost of insurance and the need to attract and retain talent, offering insurance is a major decision. Add in all the uncertainty that surrounds your responsibilities and health insurance can be a major headache.

    Simply put, health insurance administration is confusing. It’s understandable why employers are unsure about the health insurance requirements for small businesses – there’s a lot of information and only so much time to manage everything. This post will break down what you need to know about small business health insurance requirements and how you can keep your company compliant.

    Do Small Businesses Have To Provide Health Insurance?

    When it comes to small business health insurance requirements, this is likely the biggest question on your mind. The exact definition of a small business can differ from one organization to another. According to the Affordable Care Act (ACA), any business with 50 or fewer full-time-equivalent employees counts as a small business.

    That cutoff is significant because businesses with 50 or fewer full-time equivalent employees are not required to offer health coverage to their employees. However, these businesses are still required to provide a report about healthcare information to employees. This report should cover certain information about the health insurance marketplace, outlining what it is and how employees can contact the marketplace.

    A doctor going over the health insurance requirements for a small business.

    Requirements For A Small Business That Offers Health Insurance

    Despite health coverage not being mandatory, many small businesses with fewer than 50 full-time employees still choose to provide workers with health insurance because quality healthcare coverage can help businesses attract and retain top talent. This decision can be very beneficial, but it does mean that small business owners will need to take on a few new responsibilities.

    Minimum employer contribution for small business healthcare

    If an employer opts to offer group health insurance, the business must pay at least half of the monthly health insurance premiums. Employers must also meet the affordability threshold for the health coverage they offer. In 2022, an employee’s monthly contribution couldn’t exceed 9.61% of their income. The IRS adjusts this rate every year and has already announced that the affordability requirement will go down to 9.12% in 2023.

    Employees eligible for coverage

    Small businesses that offer health insurance are required to offer coverage to all full-time equivalent employees. Full-time equivalence requires an average of 30 hours of service per week for a calendar month or at least 130 hours of service in a month. You can also choose to offer health coverage to your part-time employees as well, although it is not mandatory.

    An employer may not discriminate between employees when offering insurance. If you offer insurance to some full-time employees, you must offer it to every employee. You must also provide health insurance to each employee’s dependents up until they turn 26 years old. However, federal law does not require employers to offer coverage to any spouses or other domestic partners.

    90-day maximum waiting period

    When an eligible employee is hired by a business that offers health insurance, that employee must be offered health insurance within 90 days of his or her employment start date. Employers may institute a waiting period before new employees can enroll in the company’s health insurance plan. A small business owner may also decide to waive this waiting period and allow employees to enroll as soon as possible.

    Summary of benefits and coverage (SBC) disclosure

    Employers are required to provide eligible workers with an SBC form to help individuals understand their options. This form explains what an employer’s plan covers and exactly what it costs employees. This includes breakdowns of specific costs, such as deductibles and out-of-pocket costs for varying medical events. The Department of Labor provides an online SBC template and other resources for any owners who provide health coverage.

    Tax Reporting Requirements For Small Business Health Insurance

    Offering comprehensive health coverage isn’t enough to meet your requirements. There are also certain tax reporting requirements that small business owners must follow if they decide to offer group health coverage. The following requirements include:

    What It Takes To Manage Healthcare Benefits

    In addition to following special requirements when offering healthcare, small business owners also need to consider how they’ll manage this new benefit. While employers can go through the Small Business Health Options Program (SHOP) to offer coverage for small groups, this means you’ll have to handle policy administration and health insurance billing.

    Fortunately, you don’t have to take on employee benefits administration alone. As a professional employer organization (PEO), GMS can leverage its buying power to procure quality group health insurance coverage with lower premiums than a small business would be able to obtain on its own. GMS also gives you access to trained benefits experts who can help small businesses stay compliant with any health insurance requirements.

    Looking to invest in health insurance for your small business? Contact GMS today to talk to one of our experts about how we can help you attract and retain quality employees through benefits administration and other services.

  • The fiduciary rule has had a bumpy ride in the past few years. After initially going into partial effect in June of 2017 and targeting Jan. 1, 2018 for a full rollout, the move to have all financial professionals who work with retirement plans follow the same fiduciary ethics and standards was postponed until July 1, 2019. Now MarketWatch reports that the Fifth Circuit Court “struck down the Labor Department’s fiduciary rule” in a split decision Thursday, March 15, 2018.

    This may not be the end of the fiduciary rule, however. According to Forbes Contributor David Trainer, the fiduciary rule may still make an impact even after being struck down. Trainer writes “While the ruling could end the Fiduciary Rule as law, it cannot erase the awareness the DOL [Department of Labor] raised, nor can it stop market forces leading the business towards a more ethical place.”  

    So, what does this mean for business owners? The fiduciary rule wasn’t designed to directly impact you as an owner, but it does affect the financial advisors connected to your business. Here’s a quick rundown of how the fiduciary rule can still make an impression on financial advisors and what that may mean for your business.

    Financial advisors for a small business 401(k) plan.

    What It Does

    According to Investopedia, the fiduciary rule “expands the ‘investment advice fiduciary’ definition under the Employee Retirement Income Security Act of 1974 (ERISA).” In simpler terms, it was designed to give financial professionals who work with retirement plans or offer retirement advice the same legal and ethical standards of a fiduciary.

    With this rule in place, retirement advisors would have more responsibility placed on them. According to Investopedia, the rule would leave “no room for advisors to conceal any potential conflict of interest,” which would include stating “all fees and commissions for retirement plans and retirement planning advice must be clearly disclosed in dollar form to clients.”

    Even though the rule has been struck down for now, it may not be dead quite yet. Trainer notes in his Forbes piece that the DOL could start on a new rule addressing the matter or request a stay in the Fifth Circuit Court’s ruling. The Wall Street Journal reports that the U.S. Securities and Exchange Commission is also “close to proposing rule requiring new disclosures on financial advice.” Even without going into effect, Trainer suggests that the fiduciary rule has raised awareness of fiduciary responsibility for owners and investors.

    What It Means for Owners

    Fiduciary responsibility can be intimidating, especially if you aren’t well versed in the legal responsibilities associated with 401(k) management and other financial decisions. The push for the fiduciary rule can help ease this burden by placing more of this responsibility on your financial advisors. However, it may lead some advisors to pull away from managing 401(k)s for businesses because it places more scrutiny on them. 

    Fortunately, there are other options that can take a lot of the fiduciary responsibility off your plate. By having a Professional Employer Organization like GMS manage your 401(k), you’re able to offload a lot of the financial risks associated with the plan. This includes financial transaction risk, as we’re responsible for making sure that money gets remitted to the financial institutions. We deduct that money out your payroll and send it directly to Transamerica, our record keeper. We’re also responsible for maintaining plan documents and making sure they stay compliant. If something happens, like an IRS restatement, we’re the ones responsible for applying it, not you.

    The exact form of the fiduciary rule may change, but financial responsibility can always be problematic for an owner. Contact GMS today to talk to one of our experts about how we can help your business manage its 401(k) plans so that we can take on that responsibility for you. 

  • Wellness programs have become very popular in recent years. In its 2017 Employee Benefits Survey, The Society for Human Resource Management (SHRM) found that 24 percent of organizations added to their wellness benefits, which was the biggest increase for any benefit during the year. 

    While more businesses are investing in wellness initiatives, some owners may ask how effective workplace wellness programs really are. The answer to that can depend on your goals.

    Employees using a workplace wellness program.

    How to Measure the Success of a Workplace Wellness Program

    To determine if a wellness program works, you need to define what you would consider success. It can be misleading to attribute the effectiveness of a wellness program to individual factors, like overall weight loss. Instead, the point of a wellness program is for employees to establish long-term healthy behaviors that help them improve their overall wellbeing.

    Can a wellness plan help instill long-term healthy behavior? A study in the U.S. National Library of Medicine found that people who participate in wellness coaching “improved their current health behaviors and learned skills for continued healthy living.” In turn, the improved health of these employees helps them be more productive, while their improved health can allow their employers to save money on costly healthcare benefits. 

    These small changes can have big effects, as the overall health of a group is one of the factors that determines how your group health insurance premium is calculated. For example, the American Lung Association cites that “employers can save nearly $6,000 per year for every employee who quits smoking.”

    Money isn’t the only factor. According to SHRM, “Three-fourths of organizations promote wellness to improve overall employee satisfaction and well-being, with just 25 percent hoping to reduce health care costs.” A wellness program can be about much more than just health savings and weight loss. It can also serve as a way for owners to show their employees that they have their well-being in mind and serve as an attractive benefit to attract and retain top talent.

    Small Business Guide to Health & Welness

    Is Your Wellness Program Set Up for Success?

    Like any other type of project, a wellness program needs to be run effectively to work. A Professional Employer Organization can help your business set up a dynamic program that includes several key components that foster healthier lifestyle decisions and sets your workers up for long-term success. Contact GMS today to talk to one of our experts about the benefits of a workplace wellness program or any other important employee benefits administration needs.

  • After a great year, giving back to your employees can be very beneficial for your business. Indeed states, “employees with incomes directly proportional to the organization’s profit generally become more invested in its future success and stay with the company longer.” A profit-sharing plan is one way to use your business’ financial success to benefit you and your employees.

    How Profit Sharing Works

    Profit sharing and 401(k) plans go hand in hand. When you offer your employees a 401(k) plan, you can choose to include a profit-sharing provision. These provisions are typically discretionary, giving you the flexibility to decide whether to contribute to your employees’ profit sharing at the end of the fiscal year.

    If you have a particularly good year, you can use some of that profit to make contributions to your employees. These contributions only take place after the end of a year so that you have the annual figures to determine what people made and the overall profitability of your business.

    Despite its name, profit sharing is not based on the profitability of a company. A profit-sharing plan allows you to take excess money after the end of a fiscal year and distribute it to employees’ retirement plans. These contributions typically come as set percentages applied to each employee’s salary.

    It’s important to note that these payments are not cash bonuses. Profit-sharing payments are deposited to employees’ individual 401(k) accounts as a separate line item from employee contributions. If an employee doesn’t participate in a 401(k) but is eligible to receive profit sharing, an account is automatically created for that employee.

    Another key aspect of a profit-sharing plan is that contributions are made to all eligible employees. You determine these eligibility requirements when you set up the plan. This could mean immediate eligibility for everyone from day one, or you might set a waiting period of up to one year.

    Types of Profit-Sharing Plans

    There are several types of profit-sharing plans, including:

    • Traditional profit-sharing plans: The entire company receives a part of the profit share equal to a set percentage of their salary. For example, at a 2% rate, an employee earning $100,000 per year would earn $2,000 and an employee earning $50,000 per year would receive $1,000. Typical rates vary from 1-5%.
    • New comparability profit sharing: This plan allows companies to divide employees into separate groups and allocate contributions differently to each group. It often benefits key employees, full-time employees, or higher-paid employees while still rewarding your entire team. Working with an expert is important to ensure employee groups are not facing discrimination under this plan.
    • Age-weighted profit sharing: In this plan, age and salary determine the contribution amount, favoring older employees who are closer to retirement. The idea behind age-weighted sharing is that older employees have less time to save and, therefore, need to receive more. Again, an expert should evaluate this plan to ensure age discrimination is not present in your business.

    How Profit Sharing Benefits Business Owners

    There are several good reasons to consider making a profit-sharing contribution after a successful year. One major advantage is that profit-sharing contributions aren’t considered payroll items. If you’ve had a fantastic year and want to reward your employees while saving on taxes, profit sharing allows you to contribute without paying payroll taxes. This means you won’t have to pay into Social Security or Medicare, maximizing your contribution’s value and reducing your tax burden. Additionally, you can also claim a tax write-off on these contributions, further enhancing your savings.

    Because profit sharing is linked to company profitability, it contributes to your business’s financial stability. Unlike a fixed bonus, you aren’t required to provide a standard amount each year and can instead offer variable amounts based on what your business can afford.

    Another advantage of profit sharing is that it’s an attractive tool to recruit and retain employees. In an increasingly competitive workplace, it’s an extra bonus that makes your business appealing to potential team members. For existing employees, it links their performance to the success of your business, which boosts morale and motivation to remain with the company for longer periods of time.

    Profit sharing is another way to reward employees after a successful year by contributing additional funds toward their retirement. You can also attach a vesting schedule to that profit-sharing contribution to incentivize employees to stay with your company.

    For example, you could place a six-year vesting schedule for profit-sharing contributions. Employees receiving those funds must be at your company for six years to keep all of the money. Employees who leave after two years are only partially vested in that contribution. This gives your employees an added incentive to stay at your company.

    How To Invest In A Profit-Sharing Plan

    Like a 401(k), there are certain rules and regulations that you must abide by when managing a profit-sharing plan. A professional employer organization (PEO) like GMS can help you manage the legal responsibilities associated with these benefits as well as determine what allocation models you can choose. Contact GMS today to talk to one of our experts about 401(k) and profit sharing.

  • Every day (well, at least Monday through Friday), I get a chance to meet with small business owners. Some of these business owners started their company because no one would hire them. Some started because they were tired of working for someone else. Some because they saw an opportunity to do what they wanted to do and how they wanted to do it. Many found a niche doing something no one else was doing and turned it into a lucrative business.

    In my travels, I get one common concern from employers that reaches across all industries and sizes: It’s hard to find and then keep good employees.  

    You’ve heard of all the offerings companies provide to help them address this issue: better benefits, more pay, flex time. The list goes on and on. What’s the best one that’s out there? That obviously depends on who or what you’re looking for.

    Image of employee benefits.

    Emulating Other Companies

    I was always taught that when you want to be successful, look to what the most successful people are doing and see how you can emulate them. Does that apply to the corporate world as well? 

    It’s been a couple of months since the Trump Tax Plan has been implemented. As I’m sure you’ve seen in the news, many companies have started providing bonuses and improved benefits. Among the ones you’ve heard of, Employee Benefits News listed 15 of them:

    • Aflac
    • Anthem
    • AutoNation
    • Chipotle
    • Comerica Bank
    • CVS
    • Disney
    • Hostess
    • Lowe’s
    • People’s Bank
    • Starbucks
    • SunTrust Bank
    • Unum
    • Visa
    • Walmart

    Of course, all these employers are huge companies that are flush with even more cash than before. How is a small business to compete for talent with the big boys?

    Small Business Advantages

    A small business has the ability to be more flexible than a big company can, which means it can make changes in policies and benefits on the fly without having to go through a lengthy board process to approve those changes. That can often lead to accommodating the type of people you want to hire.  

    There’s another way for a company to get access to corporate level benefits and more importantly, corporate rates. How? Well, maybe you should speak with a Professional Employer Organization like GMS. A PEO can pool their small to mid-sized client base together and take a corporate-sized group to market, providing better plans and rates while reducing the workload and liability on a small business. Contact us today to talk to one of our experts about employee benefits administration for your business. 

  • What Is Telemedicine And How Does It Work? 

    Telemedicine is the practice of delivering health care services remotely using digital communication tools such as video calls, secure messaging, and mobile health apps. It allows patients to consult with doctors, receive diagnoses, and even get prescriptions without visiting a health care facility in person. 

    During flu season, telemedicine becomes especially valuable, enabling individuals to seek medical attention from the comfort of their homes. Patients can schedule virtual appointments, discuss symptoms with a doctor in real time, and receive treatment recommendations without risking exposure to other contagious individuals in waiting rooms. Some telehealth platforms also provide remote monitoring, allowing doctors to track symptoms and recovery progress for high-risk patients. 

    The Growing Adoption Of Telemedicine In The Workplace 

    Due to its cost-effectiveness and efficiency, a growing number of employers are incorporating telemedicine into their health benefits packages. According to a 2024 report, 78% of employers now offer telemedicine services, recognizing its role in reducing absenteeism, improving employee well-being, and cutting health care costs. 

    Offering telemedicine is not just about convenience but also a strategic investment for businesses. Traditional in-person health care visits often involve significant expenses, including insurance claims, lost productivity, and emergency room visits for non-emergency issues. Telemedicine provides a cost-effective alternative, reducing unnecessary ER visits and allowing employees to receive timely medical care without disrupting their work schedules. 

    Benefits Of Telemedicine For Employers 

    Reduced absenteeism and improved productivity 

    One of the biggest challenges during flu season is the rapid spread of illness in the workplace. Employees who come to work while sick can infect others, leading to a cycle of absences. Telemedicine helps mitigate this issue by enabling early intervention. Employees can seek treatment at the first signs of illness and recover at home rather than exposing their colleagues. 

    Additionally, employees who use telemedicine services don’t have to take half-days or full days off work just to see a doctor. Virtual consultations are typically shorter and can be scheduled before or after work hours, minimizing disruptions to daily operations. 

    Lower health care costs 

    Telemedicine is significantly more affordable than traditional in-person visits. A virtual consultation costs an average of $40 to $50, compared to an in-office visit, which can range from $100 to $200 or more. Employers who integrate telemedicine into their health care plans can reduce insurance claims and overall health care expenses. 

    Competitive employee benefits 

    With labor shortages and increased competition for top talent, offering telemedicine as part of an employee benefits package can improve job satisfaction and retention. Employees appreciate having convenient, on-demand access to health care, making them more likely to stay with an employer that prioritizes their well-being. 

    Benefits Of Telemedicine For Employees 

    Convenience and accessibility 

    One of the most significant advantages of telemedicine for employees is the ability to receive medical care without leaving home. This is especially beneficial for those in remote areas, individuals with mobility issues, or employees with demanding work schedules. 

    Reduced exposure to contagious illnesses 

    Flu season poses a heightened risk for individuals with weakened immune systems, chronic illnesses, or caregiving responsibilities. Telemedicine eliminates the need for in-person visits to crowded doctor’s offices, lowering the risk of exposure to other contagious patients. 

    Faster access to care 

    Telemedicine appointments are often available within minutes or hours, whereas scheduling an in-person doctor’s visit can take days or weeks. This immediate access to health care ensures that employees receive timely treatment, reducing the severity and duration of illnesses. 

    Why Investing In Telemedicine This Flu Season Is A Smart Move 

    Flu season can significantly impact businesses financially and operationally. According to the Centers for Disease Control and Prevention (CDC), the flu costs U.S. employers $11.2 billion annually in lost productivity due to employee illness. Implementing telemedicine helps businesses minimize these losses by keeping employees healthier, reducing workplace outbreaks, and providing easy access to treatment. 

    Moreover, telemedicine aligns with broader workplace wellness initiatives, demonstrating a company’s commitment to employee health. As health care continues to evolve, businesses that adopt telemedicine will be better positioned to support their workforce while effectively managing costs. 

    Telemedicine is no longer a luxury; it’s a necessity, especially during flu season. It offers a win-win solution for employers and employees by reducing health care costs, minimizing absenteeism, and providing convenient access to medical care. As more businesses integrate telehealth into their benefits packages, they not only safeguard their workforce but also position themselves as forward-thinking, employee-focused organizations. Contact Group Management Services (GMS) to add telemedicine to your health plan and keep your employees healthy and productive. 

  • Following a 19.1 percent-32 percent hike in 2018, 2019 Obamacare rates are expected to rise by double digit percentage points, again. Though speculation by market experts have resulted in a slew of responses as to why premiums have continued to rise, 2019’s increase is one of the most cut and dry responses by insurers to current reform changes. Within this article, we’ll explore the proverbial straw that broke the camel’s back, which happens to be one of the pillars the ACA was built on: the individual mandate.

    Medical equipment sitting in front of rising costs of the current healthcare system.

    On Dec. 22, 2017, President Donald Trump signed a bill that effectively repealed the penalties associated with the ACA individual mandate. In a previously published blog post, I detailed the legislative headache this bill caused but the effects span much further than a complicated ruling by the Justice Department. As the financial implications begin to be rolled out to the public in the form of premium increases for ACA policies, let’s peel back the initial goals for the individual mandate and evaluate how we can improve on said goals during the next round of regulatory changes. 

    Improving the “Risk Pool”

    The ACA’s community rating system is geared towards diversifying risk within its pool of insured consumers. In short this means combining old, young, healthy, and ill individuals into one large risk pool from which insurers are to offer coverage. Ideally, this community pool would reduce the overall risk and stabilize premium rates. The mandate had an overarching goal of expanding this pool by including previous uninsured individuals. 

    Enforcing the Tax Penalty  

    To ensure that the ACA’s pool is properly diversified, a tax penalty was implemented to deter folks from electing to go without insurance and effectively remove themselves from the aforementioned risk pool. This “penalty” has been a serious point of contention over the last few years as it was made constitutional by being defined as a tax by the IRS rather than a penalty for lack of purchase. 

    Prior to it’s repeal, many believe the tax associated with the individual mandate was in fact too low. If one were to simply accept the tax penalty and go without coverage, they’d likely spend much less money than what a year’s worth of major medical premiums cost. This was a major concern for ACA supporters in that the very goal put in place to increase younger and healthier enrollment was doing quite the opposite. If early ACA adopters could redefine one detail regarding the bill, a higher tax to make the choice between going with or without coverage more difficult likely tops their list. 

    Premium Tax Credit

    For individuals that followed the direction of the mandate’s initiatives, a tax credit on premium was issued assuming you met certain financial guidelines. Generally speaking, subscribers would receive enough credit to keep their premium payments below 9.5 percent of household income. The amount of each subsidy issued was determined by your take home pay, but even individuals making up to four times the federal poverty limit were eligible for some form of tax credit. 

    Some experts believe that tax credits were extended too far and for too many individuals. Cutting back on the top 10 percent of earners still receiving tax credits would make a larger pool of funds available to those closer to the federal poverty limit. In an ideal world, this theoretical increase in available funds for lower earners would increase the likelihood of them implementing coverage. With most of those low earners being young post-grads, it would have behooved ACA implementers to entice those individuals into joining the risk pool by any means necessary. 

    Making Healthcare More Available and Affordable

    Hopefully the above factors and failures will open discussions to innovative and reflective reform changes. If nothing else, it should provide a blueprint for what to avoid when attempting to make our domestic healthcare more available and more affordable. 

    At GMS, we pride ourselves on relaying insightful and valuable information to our clients and their workforces. We offer unique benefit platforms and comprehensive consultation services. Reach out to your local office and inquire about how we can help you today!

  • When your employees are ailing, your business is also likely to suffer. The health and wellbeing of your employees can play a big part in your company’s success, as a happy, healthy workforce has several benefits, including:

    • Increased productivity
    • Reduced absenteeism
    • Decreased medical costs

    Many small business owners have turned to workplace wellness programs to help improve the wellbeing of their employees. Over time, these programs have evolved to address specific issues to better serve employers and their employees. Here are some recent wellness trends than may be a good fit for your business.

    An office worker stretching as part of the company’s workplace wellness program.

    Programs That Cover More Than Physical Wellbeing

    Physical health isn’t the only concern for your employees. While health concerns like chronic disease is a major issue for businesses, the stress caused by other factors can be a major source for lost productivity and morale. That’s why some businesses are expanding the definition of wellness to include areas like emotional, financial, and other types of wellbeing. 

    According to BMC Public Health, a peer-reviewed health journal, stress can increase health insurance costs for a business by 50 percent. This trend has led to the addition of skills training, financial counseling, and other outlets to some wellness programs. In addition to providing avenues for weight loss or smoking cessation, these programs focus on other avenues that can help improve both the physical and emotional health of employees by giving employees the knowledge and skills they need to reduce the stress placed on them by outside forces.

    Architectural Wellness

    You may not think about it, but your workspace can play a part in the wellness of you and your employees. Architecture and design magazine Metropolis notes that “new research about the effects of noise, light, and air quality—among many other factors—reveals direct links to long-term human health, not to mention daily productivity.” This means that certain changes to a workspace could help improve the overall wellbeing of employees, allowing them to be more productive while potentially limiting the number of sick days taken.

    Of course, most small businesses can’t do a complete redesign of an office. However, there are small changes you can make to create a healthier workspace. These include:

    • Air quality – Replace air filters and allow for fresh air flow to limit levels of carbon dioxide and other contaminants
    • Ergonomic furniture – Invest in seating and desks that relieve physical stress on employees over long periods of time
    • Private spaces – If possible, clear out some rooms or open spaces where employees can work privately when they need some space to focus
    • Noise control – Establish quiet zones for employees who need to get away from distracting conversations and use sound-deadening materials or furniture to help absorb noise

    Personalized Programs

    This shouldn’t come as a surprise, but every employee is different. This means that each worker can have certain preferences about what should be included in a workplace wellness program. Instead of trying to push aspects of a wellness program on disinterested employees, some businesses are personalizing programs so that users can take advantage of what they want.

    A wellness coordinator can meet with each employee to go over their health and to identify exactly what he or she wants to achieve through the program. Some employees may want to aggressively work to lose weight or quit smoking, while others may just want to maintain their level of health and learn other ways to improve their wellbeing. Coordinators can create personal health guides to provide workers with individualized information based on each specific user. 

    You can also offer “health hours” to employees to allow them to personalize their wellness on their own. This concept gives employees a set number of hours per week or month to go to the gym, take walks, or do some other healthy activity during company time. This can help workers who can’t find the time to work out on their own while still giving them the freedom to choose their own route to wellbeing.

    Small Business Guide to Health & Welness

    A Focus on Musculoskeletal Pain

    The U.S. Department of Health & Humans Services released a study back in 2015 that found nontraumatic joint disorders to be one of the five most costly conditions for American adults. Thanks to issues like back pain, arthritis, and carpal tunnel causing higher absentee rates and workers’ compensation claims, small business owners are now starting to realize that they may need to be proactive about musculoskeletal pain.

    A wellness program with a focus on musculoskeletal pain will help educate employees on how to prevent these issues. This may include:

    • Educating workers about what is considered a musculoskeletal disorder and how these injuries happen, which can include heavy lifting, bad work posture, and other practices that can lead to pain over time
    • Teaching prevention tactics such as important warmup stretches and proactive processes
    • Highlighting ways to improve workplace ergonomics

    Find the Right Workplace Wellness Program for Your Company

    While wellness programs can benefit small businesses, they’re only beneficial if they’re run effectively. At GMS, we can set up a customized workplace wellness program that’s designed around the needs and questions of your employees and features a quarterly review of claims and the impacts of your program. Contact GMS today to talk to one of our experts about how we can improve the wellbeing of your employees and your business.

  • With the soaring costs of healthcare in the U.S., many citizens feel they are left with little to no alternatives when it comes to significant surgeries and procedures. This has helped propel many to look into the latest trend of “medical tourism” in an effort to get the operations they need without breaking the bank.

    Citizens may be uneasy about the idea of receiving care outside of the United States, but there are some great facilities and specialists in other countries where the same level of treatment—or even better in some cases—can be received at a fraction of the price. That was the case for GMS employee Christine Mace when her husband Dan required hip surgery back in 2016.

    Health City Cayman Islands, a medical tourism destination.

    Finding Affordable Treatment Through a Medical Concierge

    Dan had been dealing with the pain for years and was willing to take any action necessary to resolve the issue.

    He had seen several doctors in the states, who eventually advised he would be required to have hip surgery to fix the issue. During a consultation with a specialist from Akron, Dan inquired when the doctor thought he’d need surgery on his other hip. The doctor’s reply was “in a couple years.”

    Chris Mace’s accounting background kicked in. She started researching the astronomical costs for a hip surgery in the U.S. and worried this would have a significant negative impact on the health insurance rates of her co-workers. She began researching alternatives to alleviate Dan’s pain. One day, Dan found an article in Parade Magazine about the idea of “medical tourism.” 

    Chris set up a meeting with GMS’ VP of Benefits, Beth Kohmann, to discuss other possibilities. The two contacted Akeso, a company who has a division specifically dedicated to assist in this process as a “Medical Concierge.” 

    Experts from Akeso discussed the problems Dan was having and began to do their research. They found that the Cayman Islands had a facility, Health City Hospitals, with some of best orthopedic and cardiac surgeons in the world. 

    Before he could even have his initial consult, Dan would first need to proceed with a full physical as well as a dental evaluation. This was a requirement of the Cayman facility so there would be no risk of bringing in a patient with existing infections that could detrimentally affect any other patients receiving treatment at their facility. The hospital boasts a 100 percent infection-free reputation. In that time, it was discovered that Dan had a Periodontal disease, and the pre-certification process helped assure the issue could be resolved without any severe affects to his dental health, an added bonus in the process. 

    Once they passed all the requirements, a meeting was set up with Dan, Chris, Beth Kohmann, and the potential surgeon from the Cayman hospital, Dr. Alwin Almeda. 

    Dan arrived shortly after their set time, and painfully walked to his seat at the table. The doctor focused on his gait and the clear pain shown on his face. By the time Dan was able to sit down, the doctor apologized and told Dan he would need to have him walk paces in front of the camera once again. 

    Between the evaluation of his gait, as well as the X-rays obtained here in the states, Dr. Almeda was able to identify the issue. He asked if Dan had ever been able to cross his legs or sit cross legged on the floor. Dan replied that he had never been able to do so, not even as a child. Dan was stunned because no one had ever asked him that before. Dr. Almeda identified the issue as Femoroacetabular Impingement (FAI). Dan then asked the doctor when he thought the other hip would need surgery, to which the doctor replied, “NEVER!” The impingement was only in the right hip, and the left hip showed no signs of needing repair. (Note – this doctor was using the same scans taken as the Akron doctor.)

    When asked about his pain level on a standard 1-10 scale, Dan replied that his pain was at a 12. Dr. Almeda then informed Dan that he was a candidate because his level of pain matched what the doctor saw on the scan. The doctor then asked Dan why it had taken him so long to seek medical treatment to resolve his discomfort. Dan’s reply was “Fear and cost.” The doctor then replied that money should never be the reason someone is robbed of the finest quality of life they deserve. Dan knew this was the guy to resolve his issue. Dr. Almeda agreed that since Dan was cleared of all possible infections, he qualified as a patient at the facility.

    Traveling Outside the U.S. for Medical Treatment

    The Akeso rep listed off dates for Dan and Chris to travel to the Cayman Islands. They quickly set up plans to travel down a couple weeks later on Feb. 4 with the surgery on that following Saturday, Feb. 6.

    Akeso set up first-class airfare for the trip down. Once Dan and Chris arrived, they had a rental car already set up. Chris quickly realized when they got to the rental that cars travel on the opposite side of the road, which led to a friendly police escort the rest of the way to the hospital. 

    Health City Cayman Islands was born from the vision of Dr. Devi Shetty, a renowned heart surgeon who was Mother Teresa’s personal physician, and supported by Narayana Health Group of Hospitals. This brain trust founded Health City Cayman Islands as part of an effort to bring low-cost, high-quality medicine and care to the Cayman Islands and nearby outposts in Central and South America.  

    According to the Maces, the hospital was comprised of staff mostly from India. At home, they would not have the same financial opportunity that Health City provided. On top of fair compensation, employees have their housing and food paid for, and the organization even pays for them to travel back to their home country for one month each year. 

    “You could tell how much they genuinely cared about their patients and improving their quality of life,”  Chris said.

    A hospital and rehabilitaiton center in the Cayman Islands that was suggested by Akeso’s medical concierge division.

    The Medical Tourism Experience

    The staff walked them through the process and advised they would need to return for tests Friday and the surgery would be all set for Saturday. Dan was admitted into the hospital that Friday evening. The Maces were not prepared for what they saw when they entered his private hospital room. The room was approximately 30-by-30 feet with a beautiful garden view, huge private bathroom, living area, and desk. They explained that Dan would actually have his first therapy sessions right there in his room. Chris set up her office in the room and was able to work remotely while Dan was in surgery. All they had to do now was wait for the big day. 

    Their exemplary experience continued. The doctor paged Chris after the surgery was completed to tell her everything went as planned, and it was a success. After cutting into the hip, Dr. Almeda advised that the ball in the hip broke into three pieces because of the severity of the deterioration. It was also found, during testing, that Dan’s legs were not the same length. Dr. Almeda explained that since the surgery went so smoothly and he was already “in there,” he used bone putty to build up the pelvic bone, prior to installing the new prosthetic hip. The doctor felt that making both legs the same length would help Dan’s back, knee, and ankle pain. Dan was thrilled to find out he was an inch taller after the surgery! There was no additional cost for that part of the surgery. 

    Dr. Almeda accompanied Chris and Dan into recovery and stayed with them for three hours, discussing the entire process, viewing scans, and helping Dan stand that very same day. He helped alleviate any concerns they had moving forward. 

    Health City Cayman Islands kept Dan in the hospital until the following Thursday. After being discharged from the hospital, Chris and Dan went to the private residence to continue the recovery process. Chris went into the bedroom to do some organizing, leaving Dan watching TV. While in the bedroom, she suddenly heard Dan saying something directly behind her. She turned and realized he was up and walking without his walker. He was already so comfortable, that he didn’t even realize what he was doing. 

    They went back and forth to the hospital for PT for the remainder of their trip. Chris was treated to first-class dining at the hospital, which held a satellite kitchen from a four-star restaurant on the other side of the island. 

    When all was said and done, the whole experience came to a total of around $11,000 as compared to about $86,000 for just the hip surgery itself in the U.S. That cost included their first-class air fare to and from the island, a rental car, gas reimbursement, a $100-a-day food stipend, private residence on the beach, the hospital stay and surgery, and the PT that was required thereafter. A $3,600 refund towards deductible was also included in the deal. 

    Consider Alternative Health Options with the Medical Concierge Industry

    The idea of undergoing a life-changing surgery is overwhelming on its own. Then there are the consultations, scheduling, financial concerns, health insurance review, recovery, physical therapy, and so on. It is clear why people like Chris and Dan Mace have become advocates of Akeso, Health City Cayman Islands, and the medical concierge industry as a whole.

    Your employees are your most important asset. By partnering with a PEO like GMS, you can get insight into these types of programs through the experts of our Benefits Department to make sure your people get the care they need at the price they deserve. We can help lay out all your options to keep your group well informed and healthy, while helping save you time and money in other areas from Payroll to Human Resources and Risk Management. Contact GMS today to talk to our experts about how we can help your business.

  • As we brace ourselves for undeniable regulatory changes within the healthcare industry, often we neglect conversation about the shortcomings of our current system to ensure we don’t repeat the same mistakes. Although many would agree that the intentions of the ACA (“Expand access to health insurance, protect patients against arbitrary actions by insurance companies, and reduce costs”) were created with social good in mind, experts are strident that the mechanisms used to create this social good have failed to correct the economic epidemic that currently infects our healthcare system. 

    If you think “economic epidemic” is a hyperbolic term to use in this context, think again. As referenced in my previous blog post about the continuing battle to repeal the ACA, the U.S. domestic healthcare system costs around $3.3 trillion to the American economy each year. What’s less known is that this figure is projected to continue rising as it has almost every year since the 1960s. 

    Chart of how total health expenditures have increased over time. 

    Some are projecting the U.S. to hit bankruptcy as early as the year 2035 if this trend continues to grow as exponentially as it has the past few decades. With baby boomers entering their elder years and both millennials and generation X set to surpass the population totals of the boomers by 2028 (Millennials in ’19 and Gen X in ’28), we can expect the requirements of our nation’s healthcare program to rise as well. Now is the time for change. As I alluded to earlier in this piece, we need to be cognizant of our past mistakes to ensure they aren’t repeated down the road with financially dire consequences. 

    The MLR Rule: Medical-Loss Ratio

    The MLR rule is a lesser known mandate to the public that was included in ACA implementation. Some will argue that it had positive intentions in how our insurers spend premium dollars, which isn’t incorrect in theory, but it has a troubling method in which it determines how the rule is executed. 

    In short, the MLR rule for small employers dictates that insurers must spend 80% of every premium dollar (it’s 85% for large employers) toward actual medical expenses, claims, and quality improvement. This percentage does not include items such as advertising, administrative costs, and profit to which the remaining 20-15% of premiums are spent. There are provisions in place that when insurers fail to satisfy at least an 80% loss ratio they must issue rebates back to consumers. These rebates totaled $469 million dollars in 2014, with 29.86% of those rebates attributed to the small group (under 500 employees) market. 

    Map of the average refund per family in the small group market. 

    Image via the Centers for Medicare & Medicaid Services

    Many insurers will build in features such as risk assessments, screenings, and coaching hotlines to ensure their “medical expenses” reach the MLR threshold regardless of whether their consumers are likely to use those enhancements or not. 

    The failings of this rule are relatively simple to point out in economic terms: if an insurer’s profits are dictated by a fixed percentage of product costs—in this case we’re speaking of “cost” as medical premiums—the business/insurer has every incentive to see the overall cost of its product rise, thus increasing profit margins. 

    As we diagnose some of the issues included in the ACA and what to avoid in future reform policies, I think this percentage based MLR rule must be exiled. Our economy can’t afford to maintain the rate of rising healthcare costs with large insurers incentivized to maintain a similar mantra. I think we can achieve a healthy balance between the two, but improved consumer-centric policies must serve as the catalyst.

    Current Solutions for Businesses: Self-Funding 

    Although the tone of this article may seem slightly cynical, I promise it’s not meant to be. However, I do think it’s necessary to be transparent of the flaws within our current system. There are alternative options for businesses looking to get ahead of the upcoming reform trend before it hits home in the coming years.

    One solution is self-funding, which was included in the ACA as an alternative funding source outside of fully funded group insurance and is immune to the MLR rule. The immunity to MLR and other provisions within the ACA allow self-funded groups to control healthcare spending by accessing live claims data, become risk rated, and earn back unused premium at the end of their policy year. Since most self-funded groups aren’t managed by a large carrier, but rather the business itself or a reinsurer with similar interests as the group, premium costs are more easily maintained to fit an appropriate fiscal trend without the controversial incentives found nestled within the ACA. 

    With GMS specializing in level-funding, a form of self-funding, we feel that the transparency of our healthcare consultants and creative product solutions align us with the goals of many employers. Continue to follow GMS benefit related blog posts to stay on top of current healthcare advances and reach out to your local office to learn more about the healthcare solutions we can create together.