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  • 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.

  • Health insurance comes with many responsibilities for small business owners. Regardless of whether you’re trying to cut health insurance costs or reward specific employees, you may wonder exactly how those responsibilities affect who you offer health insurance coverage. Can you pick and choose who can be a part of your health plan, or are there federal regulations involved? As you may expect, there are some rules you need to follow.

    Employees at a company that offers group health insurance coverage.

    Do I Have to Offer Health Insurance to Everyone?

    If you’re a small business owner, the answer depends on if you decide to offer health insurance to your employees. Businesses with fewer than 50 full-time employees aren’t required to offer health coverage, although many do because good health insurance is an attractive benefit for employees. Once you decide to offer health coverage, you must offer it to all full-time equivalent employees. As we noted in our post on small business health insurance requirements, full-time equivalent employees include those who meet “an average of 30 hours of service per week for a calendar month or at least 130 hours of service in a month.”

    It’s important to note that this means that you aren’t required to offer health coverage to part-time employees. You can choose to include part-time workers in your plan, but the setup is the same as it is with the full-time employees; if you offer coverage to one part-time worker, you will be required to offer it to all part-time workers.

    Benefits PDF

    Do I Have to Offer the Same Health Insurance to Everyone?

    While you can’t pick and choose which individual employees get health insurance and which don’t, you don’t necessarily have to offer all your workers the same level of health insurance. As an employer, you can offer varying levels of benefits based on employee-based classifications. These distinctions include:

    • Full-time vs. part-time (if part-time is even offered health coverage)
    • Different geographic locations
    • Date of hire or length or service
    • Job titles

    While you may be able to justify different levels of benefits through employee classifications, it can’t be for discriminatory reasons. It’s illegal to base decisions on benefits or other employment privileges on any factors protected by law. These include:

    • Race
    • Color
    • Sex
    • Religion
    • Health factors
    • National origin
    • Age
    • Disability
    • Genetic information

    Offer Group Health Insurance Coverage Through a PEO

    One of the reasons that small business owners are hesitant to invest in health insurance is that it can be expensive. Fortunately, a PEO can offer you a more cost-effective solution that can help attract and retain top talent. 

    Since Group Management Services represents multiple small businesses, we can leverage our buying power to get lower premiums on quality plans. Not only can we help you offer an attractive health insurance plan to your employees, we can also assist you with benefits management so that you get the most bang for your buck while helping you stay compliant. Contact GMS today to talk to one of our experts about how outsourcing payroll administration can benefit your business.

  • Even if you only follow on the fringes of healthcare reform, the inception of the ACA in 2010 may have shed light on the lack of bipartisan effort surrounding reform policies. Regardless of which side of the political spectrum you sit, the ACA (Patient Protection and Affordable Care Act) is widely regarded as the most impactful healthcare policy since the rollout of Medicare & Medicaid by President Lyndon B. Johnson in 1965. Irrespective of the clout this policy holds in the eyes of leaders within our domestic healthcare system, it has not operated within its short eight-year tenure without controversy.  

    The debate surrounding the longevity of this policy continued last Thursday (June 7, 2018) in unprecedented manner as the Justice Department filed a briefing recommending that the U.S. District Court of Texas (Fort Worth Division) rule the insurance reform provisions of the ACA unconstitutional.

    Book of recent updates in healthcare reform.

    How We Got Here

    To understand the severity of the proposed lawsuit, we must briefly glance at NFIB v. Sebelius, a previous legal decision surrounding the ACA which cleared a path for the above briefing to be filed.

    In 2012, a group of 13 states, a pair of individual plaintiffs, and the National Federation of Independent Businesses filed a motion (in the District court of Northern Florida) that the ACA was unconstitutional. According to Supreme Court multimedia archive Oyez, “The plaintiffs argued that: (1) the individual mandate exceeded Congress’ enumerated powers under the Commerce Clause; (2) the Medicaid expansions were unconstitutionally coercive; and (3) the employer mandate impermissibly interfered with state sovereignty.“ The conclusion of the suit resulted in the Supreme Court backing the ACA under the precedence that the individual mandate “is an appropriate use of Congress’ power under the taxing Clause and is, therefore, constitutional” according to a case brief for NFIB v. Sebelius.

    The important take away from this dispute is that the ACA was backed by Congress under the idea that the individual mandate was a tax and that it was “severable” from other provisions included in the ACA. This means that the judgement of one mandate within the ACA can be siloed and will not affect the policy as a whole. 

    The Filing at a Glance

    On Dec. 22, 2017, the individual mandate was repealed as a part of the Tax Cuts and Jobs Act of 2017 written in by President Trump and his administration. In ordinance with the repeal, many right-wing-leaning states have proposed the idea that an individual mandate (as of today, the requirement to have qualifying medical insurance still exists) without a penalty to do so (previously written in as a tax) is unconstitutional. The process of proving unconstitutionality within the ACA is based on “inseverability.” In short, if one mandate within the ACA is unconstitutional, the entire ACA is then unconstitutional and should be eradicated. 

    Now as defined above, the unique nature of this case is that the Department of Justice not only supports this idea but is urging the District Supreme Court to render the ACA invalid without reference to the previously approved filing of severability in 2012. The inconsistencies in the law from 2012 to current are unnerving to many analysts following this case. The provisions have been approved by Congress and signed into federal law and are not meant to be easily challenged or rehashed within a legal setting with such overarching consequences. In 2016, the domestic healthcare system within the U.S. reached $3.3 trillion dollars annually and accounted for 17.9 percent of the Gross Domestic Product. The security of such would be woefully undefined if the ACA (and mandates within it) were to be diminished without proper recourse or without a proper replacement. 

    Impacts of a Successful Repeal 

    The major concerns surrounding the impending decision are ones that largely propelled the positive social opinion of the ACA. Namely, the pre-existing conditions clause that prevented individuals with chronic illnesses from being denied coverage through ACA exchanges. The current “community rating” system of the ACA is also at risk if this motion goes without congressional defense.

    With or without the most polarizing and divisive reform policy of the last five decades, the future of our domestic healthcare system is cloudy at best. Only informed citizens having insightful conversations will spur positive change. If until now you’ve been asleep at the wheel regarding healthcare reform, this briefing should serve as a wake-up call.

    Small business owners are especially vulnerable to the ongoing healthcare uncertainty. It’s difficult to keep up with the ACA and other key policies that can affect your business. At Group Management Services, we provide owners with access to quality health insurance coverage at reasonable rates and keep them informed about changes in policies that can impact their business. Contact GMS today to talk to one of our experts about how we can help your business through these uncertain times.