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  • Open enrollment is a busy time for individuals with health insurance plans. Although the specific dates vary depending on the type of insurance, the state, and the employer, the overall process remains consistent. Open enrollment is the time when people can enroll in, update, change, or cancel their health insurance.  

    Many individuals enroll in a health insurance plan through their employer, which reduces the financial burden of health care costs such as doctor’s visits, medications, and more. It’s important to note that you cannot make changes to your health insurance plan outside of the open enrollment period unless you qualify for a special enrollment period. 

    Special Enrollment Periods 

    Whether you’re an employer or an employee, it’s important to understand special enrollment periods and what they entail. 

    Open enrollment is the only period for making changes to your health insurance. However, if you experience a qualifying life event, you can make these changes through a special enrollment period. Qualifying life events (QLE) are events that change your everyday life, such as getting married, losing your job, having a child, and more. QLEs include, but aren’t limited to the following:

    • Getting married, divorced, or separated
    • The death of a spouse or family member who shared your health plan
    • Having or adopting a child
    • Turning 26
    • A change in employment, leading to the loss of coverage
    • Moving your residence
    • See a list of other QLEs 

    While it is most common for people to qualify for a special enrollment period due to a QLE, several other situations may qualify someone for a special enrollment period. Such as: 

    • Becoming a United States citizen
    • Leaving incarceration
    • Experiencing a natural disaster such as an earthquake, hurricane, etc.
    • Learn more here 

    Assistance with Managing Enrollment Periods

    Open enrollment can already be a stressful and confusing time, but for employers, that stress can reach new heights. Managing different health insurance plans and costs can quickly become overwhelming, especially since all changes happen within that specific time frame. Employers also must be aware of employees who need to make health insurance changes during special enrollment periods and consistently review their current offerings to make the most cost-effective decision for their employees and company. Managing these changes is no easy feat, which is why business owners may look for assistance from a third-party company like Group Management Services (GMS).  

    GMS helps business owners manage open and special enrollment periods with our expert guidance, the help of a Benefits Account Manager, access to competitive group health plans, and administrative benefit support. GMS also offers business owners access to supplemental benefits, effectively reducing the cost and headaches that come from benefits administration. Contact us to learn more about how GMS can help your company during open enrollment and assist in managing special enrollment periods.  

  • As health care costs keep rising, both employees and employers are looking for ways to manage these expenses and make coverage more affordable. However, balancing these growing costs while ensuring employee satisfaction can be challenging for employers. To achieve this balance, employers can implement a variety of strategies to effectively lower health care costs while keeping employees happy, healthy, and productive. 

    What Do Health Care Costs Include

    Health care costs include all expenses related to maintaining or improving an individual’s health. While many services can fall under the umbrella of “health care”, these costs typically include accessing and utilizing health care services such as prescriptions, health insurance, doctors’ visits, deductibles, copayments, premiums, and more. While offering health care and health benefits can be expensive, they are essential to attract and retain top talent. Continue reading to learn a few ways you can reduce your health care costs.  

    Invest In Prevention

    Prevention is the best medicine, especially when it comes to health. By encouraging employees to focus on their health, either through developing healthy habits or scheduling regular check-ups, you help them focus on their current health and avoid future health issues. Regular check-ups, screenings, vaccinations, and telehealth appointments can significantly reduce long-term health care costs and prevent more serious and expensive conditions down the line. 

    Implement Wellness Programs

    Wellness programs are designed to enhance the health and wellness of individuals. They can focus on physical activity, nutrition, stress management, and mental health. According to a recent study, 91% of companies reported that their health care costs decreased because of their well-being program. These programs can include fitness challenges, stress management workshops, financial wellness resources, nutrition assistance, and more.  

    By fostering a culture of wellness, employers can reduce absenteeism, improve productivity, and increase morale. When employees feel supported, they are more likely to take better care of themselves and adopt healthier behaviors, which can lead to reduced use of health care benefits and ultimately lower health care costs. 

    Offer Telemedicine Services

    Telemedicine has expanded in the past decade, effectively transforming the health care landscape. Telemedicine provides employees with the ability to have a doctor’s appointment online. It provides greater efficiency and flexibility for physicians and patients alike. Employees are able to receive help for minor ailments and follow-up appointments, and receive faster care than going in person, reducing employee absenteeism and improving productivity. The convenience of telemedicine saves employees time by eliminating travel and waiting periods, and also reduces the need for time off work and costly co-payments. 

    Implement Additional Savings Accounts

    Another effective way to lower health care costs is by offering a Health Savings Account (HSA). An HSA is a special type of account that allows individuals to save money specifically for qualified health care expenses. With an HSA, contributions can be made tax-free as long as the funds are used for eligible medical expenses, which include deductibles and copayments. However, insurance premiums are generally not considered qualified medical expenses. To be eligible to contribute to an HSA, one must be enrolled in a high-deductible health plan (HDHP). These accounts can lower premium costs for employers and allow employees to save pre-tax dollars for medical expenses, giving them more control over their health care spending. 

    How CPEOs Lower Health Care Costs

    Reducing health care costs is a growing priority among business owners. While many business owners are reducing their coverage options to save money, this can leave employees vulnerable to higher health care-related expenses. Managing employee health plans isn’t an easy task, especially if you’re managing it alone. Luckily, Group Management Services (GMS), a certified professional employer organization (CPEO), can help you manage your employee benefits and the associated costs. 

    Our benefits experts can help you make the most of your benefits while saving you money. We provide expert guidance on health plan design and ensure compliance with the Internal Revenue Service (IRS). With our HSA and Federal Spending Account (FSA) administration services, we can simplify your account management.  

    We also provide comprehensive group health insurance plans that can reduce your premiums and deductibles. GMS represents more than 50,000 employees, which allows us to help businesses purchase group health insurance at rates up to 24% lower for employee premiums and up to 15% lower for family premiums compared to the U.S. average. 

    Employee health care and benefits are not easy to manage. That’s why having a knowledgeable partner to walk you through your options is essential. Contact us to learn how GMS can help simplify your health care and benefits today.  

  • Among many things, the COVID-19 pandemic changed how providers connected with patients worldwide. To stop the spread of COVID-19 early on, many providers postponed or canceled patients’ appointments. As a result, telehealth became a prominent source of patient care and monitoring. Telehealth provides individuals with easy access to providers while decreasing in-person contact with health care facilities and staff. Patients receive real-time interactions monitored through a smartphone, tablet, or computer. Pre-deductible telehealth coverage was included in the 2023 omnibus spending bill. The bill proposed that the telehealth pre-deductible coverage would remain available for an additional two years. On December 29th, 2022, President Joe Biden signed the $1.7 trillion spending bill into law. The bill included extending telehealth relief provision, which supported the 2020 Coronavirus Aid Relief and Economic Security Act (CARES). The CARES Act pushed payments to eligible adults, expanded unemployment insurance, and gave loan borrowers additional time to make payments.

    Understanding Pre-Deductible Coverage 

    Understanding how your deductible works is an integral part of getting the most out of your policy. It’s imperative to understand how pre-deductibles work within your business. Pre-deductible benefits are implemented when your plan starts – giving access to you and your employees before reaching the set deductible. This allows you and your employees to receive coverage while removing the financial barrier – allowing the use of essential medicines, medical devices, and diagnostic tests.

    Good news for employers: the bill’s provision allows health savings account (HSA) -qualifying high-deductible health plans (HDHPs) to cover telehealth and other remote-care service options on a pre-deductible basis. Additionally, an otherwise HSA-eligible individual can receive pre-deductible coverage for such remote-care services from a stand-alone vendor outside of the HDHP. In both cases, the pre-deductible telehealth coverage won’t affect an individual’s eligibility to make or receive HSA contributions. In short, this pre-deductible coverage has improved access to health care options, in a convenient and accessible way.

    Following the HSA contribution rules, employees remain eligible for telehealth without affecting their contributions. Individuals within your organization could receive remote care from vendors in and outside of one’s network.

    Remain Protected With GMS 

    When the world shut down amidst the COVID-19 pandemic, telehealth services reached an all-time high. As we transition out of that period, there are certain benefits employees want to stay – pre-deductible telehealth coverage being one of them. Luckily, it has been extended another two years, but still leaves uncertainty for the future thereafter. As a partner of GMS, you can receive affordable and convenient health consultations with licensed physicians. Additionally, Teladoc saves you and your employees time from sitting in waiting rooms, minimizing the need to take time off work. Through our partner, Teladoc, your employees can stay healthy and productive. Contact GMS today to learn more. 

  • Governor Ron DeSantis signed an executive order on Friday, July 8th at Cape Coral High School to increase transparency for prescription drug prices in Florida. The order would help make pharmacy benefit managers and third-party administrators of prescription drug programs, accountable when managing prescription drug benefits for insurance companies.

    Gov. DeSantis’s goal in signing this order is to create lower costs for prescription drugs in Florida. DeSantis says, “With food and gas costs on the rise, addressing the pharmaceutical costs is one area I can make a difference in.” He continues to state, “This executive order requires accountability and transparency for pharmaceutical middlemen when doing business within the state, thereby reducing the upward pressure on prescription drug costs.”

    The order directs all executive agencies to include the following in future contracts:  

    • Prohibit spread pricing 
    • Prohibit reimbursement callbacks 
    • Include data transparency and reporting requirements 
    • Review all rebates, payments, and relationships between pharmacies, insurers, and manufacturers 
    • Amend all current contracts they can with the same provisions 

    Additional Programs In Progress

    During the Drug Transparency Order signing, Gov. DeSantis’ administration is working on the Canadian Prescription Drug Importation Program. This will allow prescriptions from Canada to be imported when their prices are significantly lower than those in the United States. The Food and Drug Administration (FDA) has been reviewing this for the past 600 days. 

    By developing new programs after the Drug Transparency executive order, Gov. DeSantis’ administration can find effective ways for Florida residents to save money.

    Navigating Prescription Drug Transparency

    By partnering with GMS, you gain access to a handful of resources beneficial for your business. At GMS, we have a designated Rx specialist who works with your employees to find them the most cost-effective options. Our promise is to make your business operations simpler, safer, and stronger. Learn more by contacting us today. 

  • Effective January 1, 2022, the No Surprises Act went into effect with regard to emergency care and balance billing by non-network providers. An undoubtedly complex piece of legislation, GMS’ Vice President of Benefits Beth Kohmann experts share some of the key takeaways below.

    With this new ruling, if a group health plan covers any type of emergency care, then emergency care treatment rendered through the stabilization of the patient must be covered by the group health plan – even if services are rendered by a non-network provider. The group health plan must cover these services at the in-network level of benefits. The group health plan will consider these charges at a qualified payment amount level and negotiate (if the qualifying payment amount is appealed) with the non-network provider until an acceptable payment amount is reached. The patient cannot be balanced billed for the difference between the billed charge and the agreed-upon payment amount.

    This applies to such providers as facilities, emergency room physicians, anesthesiologists, and air ambulances. Ground ambulance providers are not subject to the above ruling and would be permitted to balance bill a patient for the difference between the total charge and the qualifying payment amount.

    The same applies to non-emergency care where the patient would have no choice of provider. For example, if a patient is having surgery at a network facility with a network surgeon and the anesthesiologist or outside laboratory are non-network providers, the group health plan must pay these providers at the in-network level of benefits and at a qualified payment amount (or a negotiated rate if the qualified payment amount is appealed). As above, the patient cannot be balance-billed for the difference between the billed charges and the agreed-upon payment amount.

    If the patient chooses treatment from a provider that is not in-network for services, for example, a surgical center or surgeon, that provider must inform the patient of the estimated fee, prior to rendering treatment, for their services and explain that they could be balance billed for any non-allowed amounts. This must be in writing and the patient will need to sign a document stating they acknowledge and understand that they could be balance billed.

    This ruling will apply to any claims incurred after January 1, 2022. To stay in the know with the latest legislation and compliance, be sure to subscribe to our email list. 

  • Occupational Safety And Health Administration’s COVID-19 Vaccine Mandate:
    In a 6-3 vote on Thursday, the Supreme Court ruled that it will not allow the Occupational Safety and Health Administration’s COVID-19 vaccine-or-test Emergency Temporary Standard (ETS). As you may recall, this ETS would’ve required employees at companies with 100 or more workers to either be fully vaccinated or test weekly for COVID. According to the majority vote, OSHA is empowered to set “workplace safety standards, not broad public health measures.”

    What Does This Mean For Employers?

    Although not certain, this most likely marks the end of the road for the OSHA ETS. Vice President of Client Services Stacey Larotonda notes employers do not need to enforce any vaccine or testing mandate the ETS would have required. Employers should continue to maintain robust and up-to-date COVID-19 safety protocols.

    Centers for Medicaid and Medicare Services (CMS) Vaccine Mandate Update:
    Unlike the ETS, the Supreme Court brought life back into the CMS Vaccine Mandate with a 5-4 vote, that determined that the Department of Health and Human Services, which operates the Medicare and Medicaid programs, did have the authority to issue its vaccine mandate. The vaccine mandate can be enforced for federally funded health care facilities.

    What Does This Mean For Employers?

    The CMS previously mandated a January 27, 2022 deadline for Phase 1 implementation, and a February 28, 2022 deadline for Phase 2 implementation. What is still unclear by the new ruling, is if the CMS will mandate the same deadlines or provide an extension. Until the CMS releases more information on the deadline, all healthcare providers subject to the CMS mandate should begin implementing their policies and procedures to comply with mandate requirements.

    While we continue to navigate these unprecedented times, you can remain in the know with the latest legislative updates by signing up for our email announcements.

  • As we near a whopping two years since the beginning of the COVID-19 pandemic, President Biden doubles down on his actions to protect Americans. With 59.9% of people fully vaccinated in the United States and the expanded availability of both booster shots and testing, the Biden administration hopes to limit the pandemic’s ongoing devastation. 

    On Thursday, December 2nd, the president announced his efforts to push all private-sector employees to offer paid time off in an effort to encourage individuals to receive their vaccine(s) and/or booster dose – a measure already offered to federal employees. Outside of the PTO incentive, highlights of the administration’s plan include free at-home tests covered by insurance, more rapid response teams to assist medical staff, and accelerating vaccination efforts. Additionally, the Transportation Security Administration will extend its requirements for all travelers to wear masks on airplanes, trains, and buses and in airports or train stations, through March 18th. 

    For workplaces, the CDC guidelines state that they should keep following prevention strategies by wearing a mask indoors and in highly transmissible areas. The vaccine mandate is still not being implemented and the law has not been passed for private-sector companies. The best cause of action for small businesses across the board is preparation and understanding. By partnering with GMS, you’ll remain in the know with all of the latest legal changes.  

  • If you’ve noticed that your family health insurance prices are on the rise, you’re not alone. In fact, the cost of family premiums for employer-sponsored coverage has jumped 47% in the last decade – which outpaces wage growth at 31% and inflation by 23% over the same period. In the last year alone, premiums for family coverage reached an average of $22,221, a 4% increase.

    Roughly 155 million people rely on employer-sponsored coverage, with 59% of employers offering health benefits. It’s no secret that the larger the company, the more likely they are to offer a health plan. That said, the looming crisis of affordability continues to be an ongoing issue throughout the country. This proves especially true for small businesses with tighter budgets and fewer management resources at their disposal. On average, small businesses pay 8-18% more than large firms for the same insurance plans. Furthermore, location and industry type can make your organization’s premiums even (you guessed it) higher. Northeast and Midwest regions of the United States typically see more expensive premiums – as do those in the transportation, utility, and construction industries.

    Outside of the cost to implement a group health plan, many small business owners are often spread too thin – thus making the cost of time to actually administer the plan yet another hurdle to overcome. Managing a group health plan can be labor-intensive because of the ongoing regulatory changes, complicated communication processes, and the dreadful renewal process.

    Still, not offering health benefits is a recruiting and retention risk that you do not want to take. “Offering a healthcare plan is one of the most effective steps you can take as we continue to witness a workforce shortage,” shared GMS VP of Benefits, Beth Kohmann. “In today’s turbulent times, people throughout the country are looking for a solid, affordable healthcare plan to give them peace of mind. As an employer, providing that to your employees is one of the most vital things you can do.”

    Given the difficulty of offering an affordable, comprehensive plan, it’s easy to see why many business owners turn to a Professional Employer Organization like GMS. When you partner with GMS, you’ll take advantage of our consultative approach, giving you plan options and savings that will benefit your organization. In fact, last year GMS family premiums were 34% lower than the U.S. average.

    Contact us today to discuss a health plan tailored to your organization’s needs.

  • The controversial COVID-19 vaccine mandate had countless private-sector workplaces with 100 or more employees concerned over the testing and vaccine mandate. After a lawsuit was filed Friday by a group of plaintiffs, including Louisiana Attorney General Jeff Landry, the order has been suspended by the court. The court ordered that OSHA, ”take no steps to implement or enforce” the ETS “until further court order.”  OSHA has suspended activities accordingly. 

    A three-judge panel of the Fifth Circuit Court of Appeals slammed Biden’s end-justifies-the-means approach. The constitution limits what the federal government can make people do, even in emergencies.   

    Because similar challenges to the emergency temporary standard (ETS) have been brought in all but one of the 11 federal circuit courts of appeals, the U.S. Judicial Panel on Multidistrict Litigation will conduct a lottery as required by statute, pursuant to 28 U.S.C.A. §2112 (a)(3), likely this week, to select which federal circuit will hear appeals in the numerous challenges, including with respect to the Fifth Circuit’s order. Any outcome from the circuit selected in the lottery process may and likely will be appealed to the U.S. Supreme Court.  

    There are many other details that the public deems unconstitutional, which the NY Post covers in detail. For example, companies right under the 100-employee mark do not apply for this new order along with people who do not work or work at home. This case is headed for the US Supreme Court where this is unlikely to pass.   

    GMS will continue updating you on all the details to come regarding this new mandate. Be sure to stay in the know by subscribing to our email list.  

  • Washington has officially announced that under government ruling, starting on January 4th, all companies with 100 or more employees will need to be vaccinated or produce a verified negative COVID test weekly.  If one should not fully comply, there will be a nearly $14,000 fine per violation – up to $136,532 for a willful violation of rules. Unvaccinated employees must also wear masks. This new ruling will affect more than 84 million workers at medium and large companies.  

    Stricter rules will apply to 17 million people who work in nursing homes, hospitals, and other facilities that receive Medicare and Medicaid. They all must be vaccinated and will have no option to be tested.  

    Along with vaccine mandates and testing, OSHA requires that businesses provide paid time off for employees to get vaccines and sick leave to those who have gotten sick from the virus, which will go into effect on December 5th.  

    OSHA also states that because vaccines are free of cost, the companies do not need to pay for the tests for employees who do not wish to receive the vaccine.  

    Administration officials say efforts to get people vaccinated are paying off with about 70% of the nation’s adults now fully vaccinated. Although some companies fear that vaccine-hesitant people might quit which leaves an already-struggling small workforce even thinner.  

    This situation remains fluid and it is expected more changes and announcements are forthcoming. 

    Partnering with GMS can help business owners navigate legislative updates during these unprecedented times. To learn more about our services, contact us today.