Nearly two-thirds of Americans have access to both health and retirement benefits

Approximately 64% of civilian employees in the U.S. had access to both an employer-sponsored health plan and an employer-sponsored retirement plan in 2009, according to the Bureau of Labor Statistics. The July 2010 Program Perspectives on Combined Benefit Plans also found that another 15% of employees had access to either a health care plan or retirement plan, but not both. The remaining 20% of civilian workers did not have access to either a health care or a retirement plan.

The results in the BLS report confirm commonly-held perceptions about the demographics of access to employer-provided benefits in America (presumably the Affordable Care Act will change this picture on the health care side).

Full-time workers have better access to benefits than part-time workers.  Seventy-seven percent of full-time civilian workers had access to both retirement and health care benefits, while only 20% of part-time workers did. In addition, 56% of part-time workers did not have access to either health or retirement benefits, while only 9% of full-time workers lacked access to either benefit.

Union workers have better access than non-union workers. Approximately 89% of union workers had access to both retirement and health care benefits, while 59% of nonunion workers had access to both.

Larger employers offer more benefit plans than smaller employers. BLS found that 86% of employees in establishments with 500 or more workers had access to both retirement and health care plans, while about 40% of workers in establishments with 1 to 49 workers had similar access.

These statistics are from BLS's National Compensation Survey: Employee Benefits in the United States, March 2009. For more information, visit http://www.bls.gov/ebs/#bulletins.

Wellness programs: employers like what they see

Employers generally believe that health and productivity management programs have a positive impact on their health-related goals, according to recent research from the Integrated Benefits Institute. The study, The Impact of Employer Health and Productivity Management Practices, found that employers believe that wellness programs reduce sick day/disability absences (44%), medical/pharmacy costs (43%), health-related lost productivity (36%), and presenteeism (32%).

IBI found that the three health and productivity management programs rated highest in overall effectiveness were early disability reporting (31.6% said the program "significantly improved" outcomes), transitional return to work (40.4%), and on-site providers (29.7%). While these were deemed the most effective at reaching corporate goals, they are used by fewer than half of responding employers.

In contrast, the two most prevalent wellness programs--employee assistance programs and smoking cessation programs--are used by more than three-fourths of employers, but are deemed to have a relatively low impact: 3.2% and 1.8%, respectively, said the program "significantly improved" outcomes.

The survey contained responses from 450 employers. For more information, visit http://ibiweb.org/.

Guidance on ACA market reforms: where do we stand?

So, the deadline for compliance with several of the market reforms contained in the Affordable Care Act--plan years beginning on or after September 23, 2010--is fast approaching. What help have employers and TPAs received from the tri-agency team (IRS, HHS, and DOL) charged with implementing the Act?

Well, you can't argue that our friendly federal regulators haven't been busy this summer. They've issued guidance--mostly in the form of interim final regulations--on the following market reforms, all contained in new sections in the Public Health Service Act (incorporated by reference into ERISA and IRC):

--PHSA Sec. 2704: prohibition of preexisting condition exclusions--rules relating to enrollees under age 19 (remember, for adults this rule won't kick in until plan years beginning on or after January 1, 2014);
--PHSA Sec. 2711: prohibits group health plans from establishing lifetime and annual limits on the dollar value of benefits (with restricted annual limits permitted until 2014);
--PHSA Sec. 2712: prohibits plans from retroactive rescission of coverage (except in cases of fraud or intentional misrepresentation);
--PHSA Sec. 2713: Requires plans to cover certain preventive services, without any cost sharing;
--PHSA Sec. 2714: Requires plans offering coverage of dependents to make that coverage available to adult children until age 26;
--PHSA Sec. 2719: Requires plans to provide an "effective" internal appeals process for coverage determinations and claims;
--PHSA Sec. 2719A: Requires plans to meet certain "patient protection" standards with respect to the selection of a participating primary care provider and for the use of out-of-network emergency services.

Go here for one-stop access to all these regulations.

No guidance has yet been issued on the following new PHSA provisions, also effective for plan years on or after September 23:

--PHSA Sec. 2715: Requires federal government to develop uniform standards for plans' benefit summaries and explanations of coverage;
--PHSA Sec. 2716: Prohibits fully-insured plans from discriminating in favor of highly-compensated individuals;
--PHSA Sec. 2717: Requires federal government to develop guidelines for health insurance issuers to report on quality of care initiatives and programs; and
--PHSA Sec. 2718: Sets minimum annual standards for medical loss ratio percentages of health insurers (note that the agencies requested comments on this provision in April).