Fencepost - May/June 2017 - 39

Employers should understand the terms of
contracts they've signed, what their rights are
and what they're actually getting in return.
receiving," Krieg says. "Employers should
make sure they truly have a transparent
relationship with each respective vendor,
and monitor this annually."
Employers should understand the terms
of contracts they've signed, what their
rights are and what they're actually getting in return, he says. Are they following basic fiduciary standards of managing
their plan, based upon audits where appropriate, and conducting a regular cycle of
impartial RFPs?
Company leadership should also make
sure the person in charge of managing the
benefits program is "properly motivated to
do what they need to do," to get the best
outcome for the plan.
"I see a lot of people who are in these
positions concerned first about their own
workload, and thus decisions they're making
are misaligned with what is the best interest of the plan," Krieg says. "Alignment
needs to happen within the leadership of
the company. They need to set expectations
and support the person in charge of the plan
to make good decisions. And if extra work
is necessary to achieve optimal outcomes,
then leadership should deploy the necessary
resources to get it done."
Employers should also deploy tools for
employees that allow them to be more
informed of healthcare service and provider options, and help them determine
which vendor or provider might be the
best fit for both cost and quality, he says.
Some insurance carriers are getting better with these kinds of tools, and there
are also third-party tools such as the
Healthcare Bluebook.
There's also a greater use of self-insurance by companies that wouldn't traditionally explore this option, Krieg says.
With this arrangement, employers can
be more involved in active plan management and focus on influencing plan outcomes. This allows them to pay insurance
companies less and leave more money for
quality employee benefits and/or reduced
company expenditures.

"But employers need to be careful when
considering this, and small employers
especially need to have the right stop-loss
protection," he says. "They need to be fully
informed about options and thoroughly
understand the terms of the stop-loss insurance, as well as any liabilities associated with
renewals and plan terminations."
Over the years employers have "squeezed
everything" they could from increasing copays and lowering benefits, says Donald
Balla, Jr., managing principal, employee
benefits division at Simpson McCrady
LLC in Pittsburgh. Now more employers
are implementing wellness and other strategies to help control utilization.

WELLNESS WAYS
For wellness programs to work, employers have to have management support and
engagement, and there also has to be a financial incentive, "because people just won't
respond unless it really hits them in their
paycheck," Balla says.
Employers can also test for certain biometrics, such as body mass index (BMI),
cholesterol, glucose levels, and smoking,
he says. They can then design the employee
contribution around these areas if appropriate, inserting achievement points if
employers meet certain standards. For
example, the Centers for Disease Control
states that a person with a BMI over 30 is
clinically obese, but an employer can state
that it will give a premium discount to any
individual who has a BMI less than 40.
However, employers must make medical
exceptions to employees who cannot meet
such standards.
While wellness programs may help lower
utilization, they will not address unit cost-
the cost for services at healthcare facilities,
Balla says. Indeed, the preferred provider
organization (PPO) discount model on average charges between 350 percent to 400 percent of Medicare.
"The traditional PPO discount model has
lost its effectiveness over the course of time
because the PPOs have included all of the
www.americanfenceassociation.com | 39 | May/June 2017

area hospitals and doctors in their networks
in an effort to be all-encompassing," Balla
says. "You have the best prices on services if
you offer all of the hospitals. Additionally,
there is nothing that prevents a hospital
from raising their charges to make up for
what they give away in discounts to the
insurance companies."
More employers that are self-funded now
negotiate a direct provider arrangement
with certain facilities, to get a particular
rate of service pre-agreed for a particular
population, he says. Small employers with
50 or less employees can join an association
that would have a focus on claims management using this type of platform.
Employers should also make sure they
have transparent relationships with their
broker and understand their compensation structure, whether it's a commission
or a fee, Balla says. Even if it remains a
commission, advisors have the ability to
change their commissionable rate with that
employer group.

IMPORTANCE OF ADMIN
A good way to increase efficiency is to
outsource benefits administration to third
parties that not only provide reports mandated by the Affordable Care Act, but also
manage the entire employee onboarding
and offboarding processes, starting with
online enrollment to transferring the files
electronically with direct carrier connectivity for onboarding to the termination of
an employee.
"Benefits administration is very important for an HR exec or CFO who have to
complete a range of reports," Balla says.
"Having the right features and understanding the costs of such a benefit management
system is mission critical."
Laura Delavan, a broker at Sterling
Risk Advisors in Atlanta, says that small
employers should evaluate whether alternative funding arrangements such as "level
funding"-a modified self-funding plan-is
right for them.
Within a true self-funded plan, an
employer puts money into a bank account
and withdraws when there is a claim,
Delavan says. However, that can be hard
to manage as money has to be taken out
throughout the year to pay for both large
and small claims. But with level funding,
an employer gives a carrier all of the money,


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Table of Contents for the Digital Edition of Fencepost - May/June 2017

Editor’s Note
Executive Director’s Message
President’s Message
Board of Directors | Board of Governors
Fencelines
Mistaken Identity: A Story of Cedar
Safety First
Minding Your Business
Class Act: AFA Education Foundation Bestows Seven Scholarships
Safety
Health Plan Checkup: Ensuring Your Benefits Program Is the Picture of Health
CLFMI
The Road More Traveled: 811 Car and 811 Bike Recognized as Damage Prevention Icons
New Members
The 811 Across Texas Public Awareness Campaign
Calendar
FenceSense
Index to Advertisers
Fencepost - May/June 2017 - Intro
Fencepost - May/June 2017 - cover1
Fencepost - May/June 2017 - cover2
Fencepost - May/June 2017 - 3
Fencepost - May/June 2017 - 4
Fencepost - May/June 2017 - 5
Fencepost - May/June 2017 - 6
Fencepost - May/June 2017 - 7
Fencepost - May/June 2017 - 8
Fencepost - May/June 2017 - 9
Fencepost - May/June 2017 - 10
Fencepost - May/June 2017 - 11
Fencepost - May/June 2017 - 12
Fencepost - May/June 2017 - Editor’s Note
Fencepost - May/June 2017 - 14
Fencepost - May/June 2017 - Executive Director’s Message
Fencepost - May/June 2017 - 16
Fencepost - May/June 2017 - President’s Message
Fencepost - May/June 2017 - 18
Fencepost - May/June 2017 - Board of Directors | Board of Governors
Fencepost - May/June 2017 - Fencelines
Fencepost - May/June 2017 - 21
Fencepost - May/June 2017 - Mistaken Identity: A Story of Cedar
Fencepost - May/June 2017 - 23
Fencepost - May/June 2017 - 24
Fencepost - May/June 2017 - 25
Fencepost - May/June 2017 - 26
Fencepost - May/June 2017 - Safety First
Fencepost - May/June 2017 - 28
Fencepost - May/June 2017 - 29
Fencepost - May/June 2017 - 30
Fencepost - May/June 2017 - Minding Your Business
Fencepost - May/June 2017 - 32
Fencepost - May/June 2017 - 33
Fencepost - May/June 2017 - Class Act: AFA Education Foundation Bestows Seven Scholarships
Fencepost - May/June 2017 - 35
Fencepost - May/June 2017 - 36
Fencepost - May/June 2017 - Safety
Fencepost - May/June 2017 - Health Plan Checkup: Ensuring Your Benefits Program Is the Picture of Health
Fencepost - May/June 2017 - 39
Fencepost - May/June 2017 - 40
Fencepost - May/June 2017 - 41
Fencepost - May/June 2017 - 42
Fencepost - May/June 2017 - CLFMI
Fencepost - May/June 2017 - 44
Fencepost - May/June 2017 - The Road More Traveled: 811 Car and 811 Bike Recognized as Damage Prevention Icons
Fencepost - May/June 2017 - 46
Fencepost - May/June 2017 - New Members
Fencepost - May/June 2017 - 48
Fencepost - May/June 2017 - The 811 Across Texas Public Awareness Campaign
Fencepost - May/June 2017 - 50
Fencepost - May/June 2017 - Calendar
Fencepost - May/June 2017 - 52
Fencepost - May/June 2017 - FenceSense
Fencepost - May/June 2017 - 54
Fencepost - May/June 2017 - 55
Fencepost - May/June 2017 - 56
Fencepost - May/June 2017 - 57
Fencepost - May/June 2017 - 58
Fencepost - May/June 2017 - 59
Fencepost - May/June 2017 - 60
Fencepost - May/June 2017 - 61
Fencepost - May/June 2017 - Index to Advertisers
Fencepost - May/June 2017 - cover3
Fencepost - May/June 2017 - cover4
Fencepost - May/June 2017 - outsert1
Fencepost - May/June 2017 - outsert2
Fencepost - May/June 2017 - outsert3
Fencepost - May/June 2017 - outsert4
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