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Laws Reduce Plan Sponsor ACA Reporting Burden

Two new laws which took effect Jan. 1, 2025 will ease the Affordable Care Act annual tax reporting burden on health plan sponsors.

In a bipartisan effort, Congress recently passed the Employer Reporting Improvement Act and the Paperwork Burden Reduction Act, both of which outgoing President Biden signed into law.

The laws are aimed at making it easier for sponsors to comply with ACA requirements on Forms 1095-B and 1095-C, which provide information about health insurance coverage to workers and the Internal Revenue Service.

Both laws take effect immediately.

Forms explainer

Form 1095-C is issued by “applicable large employers” (ALEs) — those with 50 full-time or full-time-equivalent workers — to report the offer of health coverage, while Form 1095-B is issued by insurance providers, self-insured employers or small employers to report actual coverage.

Prior to 2025, plan sponsors were required to send these forms to all of their employees covered by their health plan by March 2. The due dates for transmitting the forms to the IRS are Feb. 28 (if filing on paper) and March 31 (if filing electronically).

Both forms help workers prove they comply with the ACA’s mandate that they carry health insurance and that an employer is complying with its obligations to provide coverage under the law.

What’s changing

There are four changes that benefit employers under the two new laws:

1. Forms upon request — Plan sponsors are no longer required to send Forms 1095-B and 1095-C to all full-time and covered employees. Instead, they will only be required to furnish them upon request from an employee.

Importantly, plan sponsors who want to go this route are required to notify their staff about their right to ask for a form.

2. Electronic forms — Starting this year, employers may furnish the forms to their employees electronically rather than on paper. The new law also makes it easier for employers to use a worker’s birth date instead of their Social Security number if the number is missing.

3. Reponse times to IRS letters — Another provision expands the time employers have to respond to a “employer shared responsibility payment” letter (Letter 226J) from the IRS, to 90 days from 30.

These demand letters are sent to employers if one or more full-time employees listed on the company’s Form 1095-C received a premium tax credit on his or her federal income tax return, meaning they secured insurance on an ACA exchange like healthcare.gov.

Employers have found it challenging to  provide a response and a defense to the IRS within such a short window of 30 days. An additonal challenge has been that these letters are sent by U.S. mail, and it may take some time to reach the appropriate person in an organization after being received. Filing a response late can result in the employer being assessed a penalty when one isn’t warranted, in addition to further penalties.

4. Statute of limitations — One of the new laws imposes a statute of limitations for how far back the IRS can go to try to collect assessments for 1095-B and 1095-C reporting failures and mistakes. Prior to this, there was no statute of limitations.

The takeaway

The above changes will benefit plan sponsors by reducing the reporting burden as well as give them more time to respond if the IRS thinks an ALE failed to provide coverage as required by law.

Your HR department should be aware of these changes in order to take advantage of the them.

Employee Assistance Programs in Times of Need

Natural disasters, such as hurricanes and earthquakes, cause extensive property damage, physical injuries and loss of life. The distress might not end there, however. 

Mental health experts say that many victims of disasters experience post-traumatic stress disorder, depression and anxiety in the months following these events. The loss of loved ones, jobs, material goods and livelihoods are all traumatic experiences for victims, according to one Red Cross official.

Employers helping their workers cope with experiencing a disaster will generally find that having an employee assistance program (EAP) in place is invaluable.

An EAP is an intervention program designed to help employees resolve personal problems that might be affecting their work performance. Many employers make EAP services available to employees’ family members, as well. 

The problems do not necessarily have to be related to natural disasters – health, marital, financial and parenting issues are also among the problems an EAP can address. However, the program can be especially valuable for an employee who has suffered significant losses in a disaster such as a hurricane, earthquake or wildfire.

After a traumatic event like one of these, an EAP can provide the employee with:

  • Counseling and other forms of emotional support
  • Referrals to sources of food, shelter and clothing
  • Emergency care and boarding for pets
  • Opportunities for charitable donations
  • Assistance locating loved ones
  • Community-based recovery resources


An employee feeling overwhelmed in the aftermath of a disaster can use these services to return a small amount of stability and normalcy to their life. They help take care of short-term concerns, such as finding a place to stay and care for children and pets, allowing the individual to focus on longer-term problems such as repairing or replacing the home and obtaining financial assistance.

These programs have great benefits for employers, as well. Happy and healthy employees are productive employees. 

A study by the University of Warwick in the U.K. found that satisfied workers are 12% more productive and provide better customer service than their less happy peers. Employers who implement EAPs experience:

  • Reduced absenteeism
  • Fewer workplace accidents
  • Lower medical and workers’ compensation costs


EAPs also help managers to become more effective. They can help them develop skills in consulting with employees, managing workplace stress, maintaining drug-free workplaces, responding to crises, and helping employees achieve an appropriate work-life balance. 


EAP options
Employers have several options for establishing EAPs. 

They can run them with their own staff or outsource them to third party providers. Providers can be hired on a fee-for-service basis or for a fixed fee. 

They can be arranged by single employers, groups of small employers banding together, or by unions. Some employers or unions even train employees to provide peer counseling to their fellow workers.

EAP providers should meet the standards set by the Employee Assistance Professionals Association. These include standards for program design; management and administration; confidentiality; direct services; drug-free workplace and substance-abuse professional services; partnerships; and evaluation of the program. 


The takeaway
Even without catastrophic weather events, employees are subject to the stresses of day-to-day living, and their paths are often bumpy. Family members can develop substance-abuse problems, parents grow old and need care; unexpected financial shocks occur; and marriages often deteriorate. 

By implementing an EAP, an employer can help make these problems, and the shock of a natural disaster, a little easier for their employees to manage. 

EAPs can help retain good employees, make them more productive, and make their lives a little better. In turn, this can make a business more profitable and a better place to work.

More Employers Cover Weight-Loss Drugs: Survey

The percentage of employers who are covering new and trendy weight-loss drugs has risen in 2024, continuing a trend of increasing coverage despite the costs, according to a new survey.

The study, by Mercer, also found that employers are increasingly offering to cover in vitro fertilization for employees who may be having trouble getting pregnant. And, as costs continue rising on average 5.25% in 2024, employers are taking a number of steps to manage costs.

The fastest-growing component of costs is pharmacy benefit costs, which were up 7.7% after rising 8.3% the year prior. One of the main drivers is diabetes and weight-loss drugs like Wegovy and Ozempic (both made by Novo Nordisk) and Zepbound (made by Eli Lilly).

But, while health plans will generally cover these medications for diabetes, not as many do for weight loss.

The survey found that 44% of employers with 500 or more workers cover weight-loss drugs like Wegovy and Zepbound, as well as older medications in the same class like Saxenda (made by Novo Nordisk). That’s compared with 41% in 2023.

Weight-loss drugs are covered by 64% of employers with more than 20,000 employees, up from 56% in 2023.

These drugs, known as GLP-1s, are contributing to a significant spike in pharmaceutical costs and adding to overall health care outlays. The full list price for Ozempic was $969 in the fall, down 9.7% from 2023. The list price for Wegovy was $1,349, down 2.5% from 2023, but still about 20% higher than it was in 2022.

Most commercial health plans and Medicare pay about $290 for Ozempic and $649 for Wegovy, according to an anti-obesity medication cost report prepared by the Department of Health and Human Services.

It should be noted that health plans that cover anti-obesity medications saw a 4.8 percentage-point higher increase in their pharmacy spend in 2023 than plans that don’t cover the drugs, according to a report by Segal Group.

As a result of costs, employers are requiring pre-authorization and trying to ensure that workers are first prescribed other effective and less expensive treatments. That requires clinical coordination between clinicians, pharmacy benefit managers and insurers.

Employers are also increasingly covering in vitro fertilization. The treatment was covered by:

  • 47% of firms with more than 500 workers in 2024, up from 45% the year prior.
  • 70% of organizations with more than 20,000 employees, up from 47%.

Employer strategies

Respondents in the Mercer survey were also asked to list their most important benefits strategies for the next three to five years. They ranked the following as either important or very important:

  • Managing high-cost claimants: 86%
  • Managing the cost of specialty drugs: 76%
  • Enhancing benefits to improve attraction and retention: 71%
  • Improving health care affordability: 66%
  • Expanding behavioral healthcare access: 64%
  • Enhancing benefits/resources to support women’s reproductive health: 48%
  • Offering high-performance networks or steering to high-value care: 45%
  • Increasing use of virtual care throughout the health care journey: 42%
  • Addressing health inequities/social determinants: 36%

The takeaway

An earlier survey by Mercer, released in September 2024, found that employers had expected a 5.8% increase in health insurance costs, even after implementing cost-reduction measures.

One way employers are trying to address both their and employees’ costs is by offering their employees more plans to choose from. In 2024, two in three large employers offered three or more plan choices, up from six in 10 in 2023.

As well, the country’s largest employers offer an average of five options, compared to four in the year prior.

The Mercer survey concluded that employers would have to balance two priorities:

  1. Focusing on health care affordability and ensuring that their staff can afford their copays, coinsurance and deductibles.
  2. Managing their plan costs to keep employees’ share of premium reasonable and ensure that the benefits package is within the organization’s budget.

IRS Loosens Preventive Care Coverage Rules

New guidance issued by the IRS expands the types of preventive care benefits that high-deductible health plans are required to cover with no out-of-pocket costs on the part of plan enrollees.

The changes are aimed at reducing out-of-pocket costs for diabetes-related expenses, certain cancer screenings and contraceptives. The guidance, released in two notices — N-2024-71 and N-2024-75, — can result in real savings for Americans.

Benefits under HDHPs typically do not kick in until the enrollee has met their deductible. However, these plans are required to cover a number of preventive care services, as outlined by the Affordable Care Act, without any cost-sharing on the part of the health plan enrollee.

Under notice 2024-75, the following are considered “preventive care,” meaning that HDHPs will be required to cover them at no cost to their enrollees and even before they’ve reached their deductible:

  • Breast cancer screenings for individuals who have not been diagnosed with this type of cancer.
  • Continuous glucose monitors for individuals diagnosed with diabetes. Covered monitors must measure glucose levels using a similar detection method or mechanism as other glucometers.
  • Insulin products, whether they are prescribed to treat an individual diagnosed with diabetes, or prescribed for the purpose of preventing the exacerbation of diabetes or the development of a secondary condition.
  • Oral contraceptives (including emergency contraceptives) and condoms.

The above will be added to the other preventive care expenditures that health plans are required to cover under the ACA.

Under notice 2024-71, flexible spending arrangements, health reimbursement accounts and health savings accounts will be required to reimburse for the cost of condoms.

The takeaway

If you offer HDHPs, HSAs, HRAs or FSAs, consider sending out a memo informing your employees of the changes, which are designed to help reduce their out-of-pocket medical expenses.

You should also add the changes to your benefits manual so that your staff know what they are entitled to.

If you are a self-insured employer, you should ensure that your third party administrator is aware of the changes to coverages by HDHPs. As well, plan materials for employers who choose to reimburse the cost of male condoms should ask their administrator to update the plan materials for FSAs, HRAs and HSAs.

What to Expect in Health Insurance During Trump 2.0

When Donald J. Trump was president during his first term, he tried but failed to repeal the Affordable Care Act, but succeeded in efforts to expand short-term health plans.

His administration also attempted to make it easier to form an association for the purposes of purchasing health insurance that was exempt from many of the ACA’s requirements for health plans, an effort that was beaten back by the courts.

Now that he’s on his way back to the White House, what can we expect for health insurance coverage and regulations during his second term? For certain, there will be a focus on deregulation and efforts to lower costs.  

Pundits from various trade publications have weighed in on what areas could be ripe for changes under a Trump presidency.

The ACA

While Trump previously tried but failed to get the ACA repealed, he has indicated that he doesn’t want to repeal it but make changes to it this time around.

Absolute repeal is likely a non-starter considering that residents in a number of Republican-led states are heavy users of ACA marketplace plans, including Florida, Texas and Idaho, the latter of which runs its own ACA exchange. Florida and Texas residents purchase coverage on HealthCare.gov.

The Biden administration has focused on boosting enrollment in marketplace plans and the president signed legislation in 2022 that extended until the end of 2025 enhanced federal subsidies from the COVID era to help individuals purchase plans.

Thanks to those subsidies, people at the lower end of the income spectrum are often paying no or very low premiums for plans with generous coverage, such as low deductibles and copays, but even middle-income individuals see significant benefits.

With Trump in the White House, and the GOP in a majority in both the House and Senate, those subsidies may not be extended again.

Will alternative plans rise again?

The Biden administration repealed Trump-era regulations that significantly eased restrictions on short-term health plans, multi-state association health plans and hospital indemnity insurance.

For example, the first Trump administration rules allowed individuals to purchase short-term health plans and keep them in place for up to 364 days, which could be renewed or extended for roughly three years. The Centers for Medicare and Medicaid Services in September 2024 issued new final rules that limit short-term health insurance to up four months at most, without the possibility of renewal. 

When originally floated about 10 years ago, short-term health plans were intended to provide temporary coverage for people in between group health plans.

Also, the Trump administration introduced a rule in 2018 that lowered the barriers to entry to association health plans that would be considered single employer plans (and exempt from individual and small-group market rules).

The U.S. District Court for the District of Columbia in 2019 overturned the regulation and in 2023, the CMS repealed the regulation altogether.

Trump might attempt to rewrite the regulation in a way that may pass legal muster. Sen. Rand Paul (R-Kentucky) recently reintroduced legislation that would let any membership organization provide a self-insured, multi-state health plan.

Drug costs

Trump in the past has supported plans to negotiate for lower pharmaceutical prices and make it easier to import drugs from lower-cost countries. He also advocated during his first term for pharmacy benefit manager reform.

Under the Biden administration, the CMS has started negotiating with drug makers for price reductions of commonly prescribed drugs for Medicare beneficiaries. The first round of negotiations took place earlier this year, helping reduce the prices that Medicare pays for 10 high-cost drugs.

The CMS under Trump 2.0 may end up floating new regulations changing the parameters of the negotiations, and he may push again for government programs to import drugs from lower-cost countries, like Canada.

The takeaway

Trump is entering office on the back of his populist policies, and that means making the working class happy.

He will have to work with two types of Republicans in Congress: traditional, establishment members and the ones who are not skeptical of the traditional GOP pro-big business and small-government ideology.

The president-elect will have the power to implement certain regulations that can change the health insurance marketplace, but they have to be written within the parameters of existing law and many changes can, and will, be challenged in court.

The Holidays Have Their Own Workplace Perils

On-the-job accidents may increase during the holidays as distractions in the workplace increase and decorations can pose safety issues. 

Normal routines and schedules are disrupted, and your staff — like everyone else — are also rushing around to crowded and chaotic stores and malls after work and on weekends.

Be aware that accidents may be more likely to happen at this time of the year at the workplace, on the road or at home. Employees tend to take extra physical risks ― such as when hanging lights and lugging trees around. And if you hold a holiday party, it opens up a new set of potential liabilities. 

In-office safety

When planning decorations for the office, it is important to keep holiday safety in mind.

Decorating the office helps workers enjoy the spirit of the season together, but remember that proper safety precautions should be observed at all times:

  • Be mindful of potential fire hazards when selecting holiday decorations and where you place them.
  • Be careful of stapling holiday lights, do not add too many strings of lights and make sure illuminated items are turned off.
  • Verify that all fire extinguishers are in place and fully charged and accessible.
  • Do not block exits, hang decorations on fire extinguishers, fire alarms or fire hose boxes, or obstruct the view of exit signs.
  • Do not hang decorations from sprinkler heads or electrical panels.
  • Without proper planning, holiday decorations can create tripping hazards. Extension cords should not be run through traffic areas where they pose trip hazards and, if you have to use an extension cord, use the proper one.
  • Avoid placing trees, freestanding decorations and presents in traffic areas.

Holiday party

The holidays bring office parties and, if alcohol is being served, keep in mind the liability involved.

Provide plenty of alternatives to alcohol, such as soft drinks, coffee, tea, water and cocoa. Hire a professional bartender who can cut people off if they have too much.

Enforce the same workplace rules of etiquette at the party as you do in the workplace.

If you serve alcohol, also serve food.

Stop serving alcohol a few hours before the party ends. Offer to cover the cost of an Uber or Lyft ride home for anyone who needs it.

The takeaway

If you keep in mind that the holidays put extra pressure on everyone, it may help you to keep your workplace free of accidents.

By following a few simple safety tips, it will be easy to enjoy the holiday and the events at work without dealing with injuries or damage to property.

When planning for the holidays, incorporate safety precautions into the planning process.

Employee Assistance Programs in Times of Need

Natural disasters, such as hurricanes and earthquakes, cause extensive property damage, physical injuries and loss of life. The distress might not end there, however. 

Mental health experts say that many victims of disasters experience post-traumatic stress disorder, depression and anxiety in the months following these events. The loss of loved ones, jobs, material goods and livelihoods are all traumatic experiences for victims, according to one Red Cross official.

Employers helping their workers cope with experiencing a disaster will generally find that having an employee assistance program (EAP) in place is invaluable.

An EAP is an intervention program designed to help employees resolve personal problems that might be affecting their work performance. Many employers make EAP services available to employees’ family members, as well. 

The problems do not necessarily have to be related to natural disasters – health, marital, financial and parenting issues are also among the problems an EAP can address. However, the program can be especially valuable for an employee who has suffered significant losses in a disaster such as a hurricane, earthquake or wildfire.

After a traumatic event like one of these, an EAP can provide the employee with:

  • Counseling and other forms of emotional support
  • Referrals to sources of food, shelter and clothing
  • Emergency care and boarding for pets
  • Opportunities for charitable donations
  • Assistance locating loved ones
  • Community-based recovery resources


An employee feeling overwhelmed in the aftermath of a disaster can use these services to return a small amount of stability and normalcy to their life. They help take care of short-term concerns, such as finding a place to stay and care for children and pets, allowing the individual to focus on longer-term problems such as repairing or replacing the home and obtaining financial assistance.

These programs have great benefits for employers, as well. Happy and healthy employees are productive employees. 

A study by the University of Warwick in the U.K. found that satisfied workers are 12% more productive and provide better customer service than their less happy peers. Employers who implement EAPs experience:

  • Reduced absenteeism
  • Fewer workplace accidents
  • Lower medical and workers’ compensation costs


EAPs also help managers to become more effective. They can help them develop skills in consulting with employees, managing workplace stress, maintaining drug-free workplaces, responding to crises, and helping employees achieve an appropriate work-life balance. 


EAP options
Employers have several options for establishing EAPs. 

They can run them with their own staff or outsource them to third party providers. Providers can be hired on a fee-for-service basis or for a fixed fee. 

They can be arranged by single employers, groups of small employers banding together, or by unions. Some employers or unions even train employees to provide peer counseling to their fellow workers.

EAP providers should meet the standards set by the Employee Assistance Professionals Association. These include standards for program design; management and administration; confidentiality; direct services; drug-free workplace and substance-abuse professional services; partnerships; and evaluation of the program. 


The takeaway
Even without catastrophic weather events, employees are subject to the stresses of day-to-day living, and their paths are often bumpy. Family members can develop substance-abuse problems, parents grow old and need care; unexpected financial shocks occur; and marriages often deteriorate. 

By implementing an EAP, an employer can help make these problems, and the shock of a natural disaster, a little easier for their employees to manage. 

EAPs can help retain good employees, make them more productive, and make their lives a little better. In turn, this can make a business more profitable and a better place to work.

ScriptSourcing: The PBM-Agnostic Solution for Consistent Pharmacy Benefits Management

ScriptSourcing’s PBM-agnostic approach offers a unique and valuable proposition in the ever-changing landscape of pharmacy benefit management. This strategy provides consistency and continuity for employers, even as they navigate the frequent transitions between Pharmacy Benefit Managers (PBMs).

Recent studies have shown that employers, on average, switch PBMs every one to three years. This frequent turnover is often driven by the search for better pricing, improved services, or more favorable contract terms. However, these transitions can be disruptive and costly, potentially impacting employee care and employer budgets.

ScriptSourcing’s PBM-agnostic model is designed to transcend these frequent changes. By remaining independent of any specific PBM, ScriptSourcing can maintain its relationship with employers regardless of which PBM they choose to work with. This consistency allows for long-term strategic planning and continuous cost optimization, unaffected by PBM transitions.

The company’s approach focuses on sourcing medications at significant discounts, typically achieving savings of 25-75% on specialty and brand-name drugs. This service complements rather than replaces the PBM’s role, allowing ScriptSourcing to work alongside any PBM an employer selects.

ScriptSourcing’s model aligns perfectly with employers’ interests. The company typically operates on a performance-based compensation structure, earning revenue only when it generates savings for its clients. This arrangement ensures that ScriptSourcing remains motivated to deliver value regardless of the PBM in place. 

Moreover, ScriptSourcing’s PBM-agnostic stance allows it to provide unbiased advice and solutions. It can objectively assess the offerings of different PBMs and help employers navigate the complex pharmacy benefit landscape without any conflicts of interest.

By maintaining a consistent presence through PBM changes, ScriptSourcing offers employers a stable partner in managing prescription drug costs. This continuity not only simplifies the transition process between PBMs but also ensures that cost-saving initiatives and employee wellness programs remain uninterrupted.

In an industry where change is constant, ScriptSourcing’s PBM-agnostic approach provides a reliable anchor for employers seeking to optimize their pharmacy benefits while maintaining flexibility in their PBM choices.

New Class-Action Lawsuits Target Group Health Plan Tobacco Surcharges

A new wave of class-action lawsuits is targeting employers that apply health insurance premium surcharges to employees who use tobacco, accusing them of discrimination and violating the Employee Retirement Income Security Act (ERISA), according to two new blogs by prominent law firms.

The lawsuits, according to a blog by Chicago-based Thompson Coburn LLP, assert that the surcharges are violations of fiduciary duty rules under ERISA, as well as discrimination regulations under the Health Insurance Portability and Accountability Act (HIPAA).

The law firm says these cases are being filed across the country on an almost daily basis and to date no courts have ruled to have the cases dismissed.

The fast-developing lawsuit trend is notable, considering that tobacco surcharges are widely used, and if any of the new lawsuits are successful, they could set a precedent that could expose thousands of employers to legal action. Most of the lawsuits are against self-insured plans, but even employers who purchase health insurance and also impose surcharges for tobacco use could be targeted as they are considered “fiduciaries” under ERISA.

The lawsuits hinge, in part, on a HIPAA prohibition on group health plans and wellness plans discriminating on the basis of health status. For example, health plans are barred by the law from charging higher premiums to group health plan participants with pre-existing conditions.

However, HIPAA has one exception to the rule: It allows plans to charge different premiums for employees who enroll in and adhere to “programs of health promotion and disease prevention.”

You can find HIPAA’s non-discrimination rules for wellness plans here.

The lawsuits target a common practice: requiring employees who use tobacco to pay higher health plan premiums than their colleagues who certify that they don’t use tobacco products (cigarettes, e-cigarettes, chewing tobacco and similar products).

Common themes

The lawsuits have two common themes. They allege that the plan:

  • Did not provide an alternative standard for tobacco users to obtain a discount because the premium reductions for participating in the wellness plans are only available on a prospective basis, in violation of ERISA Section 702, and
  • Failed to provide information on the existence of such alternatives in “all plan materials.”

The lawsuits typically seek several of the following remedies:

  • Declaratory and injunctive relief.
  • An order instructing the employers to reimburse all persons who paid the surcharges, with interest.
  • Disgorgement of any benefits of profits the businesses received as a result of the surcharges.
  • Restitution of all surcharge amounts charged.

It should be noted that as of the end of October 2024, no court has ruled on a motion to dismiss a case, according to the blog. At least one case has settled as a class action and the employer and plaintiffs in another class-action case had informed the court that they were working on a settlement agreement and would both ask the court to dismiss the case.

In addition to these private actions, the Department of Labor has sued several employers targeting premium surcharges, including in 2023 when it brought action against a firm whose health plan was charging tobacco users a $20 per month surcharge, according to a blog by Washington, D.C.-based Groom Law Group.

The takeaway

Thompson Coburn said in its blog that these types of cases are snowballing: “Given the number of complaints being filed weekly — at times daily — it is highly possible that any group health plan that applies tobacco surcharges as discussed faces the possibility of a class action lawsuit.”

The law firm recommends that businesses consider reviewing their health plans to ensure that they comply with HIPAA’s non-discrimination rules for wellness plans, which allow tobacco surcharges when applied properly, such as charging different premiums for workers who enroll in and adhere to a program that’s focused on promoting health and preventing disease.

This is a newly evolving threat to employers. We’ll provide future updates after courts rule on the merits of the cases, which will provide more guidance on when tobacco surcharges can be applied.

Open Enrollment Prep: Identify Workers’ Needs, Consider Costs to Plan Benefits

It’s almost time for year-end small group open enrollment and you need to drive engagement so that your employees can make informed decisions about their health insurance options.

We want to help you help your employees understand all of their options so that they can purchase a plan that is appropriate for their situation. So here is our advice for the open enrollment:

Listen to your workforce

Before you make any decisions, you should listen to your employees and better understand their needs and preferences.

With answers and feedback in hand you can create a benefits package which is more appealing to them, which in turn gives you a competitive edge when attracting and retaining workers.

Engage employees and solicit feedback through quarterly employee-benefits round table meetings. Invite employees from different age groups and different departments to participate in these meetings to ensure you have a good cross-section of your staff represented.

Give advance notice

You can start this month with simple reminders for them to start thinking about open enrollment and evaluate their current health plans. Send out memos and place posters in high traffic areas.

If you start with this in September or October, they can have time to assess their options, particularly if anything has changed in their lives like marital status, new children or health issues.

Costs are paramount

You can work with us to settle on plan arrangements that will be within your and your employees’ budgets (in their case, the plans also have to be deemed affordable under the Affordable Care Act).

Employees have a right to understand the costs, so let them know how to access the free transparency tools provided online by most medical carriers. Provide employees with a breakdown of medical and pharmaceutical cost increases to avoid sticker shock.

Get an early start

If your plan year starts Jan. 1, you should hold open enrollment meetings and dispense plan materials in October or November.

Avoid holding meetings in December. It’s too busy and the ramping up period is too short.

Communicate effectively

Your task is to get employees out of cruise control and truly assess all of their options.

This is especially true if you are making changes to cost-sharing, introducing new plans, introducing a wellness plan or health savings accounts or flexible spending accounts.

You should use a variety of different media to communicate with your workforce.

Use video, virtual and live meetings, e-mail communications and print materials to get through to your employees. While the attentive ones may think it’s overkill, using different forms of communication ensures that you reach the widest number of staff.

Get spouses involved

If you also offer insurance to spouses, you should communicate through your employees that they are also invited to join your open enrollment meetings.

You can also invite them to view any electronic material you may post online, like the aforementioned videos.

If they cannot make a general meeting, you can invite them to come in to meet with your human resources manager if they have questions.

Remind them of the Law

You can use open enrollment as a way to remind your staff of their responsibilities to secure coverage under the Affordable Care Act.

Let them know that employees who refuse affordable coverage from their employer and opt to purchase it on a public exchange will usually not be eligible for government premium subsidies.

Ask us about the most frequently asked questions about the ACA and we can help you prepare a list of online resources that they can access to get answers to those questions you may not be able to answer.

The meeting

Send out meeting notices early to give your employees time to prepare and set aside time.

Try to make the meeting engaging.

You may want to consider video recording the session and also providing remote access to employees who don’t work onsite.

Provide enough time for the main presentation as well as questions from your employees.

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