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Wednesday, 09 March 2016 04:00

Tackle Your Healthcare Costs

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Are you paying more and more for worse benefits? While some aspects of rising healthcare costs are driven by factors outside our control, there are MANY factors within our control, even for smaller employers.  The problem is that the strategies used by most brokers aren’t sustainable.

Learn how employers of all sizes, but especially with at least 20 employees, can manage their health care costs down, by taking an out-of-the box approach in multiple areas:

  • Re-thinking your provider delivery model
  • Focusing on paying for health improvements rather than just paying for sick care
  • Heavily incenting positive health changes without costing you a dime 
  • Harnessing the natural “outrage” in your employees to lower your costs
  • Taking advantage of innovative product and funding designs that help you cash in on the savings achieved by the other methods (check out our Self Funding Feasibility Study to see if this is right for you!)

Much of this work is best done well before the renewal starts, so now may be a great time to get started on this type of strategy work.  Join our webinar on April 7th from 10-11:15 am to jump start your game plan for your upcoming plan year! Register now!

This event is a Webinar only.  The day prior to the Webinar, all registrants will be sent the weblink and dial-in instructions to attend the program.


Thursday, 25 February 2016 15:34

How well do You Know Your Section 125 Plan Rules?

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While Section 125 plans seem basic on the surface, we find this to be one of the greatest areas of misunderstanding in benefit plans.  Almost all HR professionals are familiar with the basic qualifying life event rules of a Premium Only Plan, and the use-it-or-lose-it rules of a Medical Flexible Spending Account.  But there are still common questions about when an employee can add or drop coverage during the year, without the standard “life events”, as well as some interesting benefit design questions that are surprisingly governed by your Section 125 plan.

Sometimes the situations can get tricky.  How would you handle the following scenarios?

  1. The owner of the company wants to make matching contribution into HSA accounts for everyone including herself, up to a set dollar limit. What requirements and limitations should she be aware of?
  2. Your anniversary date is 5/1, but on 9/1 an employee wants to opt off your plan onto his spouse’s plan.  Assuming there has been no life event such as marriage, divorce, birth or death, what conditions would make this possible? 
  3. You have a calendar year FSA plan with a large number of participants. On your 7/1 policy year anniversary, the company’s leadership decides to switch to a sole option High Deductible Health Plan strategy. What do you need to do for the 6 months until your FSA plan year ends?
  4. You have a 10/1 plan but an employee wants to drop coverage 1/1 because they found a cheaper policy on the state or federal exchange.  Can he or she do so?

Scroll down for the answers:







  1. First of all remember that HSA contributions tied to a match or to wellness incentives must be run through a Section 125 plan, subjecting it to non-discrimination and other requirements.  In this example, the owner can certainly make matching contributions to employees, but she herself, her immediate family (even if they are also employees), and anyone else who owns more than 2% of an LLC or S-Corporation may NOT participate. If the organization is a C-Corporation (including non-profits) or a government entity, there are no limitations on owners or key employees participating as long as discrimination tests are performed and passed.
  2. There are two optional events which employers CAN choose to designate as qualifying events, but these must be written into your Section 125 Cafeteria plan document.  We also recommend writing them into your overall ERISA Wrap Plan Document and Summary Plan Description which govern your plans (if you don’t have one of these documents, let us know and we can help!). These two events are:  availability of other coverage (ie the open enrollment) such as that of another employer, a spouse, or a parent; and a significant change in the cost or coverage you are offering.  If the employer has made these two events available as qualifying events, the employee in question could drop coverage on 9/1 to take coverage with another job they have, or with a spouse or parent. 
  3. Implementing an HDHP plan mid-way through your FSA plan year can be tricky if you don’t plan in advance for it. First of all, it should be communicated that anyone who made an FSA election, is bound by that election for the entire calendar year, even if they’ve used up the money before you make the plan change. In this case, where everyone is moving to the HDHP option since the company is choosing to eliminate other plans, this means that anyone who participated in the FSA that year may not contribute to an HSA account (or receive employer contributions) until the end of the FSA plan year. We recommend that the employer hold off on contributing for all employees until the start of the new year to avoid confusion, and perhaps consider a one-time contribution in the new year equal to some or all of what they would have contributed had the employees all been eligible.  We also recommend that if your FSA plan offers a rollover feature, that the rollover amounts be converted to a limited purpose FSA plan (for non-medical expenses only) so that employees can begin using the HSA accounts 1/1.  Finally, we’d recommend moving both the FSA plan year (if you’re keeping such a plan at all) to match your anniversary date of 7/1, as well as changing your deductible to run on your 7/1 policy year rather than calendar year, if your carrier will allow it.  (Incidentally, this same scenario is present for any employee changing benefits in a company with a dual option offering, if their medical plan year does not match their FSA plan year. Some employers think they have to have a 1/1 effective date to implement an HDHP/HSA plan for these reasons, but as long as you can match your deductible year up with the medical and FSA plan year, any plan anniversary will work just fine.)
  4. Yes.  Since the issuing of IRS Notice 2014-55, there is now a new optional qualifying event for all Section 125 plans, allowing individuals to opt out if they purchase coverage in the state or federally-facilitated marketplaces, if the employer chooses to include this in their plan document.  They may only return to the group coverage, however, at your regular open enrollment period or with a traditional life event.  Please note that while they can drop coverage to enroll during the annual open enrollment period (typically including 1/1, 2/1, or 3/1 effective dates), they cannot drop coverage to go to the exchange at other times of the year unless they have another qualifying event.

Have you ever experienced billing or invoice issues? Frustrated with people you already terminated still showing up on your bill? Look no further as your Fall River team is here to help! 

When processing eligibility changes such as enrollments, changes or terminations, you can follow these three simple steps to improve the accuracy of your carrier bills. 

Step 1 – Process On Time

  • If you have an impending enrollment, change or termination, it is best to get these submitted to the carrier as soon as possible to prevent any processing delay. The cutoff for the next bill is often 2-3 weeks before the end of the month, which is why people you’ve already terminated can still be showing up if you didn’t terminate them soon enough.  If you want a person who’s terminating on 3/31, for example, to NOT be on your April bill, you may need to get that done as soon as 3/10, depending on your carrier and the billing cycle dates you’ve selected.
  • If terminations are not submitted prior to the actual termination date, carriers do have the right to bill you for the following month of coverage. It’s the most common billing issue and unfortunately, there’s not much that can be done about it. In the Colorado fully insured market for groups with 2-99 employees, carriers will not allow terminations after the effective date unless proof of other coverage is provided.  So, that 3/31 term MUST be done on or before 3/31, otherwise you may be tracking down a copy of the employee’s next ID card before the term can be done.

Step 2 – Process Online

  • Most carriers offer an Online Employer Portal for managing eligibility and paying premium invoices. The fastest way by far to process any eligibility enrollment, change or termination is to complete them online, as most carriers will update their systems in real-time or within 24 hours of the transaction. If you need help obtaining a login and password for an Employer Portal or would like additional training for your carrier-specific portal, please contact your Fall River Account Executive.
  • Billing and invoicing cycles vary from carrier to carrier. The invoice should show your due dates, remittance details (including overnight payment or wire transfer options) and/or other carrier-specific instructions. 
  • If you have signed up to receive electronic invoices, carriers will typically email you in advance when the invoice is ready to view. But watch out…sometimes these emails will appear in your junk folder and could go unnoticed unless you check that folder regularly. 

Step 3 – Audit Your Bill 

  • As soon as you receive your premium invoice, whether paper or electronic, try to reconcile it with your records as soon as possible - the sooner the better while it is still fresh in your mind. If you notice any concerns, reach out to your Fall River Account Executive and we can help you get it resolved. Clients have called us after finally noticing errors that have been on the bill for many months – it is very difficult to help you get your money back if too much time has passed.
  • Most carriers do not allow self-adjusting and require that you pay your invoice as billed.  There can be serious consequences to short-paying your bill, up to and including termination.  If there are folks on your invoice you’ve already terminated, the invoice will auto-adjust next month to credit the premiums back.
  • If payments aren’t received within the 31 day grace period, carriers may terminate coverage and it can be difficult to reinstate. To prevent a lapse in coverage, make payments by the due date or call the carrier to discuss financial arrangements, and don’t self-adjust (ie short-pay) your bill. 

We hope these tips are helpful – please feel free to call us at any time at 303.369.3200 with any billing challenges you may be having.

Tuesday, 09 February 2016 17:00

Brother, Can You Spare Two Minutes?

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Fall River publishes this monthly newsletter in the hopes of bringing valuable information to our readers.  This month we’d like to ask you give us two minutes to take a 3-question survey, and share your feedback about what topics you find most useful.  Please click here, and thank you for your participation!

Wednesday, 27 January 2016 14:41

On Wellness, One Size Fits ONE

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Guest Article by Brad Cooper, CEO of US Corporate Wellness

The research is in, and it warrants an exclamation point!  An effective employee wellness program will provide a 125-600% ROI or more through decreased health care, sick time and disability costs, as well as improved recruitment, retention and employee engagement (and that doesn’t take into account the personal enhancements participants experience in their own lives!).  The result of this research has been a two-fold increase in the number of organizations that have launched wellness programs for their employees in recent years.  Only one problem – the first word in the phrase “Effective Employee Wellness Program.”

There are many approaches to employee wellness.  Common entry level approaches include holding an internal “biggest loser”-like contest or providing paid memberships at the local health club. 

While both of these types of programs provide proof to employees (and customers) that the organization is somewhat serious about really doing something beyond lip service, their true effectiveness is limited.  With the “biggest loser”-type of contest, 97% of the people who lose weight will gain it back without an ongoing process.  And in terms of paid health clubs, you’re likely to find that – while a great tool as part of a personalized program – when done as a singular approach, this typically only provides a benefit for 10-20% of employees, the vast majority of whom would have joined a gym anyway.  Both scenarios are missing a key element that can result in participation – and movement – by 50-70% or more of your employees. What is that key element that will move your program from “nice to have” to truly “effective”? 


As you’ve probably noticed many times over, every employee is different.  They are each unique in their goals, histories, situations and pursuits.  As a result, generic, impersonal approaches to employee wellness simply don’t work over the long haul.  Only personalized approaches create the desired results.  Here are a few tips to get you started:

  • Avoid “One Size Fits All” approaches.  We’ve found a clear trend when it comes to employee wellness – the popular “one size fits all” actually turns out to be “one size fits NONE.”  As you look over your proposed approach (or review your wellness vendor’s proposal), think about a few of your employees on opposite ends of the spectrum.  If it won’t meet the needs of these “extremists,” there’s a good chance it won’t work for your organization
  • Build a “customization” ability into the program.  People adjust, grow, back-slide, excel, and change their goals.  For an employee wellness program to be effective, it needs to be able to move along with the individual.  An employee who’s never even owned a pair of running shoes the first 42 years of her life might lose 15 lbs and decide to train for and run a half marathon down the road.  Does the program adjust along with her life?  Or is it all just about weight loss?
  • Take Temperament into account.  This brief article is obviously not intended to review the various personality or temperament styles that exist within your team.  But you see it everyday – people are inherently different in the way they approach various aspects of their lives, including wellness pursuits.  Without getting into details, it’s important for any effective wellness program to take those individual styles into account.  Simply stated – a program that’s perfect for a “Guardian” (who craves structure at the core) will be an absolute disaster for an “Artisan” (a temperament that requires freedom, options and variety), and vice-versa.  
  • Involve others.  There are many ways to put this into practice, ranging from accountability groups to partnership programs.  But one thing is certain – the involvement of others is absolutely essential to achieving long-term success in the area of wellness.  “We become the people with whom we spend time” is an ageless truth that can be effectively integrated into your wellness program.

The “why” is no longer in doubt, as study after study has confirmed the ROI of employee wellness programs.  But as these programs gain acceptance and a broader range of providers step into the marketplace, the “how” is still far from consistent.  As you look for ways to maximize your ROI, be absolutely certain that “personalization” is a central part of the equation as you create a one size fits ONE approach to improving the lives of your employees (and as a result – your own bottom line).

Brad Cooper is CEO of US Corporate Wellness, Inc., the only Colorado-based firm to earn Full Accreditation as a Comprehensive Wellness Provider through URAC and an organization known for helping create meaningful wellness program strategies.  He can be reached personally at 303-521-1570 or This email address is being protected from spambots. You need JavaScript enabled to view it..  More information and a special report on integrating temperament into your wellness program strategy are available by emailing This email address is being protected from spambots. You need JavaScript enabled to view it..


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