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Wellness focus could boost health benefit costs, experts say

Employers again are sharply focused on employee wellness, and some are raising the bar to qualify for program incentives.

During this fall's open enrollment period, workers who get health insurance through their employers may not see huge premium increases or significant hikes to deductibles or other out-of-pocket costs. But there may be less obvious changes that could make a notable difference in coverage or costs, benefits consultants say.

Employers again are sharply focused on employee wellness. The difference: Some are raising the bar to qualify for program incentives, says Tracy Watts, senior partner at human resources consultant Mercer. Employers frequently have offered cash incentives or made deposits into workers' health savings accounts or given them breaks on premiums if they filled out a health risk assessment. But it's becoming more common, she said, that they require workers to participate in biometric screening -- such as measuring workers' blood pressure, cholesterol or blood sugar levels to ensure they're within recommended ranges -- to get that contribution. Likewise, some employers that had already moved to require biometric screening to earn financial rewards are now moving to limit those perks to people who've actually achieved target levels or who are working with a health coach to get there.

[Also: Wellness centers, no longer hospital gimmicks, become money-making population health engines]

The financial rewards can be significant, but most workers leave money on the table, according to a survey by Fidelity Investments and the National Business Group on Health. The survey of 121 mid- to large-size employers found that the average wellness incentive was $693 per employee in 2014. However, only 47 percent of employees earned the full incentive to which they were entitled, the survey found.

Premium increases for dependents, especially spouses who have health insurance available through their own jobs, are likely to be higher next year than for employee-only coverage.

"If employee-only coverage is going up 5 percent, coverage for the spouse and maybe the family is going up 10 percent," says Randall Abbott, a senior consultant at Towers Watson.

Meanwhile, benefits consultants say the Supreme Court decision declaring that same-sex marriage is legal in every state may reduce access to health insurance on the job for unmarried couples, both gay and straight, as companies move to eliminate health insurance benefits for unmarried couples who are domestic partners.

As workers evaluate their plan offerings, one key area to check is coverage of specialty prescriptions, pricey drugs that often require special handling or administration and are typically used to treat complex conditions such as cancer, hepatitis C or multiple sclerosis.  Biologic drugs derived from living cells are often considered specialty drugs. Specialty drugs currently account for about one-third of total drug spending in the U.S., and that figure could increase to half by 2018, according to a report published in August by the Congressional Research Service.

Health plan strategies to contain specialty drug spending may make it tougher for consumers to access them.

"We're seeing acute attention to prescription drugs, especially specialty drugs," says Abbott. When evaluating plans, workers who take specialty drugs should make sure their drug is covered and determine what their cost sharing responsibilities will be. In addition, check for restrictions such as a requirement that a doctor get authorization from the plan before prescribing it, Abbott says.

In addition, some employers have been ratcheting back generous health benefits and shifting more costs to workers in anticipation of the so-called Cadillac tax on health plans with generous benefits.

Under the law, employee health benefits that exceed $10,200 for single-coverage and $27,500 for family coverage in 2018 will trigger a health plan excise tax of 40 percent on the amounts over those thresholds. About a quarter of employers could be affected by the provision, according to a recent analysis by the Kaiser Family Foundation (KHN is an editorially independent program of the foundation.)

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Delving into coverage details may not be the formidable task it once was because employers and insurers increasingly are making tools available that help workers evaluate and compare plans. Some online tools now load workers' actual claims data so they can see how next year's plan or plans stack up.

Although it's tempting to do nothing, "even if you're planning on staying with the same plan, that plan may be changing," says Craig Rosenberg, who leads the health and welfare benefits administration practice at Aon Hewitt. What's more, "Your health may be changing, and maybe the best health plan for you has changed."

Kaiser Health News is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

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