There was a flurry of activity at the federal level that involved state and local paid family and medical leave (PFML) programs in the days leading up to President Trump’s inauguration. Both the Department of Labor (DOL) and the Internal Revenue Service (IRS) provided additional guidance and clarification, which is summarized in this Alert.

I. DOL Opinion Letter Clarifies Interaction of FMLA and State of Local PFML Programs

As the paid leave landscape has evolved, employers have struggled with how to reconcile compliance with the Family and Medical Leave Act (FMLA) with that of state or local paid family and medical leave (PFML) programs. While running FMLA, PFML, and other leaves concurrently has been a common and often recommended practice, understanding specific rules that apply in these scenarios has long been a concern for employers. The Department of Labor, in recently issued DOL Opinion Letter FMLA2025-1-A, finally addresses the interplay between the FMLA and state or local PFML programs when an employee’s absence qualifies for both.

The core issue explored in the opinion letter is how the FMLA’s “substitution” rule operates in these concurrent leave scenarios, particularly regarding the use of PFML and whether the same principles as those that apply to disability plans and workers’ compensation benefits apply to PFML. The substitution rule generally allows an employee to elect, or an employer to require that an employee, substitute accrued employer-provided paid leave (including vacation, PTO, or sick leave) while also falling under the protections of unpaid FMLA leave, which means that the employee can elect to have, or an employer can require, that the employer-provided paid leave run concurrently with FMLA leave. Employers have long been uncertain how to apply the rule when state or local PFML benefits are also involved.

The opinion letter clarifies that the FMLA substitution rule does not apply when employees receive benefits under a state or local PFML program, just as it does not when the employee is receiving paid disability or workers’ compensation benefits. This clarification means employees can choose, or be required by their employer, to use their state or local PFML concurrently with FMLA leave. The DOL emphasizes that this coordination is permissible even if the state or local law does not explicitly address the interaction with FMLA and offers employers a clearer framework for managing these often complex leave situations.

Another key takeaway from the opinion letter is that using state PFML concurrently with FMLA leave does not diminish the employee’s protections under FMLA. The FMLA’s 12 weeks of leave remain protected, regardless of whether the employee receives state or local PFML benefits during that time, thereby ensuring that employees receive the full federal protection of the FMLA while also accessing state or local benefits.

Additionally, the DOL’s guidance touches upon the implications of PFML providing partial income replacement. If an employer offers employer-provided accrued paid leave benefits in addition to state or local PFML, the opinion letter suggests that these employer-provided benefits can also be used concurrently with FMLA leave to “top off” the PFML benefit.

This opinion letter is significant because it provides much-needed clarity in an area where confusion often arises. The increasing prevalence of state and local PFML programs necessitates clear guidance on how these laws interact with the FMLA. By addressing the substitution rule in this context, the DOL helps employers navigate the complexities of concurrent leave and ensures employees understand their rights and options.

Ultimately, FMLA2025-1-1 aims to streamline the administration of FMLA leave when state or local PFML is involved, promoting a more consistent and predictable approach for both employers and employees. It reinforces the principle that the FMLA provides a baseline of protection, which can be supplemented by state benefits, without diminishing the federal entitlement.

Next Steps for Employers:

Employers should carefully review DOL Opinion Letter FMLA202-1-A and ensure that their current policies and procedures are consistent with the new guidance.

II. Navigating the Tax Implications of State PFML Programs

The rise of state-level PFML programs has brought a wave of tax-related questions from employers, employees, and other stakeholders. Previously, state guidance on PFML taxation was often vague, leaving many to seek expert advice. However, the IRS issued Revenue Ruling 2025-4, providing much-needed clarity on these complex issues.

Federal Tax Implications:

• Employer Contributions: Generally, employer PFML contributions are excluded from an employee’s gross income and are not subject to FICA, FUTA, or federal income tax withholding.
• Employee Contributions: Employee PFML contributions are typically considered after-tax and are therefore not subject to federal taxation. If an employer funds the employee portion, this payment is considered additional compensation and is subject to FICA, FUTA, and income tax withholding.
• Benefits Paid: The tax treatment of PFML benefits depends on whether the leave is for medical or family reasons, and whether the benefit is attributable to employer or employee contributions. Some states specify contribution allocations (e.g., Delaware, Massachusetts, Minnesota, New Jersey, New York), while others do not, potentially creating ambiguity for employers.
  • Medical Leave:
    • Employer-Attributable Benefits: Included in federal gross income as wages, subject to sick pay reporting rules, and considered third-party payments of sick pay.
    • Employee-Attributable Benefits (or Employer-Funded Employee Portion): Excluded from federal gross income.
  • Family Leave:
    • Employer-Attributable Benefits: Included in federal gross income (not wages). The state must file with the IRS and issue a Form 1099 to the employee.
    • Employee-Attributable Benefits (or Employer-Funded Employee Portion): Included in federal gross income (not wages). The state must file with the IRS and issue a Form 1099 to the employee.

State Tax Implications:

State tax treatment of PFML contributions and benefits varies. Employers must consult the specific laws, rules, regulations, and guidance for each state program to ensure compliance.

PFML Contribution Requirements:

In 2025, state PFML programs have varying requirements for employee and employer contributions when the employer participates in the state plan. Exceptions may apply based on employer size or private plan offerings. Consult the specific state program details for accurate contribution requirements.

Next Steps for Employers:

Employers should carefully review Revenue Ruling 2025-4 and any related state guidance. During the 2025 transition period, adjustments to taxation practices may be necessary. This may include updating employee handbooks, policies, FAQs, payroll systems, and other relevant resources. Proactive compliance is crucial, as employers are generally responsible for the correct administration of these programs.

For further questions or assistance regarding either the DOL Opinion Letter or the IRS Revenue Ruling, please contact Spring.

History of MHPAEA

Mental Health Parity is designed to ensure individuals receive equal access to Mental Health and Substance Use Disorder (MH/SUD) benefits as they do for Medical and Surgical (MED/SURG) benefits. This quest for parity began legislatively in 1996 with the Mental Health Parity Act (MHPA), prohibiting insurance companies from imposing more restrictive annual or lifetime dollar limits on mental health benefits than MED/SURG. Since then, many regulations have been passed to help achieve this goal.

• In 2008, the Mental Health Parity and Addiction Equity Act (MHPAEA) incorporated additional provisions, enforcing that financials (copays or deductibles) and treatment limitations (number of visits or days of coverage) were equal, as well as applying all requirements to substance use disorder benefits.
• Additional MHPAEA regulations were published in 2013, providing much more guidance on how to achieve compliance.
• The Consolidated Appropriations Act of 2021 introduced the requirement to perform a comparative analysis of non-quantitative treatment limitations (NQTL), such as preauthorization, network administration standards, or step therapy. However, nearly all the analyses submitted were found insufficient.

Despite previous efforts and regulations, disparities between MH/SUD and MED/SURG benefits have continued to grow over the last 15 years. In 2022, according to the Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Survey on Drug Use and Health (NSDUH), almost 54.6 million people aged 12 and older were diagnosed for needing treatment for substance abuse, and only 24% of that population were able to receive treatment.¹ Additionally, a study by RTI International showed that in 2021, out-of-network behavioral health clinician office visits were reported to be 3.5 times higher than all MED/SURG out-of-network office visits.²  

Final Rules to the MHPAEA were released by the Departments of Labor, Health and Human Services, and the Treasury on September 9^th, 2024, with the intent to rapidly address these barriers. These rules take effect on January 1, 2025, with some requirements having a delayed application until January 1, 2026. The Final Rules expand on previous requirements, provide clarification for group health plans and health insurance issuers to stay compliant with MHPAEA, and aim to eliminate any restrictions on MH/SUD treatments or resources, ensuring the same level of coverage as MED/SURG benefits. 

The final regulations are complex and will be cumbersome for all employers, especially those with self-insured plans.  At the core of the regulation are two requirements: a Benefit Coverage Requirement and an NQTL Comparative Analysis Requirement.

Benefit Coverage Requirement

This review must ensure that financial requirements and quantitative treatment limitations (QTL) are not more restrictive when comparing MH/SUD and MED/SURG benefits. The final rules remove away from the tests mentioned in 2013 and emphasized that plans cannot impose an NQTL that is more restrictive on MH/SUD benefits compared to MED/SURG benefits. To determine whether the NQTL meets the requirement to be no more restrictive, the plan must satisfy both a Design and Application Requirement as well as a Relative Data Evaluation Requirement. 

Design and Application Requirement: Plans must show that the processes, strategies, evidentiary standards, and other factors used when both designing and applying the NQTL are comparable, rather than the previously only evaluating the application itself. Additionally, a key provision prohibits using discriminatory factors or evidentiary standards when designing the NQTL.

When evaluating the plans, the regulation is clear that health plans must provide “meaningful benefits,” which entail covering at least one core treatment in each category for MH/SUD benefits, as they do for MED/SURG. The six recognized categories are emergency services, in-network inpatient, out-of-network inpatient, in-network outpatient, out-of-network outpatient, and prescription drugs. For example, if a health plan covers a hospital surgery in the inpatient category, it must also provide access to mental health treatment, such as inpatient psychiatric care, in the same category. If they provide antibiotics in the prescription drugs category, they must also provide antidepressants.

Data Evaluation Requirement: Plans must collect and evaluate data to assess the relevant outcomes of applying the NQTL. Plans and issuers must identify material differences in access to services and take reasonable action to address them. Although the Departments will not provide a set list of required data, they expect plans to collect data relevant to most NQTLs, allowing flexibility based on the NQTL in question. If data is lacking, plans must state why it is missing, how they will collect it in the future, or provide a reasoned justification concluding no data exists.

If the Departments determine that the NQTL is more restrictive and that the above requirements are not met, they can enforce plans to stop imposing the NQTL on their MH/SUD benefit offering.

NQTL Comparative Analysis Requirement

The Final Rules reiterate the need for an NQTL comparative analysis, which has been a requirement since the CAA (2021). The analysis requirements are robust, requiring the Plan to explain how and why the Benefit Coverage Requirements are satisfied within their NQTL Comparative Analysis.  This narrative must be detailed and include the following Content Elements:

• Description of the NQTL, including identification of benefits subject to the NQTL
• Identification and definition of the factors and evidentiary standards used to design or apply the NQTL
• Description of how factors are used in the design or application of the NQTL
• Demonstration of comparability and stringency, as written
• Demonstration of comparability and stringency, in operation, including the required data, evaluation of that data, explanation of any material differences in access, and description of reasonable actions taken to address such differences
• Findings and conclusions

This analysis must consider all facets of the plan, including core treatment, standards of care, utilization, access, networks, prior authorizations, etc. The plan must assess any material differences and what meaningful actions are being taken to ensure compliance. 

For ERISA-covered plans, the named plan fiduciary must verify an appropriate analysis was conducted with a prudent process.  Fiduciaries are also responsible for continually monitoring the plan and compliance with the NQTL analysis. 

The comparative analysis must be readily available upon request and provided within the specific timeframe: 10 business days for the relevant Secretary, and 30 days for participants or beneficiaries. If an insufficient analysis is determined, plans must submit additional information within 10 business days. If there is an initial determination of noncompliance, they have 45 calendar days to make corrections. If there is a final determination of noncompliance, the plan must inform all enrolled participants and beneficiaries within 7 days and provide the Secretary with a copy of this notice, along with the names of everyone involved in the process.

Action Plan

The Departments recognize that employers with self-insured health plans rely on TPAs and service providers for plan administration and understand the challenges in obtaining the necessary comparative analyses or required data. However, plans and issuers are ultimately responsible for compliance with MHPAEA. If you don’t already have a comparative analysis on hand, it should become a top priority due to the quick turnaround response times outlined. It is recommended to consult with a legal partner for an in-depth analysis. Additionally, the MHPAEA Final Self-Compliance Tool, finalized in 2020, serves as a valuable resource, guiding plans and issuers to meet compliance with MHPAEA’S parity requirements. This tool has not been updated, but that is expected. 

The Final Rules generally apply starting January 1, 2025, though provisions like meaningful benefits and certain comparative analysis requirements are delayed until January 1, 2026, to give employers more time to comply.

Although we recommend that employers carefully examine their plans and work toward immediate compliance, a lawsuit has been filed and more are anticipated.  The lawsuit from ERIC (The ERISA Industry Committee) indicates that the new regulations are fundamentally flawed, exceed the statutory authority that Congress provided to the agencies and threaten the ability to offer quality and affordable benefits in compliance with applicable laws. 

¹ SAMHSA (2023), Key substance use and mental health indicators in the United States: Results from the 2022 National Survey on Drug Use and Health (HHS Publication No. PEP23-07-01-006, NSDUH Series H-58), https://www.samhsa.gov/​data/​report/​2022-nsduh-annual-national-report.
² Mark, T.L., Parish, W. (2024), Behavioral health parity—Pervasive disparities in access to in-network care continue, RTI International, https://dpjh8al9zd3a4.cloudfront.net/​publication/​behavioral-health-parity-pervasive-disparities-access-network-care-continue/​fulltext.pdf.

In today’s rapidly evolving workforce, one-size-fits-all benefits are no longer sufficient to meet the diverse needs of employees. As expectations shift toward personalized and flexible offerings, voluntary benefits are emerging as a vital solution. These supplemental programs empower employees to customize their benefit packages by adding coverage tailored to their unique personal, health, and financial circumstances.

For employers, voluntary benefits offer significant advantages, including enhanced employee engagement, improved retention rates, and a more comprehensive approach to wellness. Additionally, since employees often bear the cost of these programs, they present a low-risk, cost-effective investment that boosts satisfaction and productivity.

What Are Voluntary Benefits?

Voluntary benefits are optional, supplemental offerings provided by employers in addition to traditional health insurance and retirement plans. These benefits are typically employee-paid, allowing individuals to select the coverage that best meets their needs.

Common examples of voluntary and supplemental benefits include:

• Health and Wellness Coverage: Critical illness, hospital indemnity, accident insurance, dental, vision, and other health-related services
• Financial Support: Life insurance, accidental death and dismemberment (AD&D) insurance, disability insurance, long term care, and other financial safety nets for employees and their families
• Legal Protections: Legal services, identity theft protection, and other personal security-related offerings
• Pet Insurance: Coverage for employees’ pets, offering financial protection in case of veterinary emergencies.

This graph breaks down the most common insurance benefits offered according to Alera Group’s 2024 Employee Benefits Survey:

Meeting Employee Needs: The Rise of Voluntary Benefits

As the workforce becomes more diverse, employees are seeking benefits that go beyond traditional offerings. Over 75% of employers offer Medical, Dental, Vision, Life, and AD&D, with the number and type of benefits varying by employer size. Larger employers tend to offer a greater variety of benefits and are more likely to offer supplemental products, such as pet insurance. Employees want to feel valued, and a broad range of benefits demonstrate an employer’s commitment to their well-being, while also allowing employees to select products that best fit their needs.

Voluntary benefits align with the growing demand for personalized, flexible workplace solutions. With more employees working remotely and managing diverse personal circumstances, the ability to choose supplemental benefits has become increasingly important.

The Value of Voluntary Benefits for Employers and Employees

For Employees:

• Customization: Employees can select the benefits that best fit their lifestyle, such as additional health coverage, financial protection, or wellness services
• Financial Accessibility: Group rates make many voluntary benefits more affordable compared to individual plans
• Peace of Mind: A broader range of benefits provides employees with greater confidence in managing health, financial, and personal challenges

For Employers:

• Attracting Top Talent: A comprehensive suite of voluntary benefits enhances an employer’s appeal to prospective employees
• Improved Employee Engagement: Employees who feel supported by robust benefits are more likely to remain engaged and productive
• Cost Efficiency: Since employees typically cover the costs, employers can expand their benefits offerings without significant additional expenses

How Can Employers Implement Voluntary Benefits?

To introduce voluntary benefits successfully, employers should follow these steps:

1. Understand Employee Needs

Use employee surveys or analyze workplace trends and healthcare data to identify areas where employees might benefit from additional support, such as health coverage, financial protection, or wellness initiatives.

2. Evaluate Vendors and Packages

Assess potential vendors and benefits packages based on factors like cost, employee participation rates, and ease of administration. Ensure employees have easy access to these benefits and understand their value.

3. Communicate and Educate

Clear communication and ongoing education are crucial. Employers should regularly inform employees about available options, provide updates, and encourage participation.

Voluntary benefits are becoming an essential tool for employers seeking to support their workforce in ways that go beyond traditional offerings. By offering flexibility and choice, voluntary benefits empower employees to address their personal health, financial, and well-being needs while helping employers enhance engagement, retention, and overall satisfaction.

As we slowly approach the end of 2024, we had the pleasure of sponsoring and attending The Northeast HR Association (NEHRA)’s Annual Conference in the scenic Newport, RI. NEHRA brings together HR experts across the region to discuss current trends and developments impacting the HR and benefits industry. Some of the topics I found most noteworthy include:

Championing Diversity, Equity and Inclusion (DEI)

Championing DEI was a focal point at NEHRA’s Annual Conference this year, underscoring its significance in today’s workforce. By actively promoting diverse perspectives, organizations can enhance creativity and problem-solving capabilities, driving better business outcomes and creating equitable workplaces. Here are some related sessions I found impactful:

– The kickoff session, “Live & In-Person Employment Law Update – Cultural Flashpoints Edition,” spotlighted how HR teams can stay compliant regarding protected classifications such as religion, race, LGBTQ+ identity and national origin.

– The presentation “DEIB in Action: A Diversity Monologues Experience,” featured actors reenacting authentic employee experiences related to race, gender and sexual orientation.

– The interactive workshop, “Disability Etiquette,” demonstrated the do’s and don’ts when interacting with co-workers with disabilities such as vision, hearing, and mobility impairments as well as mental health, learning, and other non-apparent disabilities.

Fostering a Supportive (& Efficient) Work Culture

Creating a supportive yet efficient work culture remains a challenge for HR teams nationwide. Speakers shared best practices for prioritizing collaboration and open communication while emphasizing efficiency. This focus on supportive environments that boost employee morale and productivity was a hot-button topic this year.

– HR leaders explored unique “Situational Awareness & De-Escalation [tactics] in the Workplace” and tips for addressing high-tension workplace situations.

– As the war for talent continues, two talent acquisition professionals discussed the importance of “Strategic Flexibility: [and] Navigating Talent Shortages with Flexible Hiring Practices.”

-Berklee College of Music’s Associate Director of Talent Acquisition discussed the importance of “Stay Interviews” and how simple check-ins can remind employees of their importance to organizational success.

Supporting Mental Health

Mental health continues to be a top priority for  HR and benefits professionals across the region. Workshops and panels highlighted the need for initiatives that reduce stigma and promote work-life balance. By prioritizing mental health, HR professionals can create happier, healthier workplaces that enhance company culture and drive long-term growth. Below are some valuable sessions I’d like to spotlight.

– This year, attendees were able to enjoy a Sunrise Wellness Walk each morning of the conference. It provided a great opportunity to destress and explore the beautiful Newport neighborhood.

– As isolation and loneliness continue to impact many Americans, the session “Isolation, Inclusion and Workplace Collective Care: Strengthening Staff Mental Health” showcased tactics  for fostering a supportive environment.

– A clinical psychologist addressed “Getting Intentional About Managing Stress and Burnout: From Personal Practice to Organizational Impact,” providing guidance on navigating personal stress and building confidence.

In summary, the NEHRA’s Annual Conference created a vibrant atmosphere for networking and meaningful discussions on pressing trends shaping the HR landscape. We thoroughly enjoyed reconnecting with industry leaders, meeting emerging talent, and participating in insightful sessions. We look forward to seeing how these discussions evolve at next year’s conference.

Regardless of the specific line of coverage, claim audits are a best practice for employers and plan sponsors to ensure accuracy, identify errors, and document process gaps. A comprehensive claims audit can uncover issues related to compliance, adherence to contractual provisions, and consistency with best practices.

While most employers and plan sponsors understand the value of a claim audit, it is common to struggle with knowing where to start, and more specifically, when to start. For clients looking to audit their disability claims, we recommend considering the following factors in determining an optimal timeframe:

1. Vendor Implementation

If you are implementing your fully-insured disability plan with a new carrier or your self-funded disability plan or program with a new claim administrator, conducting a claim audit after the go live date can ensure that:

• Workflows established during implementation are being properly followed
• The vendor is correctly managing claims through the entire claim cycle
• Any areas where additional training or communication would be beneficial are flagged

Conducting a claim audit post-vendor implementation can help solidify the foundation for the relationship and serve to identify opportunities for improvement before they grow into more significant roadblocks as the volume of claims increases.

2. Renewal & Stewardship

Whether you have a vendor administering your self-funded disability plan or program or a carrier insuring your fully-insured plan, it may make sense to conduct a claim audit in anticipation of your renewal, allowing you greater insight into:

• Any process or performance issues that need to be addressed
• The financial implications of any findings of non-conformance
• Whether any performance guarantee should be added as part of the renewal negotiation to address a specific area of concern identified by the audit

As your team comes to the table to advocate for a fair renewal, audit findings can be a powerful negotiation tool. They can be used not only to position your organization for a more favorable renewal, but also as leverage to correct those findings that have had a negative impact on the plan or program’s financials and/or your employees’ experience.

3. Compliance

When determining the right time for a disability claim audit, if your plan is subject to The Employee Retirement Income Security Act (ERISA), your fiduciary duties may drive your decision to conduct an audit. As the plan sponsor, your organization is a fiduciary and must act prudently. An audit is one way to fulfill your fiduciary duty to act prudently as it not only monitors your vendor’s performance, but also ensures that the plan is in compliance with ERISA, the Internal Revenue Code, and other applicable laws.

4. Trend

Most employers receive some type of regular reporting and claims analysis from their vendor partners. When considering a claim audit, pay close attention to the data you are receiving, and consider setting things in motion if your plan or program’s experience is yielding an unexpected or new trend. In doing so, the claim audit can:

• Validate whether the trend is real and/or significant
• Identify the root cause of the shift in trend to inform potential strategies for mitigation or reversal  

5. Self-Funded, Self-Administered

If you have a self-funded disability plan or program which you manage inhouse, you may want to consider establishing a routine cadence for conducting an audit of your team’s claim handling to:

• Validate that insourcing is still the right path for your organization
• Determine if there are any areas of opportunity for improvement and efficiency
• Confirm that your workflows and controls are being properly followed and applied
• Identify if there are any compliance issues

Conclusion

Disability claim audits should be one tool in an employer’s toolbox for ensuring compliance, vendor and internal performance, and an overall positive claim experience for your employees. In conducting a claim audit, employers need to determine stakeholders involved, resources (internal or external), data gathering methods, goals, and processes. While the ideal time may vary by employer, the question of when to conduct the audit is another integral component of your claim audit strategy and should not be overlooked.

If you are interested in conducting a claims audit but need guidance or an objective partner to assist, please get in touch with the Spring team.

Spotlight on Cancer Point Solutions: Supporting Employees with Targeted Innovations

In today’s rapidly evolving healthcare landscape, cancer remains one of the most complex and challenging conditions to treat and is a top cost driver for many employers, including colleges and universities. Thankfully, advancements in cancer care are offering hope and transforming patient outcomes. One of the most promising developments is the rise of cancer point solutions, which aim to address the specific needs of cancer patients through targeted interventions and comprehensive care models.

What Are Cancer Point Solutions?

Cancer point solutions are specialized programs or services designed to address key aspects of cancer care, from prevention and diagnosis to treatment and survivorship. These solutions often combine cutting-edge technology, personalized care, and multi-disciplinary approaches to improve patient outcomes and enhance the overall healthcare experience.

Why Are They Important?

Traditional cancer treatment often involves navigating a fragmented system of specialists, treatments, and services. Cancer point solutions are designed to streamline these touchpoints by offering a holistic approach that integrates various aspects of care. These areas may include:

• Early Detection and Screening: Advanced diagnostic tools and AI-driven screening methods improve the chances of detecting cancer at its earliest, most treatable stages.
• Personalized Treatment Plans: Leveraging genetic testing and precision medicine, cancer point solutions can tailor treatments to the unique genetic profile of each patient, improving efficacy and reducing side effects.
• Patient Support and Navigation: Dedicated care teams, including patient navigators, help guide individuals through their cancer journey, ensuring they receive timely care, emotional support, and access to necessary resources.
• Holistic Care Models: Integrating mental health, nutrition, and survivorship programs helps address the broader impacts of cancer, providing patients and their loved ones with the comprehensive support they need for both physical and emotional recovery.

Benefits to Patients and Providers

Cancer point solutions offer several advantages to both patients and healthcare providers:

1. Improved Patient Outcomes: By leveraging innovative treatments and technology, cancer point solutions can lead to more successful outcomes, fewer hospital readmissions, and improved quality of life for patients.
2. Cost-Efficiency: Early detection, personalized treatments, and streamlined care processes can reduce unnecessary treatments and hospital visits, ultimately lowering overall healthcare costs.
3. Enhanced Care Coordination: With all aspects of cancer care integrated under one solution, providers can collaborate more effectively, reducing the risk of miscommunication and errors in treatment and improving the patient experience.

How Cancer Point Solutions Are Shaping the Future

As healthcare systems continue to adopt value-based care models, cancer point solutions may play an increasingly important role in optimizing care delivery. By focusing on both clinical and holistic outcomes, these solutions not only enhance patient care but also align with broader goals of improving efficiency and contributes to a holistic employee benefit model to support employees at various points in their lives.

Conclusion

While many cancer patients may have access to certain benefits through their providers and care teams, providing additional support through an employee benefit solution can give employees seeking care or caregivers supporting their family members additional resources and tools during a difficult time. By embracing these innovative models within a benefits program, employers can help their employees access more personalized, coordinated, and effective care, ultimately improving the lives of those affected by cancer and positively impacting organizational population health.

For more information on how our health and welfare consulting team can help you implement or optimize cancer point solutions within your organization, please contact us today.

¹ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8634312/
² https://www.cancer.org/#:~:text=The%20American%20Cancer%20Society%20offers,patients%2C%20families%2C%20and%20caregivers
³ Improving Modern Cancer Care Through Information Technology
⁴ Patient-Centered Cancer Treatment Planning: Improving the Quality of Oncology Care. Summary of an Institute of Medicine Workshop

In recent years, a new term, carewashing, has emerged in discussions about workplace culture and employee benefits.  The concept reflects a growing concern that companies are superficially adopting caring practices and policies—often as part of their branding—without genuine commitment.  Modern employers aiming to foster authentic and supportive workplace environments should reflect on this term and how it relates to their positioning with their external clients as well as their employees.

When we shine a spotlight on employee benefits, carewashing refers to the practice of companies presenting themselves as caring and employee-focused, without implementing substantial, changes that truly benefit employees. In some instances, employers may implement meaningful programs, but since employees are unable to take advantage of them due to cultural limitations they are still viewed as carewashing.  For example, a company might promote its new mental health day policy or wellness app extensively but fail to address systemic issues like excessive workloads, inadequate mental health resources, or poor management practices. The result is a veneer of care that can mislead both current and prospective employees about the organization’s true commitment to well-being. 

It is imperative that organizations work to combat carewashing because of the impacts it can have on the business, employees, and their families.

• Genuine care and support for employees are critical for building trust and engagement.  According to Gallup, organizations that show true commitment to their employees’ well-being experience higher levels of engagement and lower turnover rates¹
• When employees recognize that initiatives are merely cosmetic, McKinsey & Company indicates it can not only lead to disengagement and turnover, but reduced productivity as well
• Negative perceptions about carewashing can damage a company’s reputation, making it harder to retain and attract top talent. A Harvard Business Review article highlights that companies perceived as inauthentic in their employee care practices can face significant reputational damage
• Although on the surface carewashing is not illegal, it could lead to legal risks (e.g., promoting care but not giving adequate support) and certainly presents ethical concerns

To mitigate the risk, employers must self-reflect and talk openly about their approach to employee benefits, ensuring their programs reflect their culture and vice versa.  In some instances, offering programs without cultural support may do more harm than good.  Using these guiding principles will go a long way to reduce the risk of carewashing:

• Set a holistic approach considering mental, physical and financial health
• Focus on implementing highly effective programs, invest in understanding the impact and align solutions with employee needs while considering business impact (positive and negative)
• Involve front line managers in roll-out campaigns to convey the importance of the program, understand their concerns and work together to find solutions
• Work toward a culture of caring that includes training and advocacy.  If that is not possible in your organization, pinpoint solutions that can be genuinely adopted, appreciated and accepted
• Be transparent; every organization is unique.  It’s better to make incremental, successful change than provide an offering that provides little to no value to employees and creates reputational risk for the organization

Although the terminology will change, any program design that undermines the trust of employees or clients will lead to disengagement and dissatisfaction.  Make sure the programs you implement within your benefit offering do not mislead employees.  Employees often tap into employee benefit programs during some of the direst times in their lives; nobody wants to feel carewashed when what they really need in that moment is care. 

If you could use objective guidance on building and prioritizing realistic benefits initiatives, or evaluating your current state for carewashing red flags, please get in touch with our team.

¹ Witters, Dan. “Showing That You Care About Employee Wellbeing.” GALLUP. https://www.gallup.com/workplace/391739/showing-care-employee-wellbeing.aspx

As summer winds down, the Disability Management Employer Coalition (DMEC) hosted its 2024 Annual Conference in the energetic city of Nashville, TN. Known for its rich musical heritage, Nashville provided a lively backdrop for this year’s event, bringing together professionals from across the absence management spectrum to discuss the latest trends, challenges, and best practices. Here are some key highlights from the conference.

1) The Future of Paid Family and Medical Leave (PFML)

The focus on mental health remains prevalent as organizations continue to find innovative ways to support employee well-being. This year’s conference offered valuable insights into how mental health is evolving in the benefits industry:

-The session The Importance of a Guided Claim Experience emphasized the need for compassionate and informed support during the claims process, which can significantly impact employee well-being.

– I was joined by a group of leave solution leaders to examine findings from a recent leave report which looked at various factors including recruitment, retention, productivity, moral, and more with a focus on how successful employers are addressing leave managementns on benefits spend and workplace culture.

– One of the catchiest presentations, Walk, Crawl, Run: The PWFA Turns One, reflected on the one-year anniversary of the Pregnancy Workers Fairness Act (PWFA) and best practices for HR teams to stay compliant.

2) ADA/FMLA Compliance Updates

Navigating the complex web of federal, state, and local regulations remains a critical challenge for employers. This year’s sessions provided valuable guidance on staying compliant while managing diverse and geographically dispersed workforces:

– The Cost of Compliance: ADA/FMLA Court Cases and Jury Verdicts offered a deep dive into recent legal cases, providing lessons on how to avoid costly compliance mistakes.

– The ADA Compliance Mini Boot Camp led by Rachel Shaw was a must-attend for anyone looking to deepen their understanding of ADA requirements and refine their compliance strategies. This workshop was instrumental in equipping participants with tools to tackle common challenges and elevate their programs.

– I led a workshop with Baystate Health’s Manager of Disability and Leave, Lauren McCormick, in a session titled A Step-by-Step Guide to Refining Your ADA Strategy. In an interactive format, the session provided participants an opportunity to address real-life ADA scenarios and how to best address each individual case using a methodical process.

3) Telework Accommodations

As companies continue to navigate the post-pandemic landscape, finding the right balance between remote work and returning to the office is top of mind. The conference sessions provided practical insights into managing this transition effectively:

– The session “You Can Have Paid Leave AND a Productive Workforce. Here is the Secret Sauce.” explored how flexible work arrangements can coexist with robust paid leave policies to enhance employee satisfaction and productivity.

– Council from Reliance Matrix explained how many employers are quick to provide leave of absence to workers with a medical condition, whereas many alternative compliant leave options exist in their presentation, Encouraging Employees to Stay at Work or Return to Work.

–Another eye-catching session, We Goofed. Now What? An Accommodations Tale, brought light to a common scenario in which an employer fails to provide adequate accommodations under the ADA and/or PWFA; as well as best practices to address said employees’ needs.

4) Tech/AI’s Role in Absence Management

Technology continues to play a transformative role in the absence and disability management space, offering new ways to streamline processes and improve decision-making:

– Spring’s in-house attorney, Lynne Noel, together withPatagonia’s Senior Manager, Leave of Absence, Lauren Shipper, discussed Using Benchmarking to Refresh Your Program. They highlighted the importance of leveraging data to stay competitive and refine absence management programs. Insights provided actionable strategies for using benchmarking as a tool for continuous improvement.

– A group of data analytic experts explained the practical parameters of AI solutions in claims processes and the upsides and dangers to implementing AI systems in their presentation, The Transformation: How AI is Enhancing Analytics and Optimizing Decision-Making.

– During the session, The Future of AI in Leave and Disability Management, three leave and disability administrators discussed the current state of AI in the industry and how it can help streamline processes and improve employee satisfaction.

Final Thoughts

The DMEC 2024 Annual Conference in Nashville was a resounding success, filled with opportunities to learn, connect, and share best practices. From deep dives into compliance and mental health to exploring the latest technological innovations, the conference offered something for everyone. As always, it was a pleasure to reconnect with industry leaders and bring back fresh ideas to enhance our consultative offerings. We’re already looking forward to what next year’s conference will bring!

The absence management conversation is a critical component of every employer’s broader employee benefit strategy discussion these days, especially given the competitive talent market and the rapidly evolving regulatory landscape surrounding leave of all types and at all levels (federal, state, local). Now, more than ever, employers and employees need to understand how all available benefits, including supplemental health plans, such as Accident, Critical Illness, and Hospital Indemnity, work together. Compliance isn’t the only consideration, though. Employers need to be sure not to duplicate processes which can increase costs as well as to ensure a smooth and positive employee experience.

Understanding supplemental health products and the benefits provided by them ensures that those paying for the coverage will fully utilize the benefits available. Since Accident, Critical Illness, and Hospital Indemnity benefits are paid when an accident occurs, a critical illness is diagnosed, or a hospital stay is required due to injury or illness, they offer a way to fill in the financial gaps left by traditional health insurance, disability coverage, and paid leave benefits. The lump sum benefits paid by the supplemental health plans can be used to cover out-of-pocket expenses like medical copays and deductibles, as well as to supplement the income replacement benefits provided by paid leave and/or disability plans.

The good news is that insurance carriers have made significant progress over the last few years toward the integration of absence and supplemental health products.¹ Many are, now, not only bundling supplemental health products with their core disability and absence products and offering a package discount to the core products when quoting, but also tackling the more complex issue of how to ensure that employees enrolled in supplemental health plans are receiving the financial benefit of the products they pay for with payroll deductions.

To ensure that supplemental health plan participants receive the benefits they are entitled to under their policies, most carriers are digging into questions like:

• How can they identify disability and leave claimants who are also enrolled in one or more supplemental health product(s)?
• Is there a way to leverage the claim information obtained during the leave and disability claim process(es) to pay supplemental health claims without having to request redundant or additional medical information?

Carriers are also reviewing their processes to find efficiencies and create a better claimant experience. This internal retrospection has led to things like coordinated leave, disability, and supplemental health claim intake and the sharing of medical information across all claims. Many carriers are not only building out coordinated claim paths and workflows for leave, disability, and supplemental health claims, but they are also having their leave and disability claim specialists conduct routine analysis of current leave and disability claim files to see what other coverages an insured is eligible for and whether the medical information on file could be used to adjudicate the corresponding supplemental health benefit claims. Some carriers who have access to medical claim files offer auto-generated notifications, which are sent to supplemental health plan participants, reminding them of their supplemental health benefits based on the medical claim data. Software and technology companies as well as third-party administrators (TPAs) who often handle leave benefit administration are also focused on product improvements in the areas of artificial intelligence (AI), automations, self-service portals, communications, intake, and reporting. All these claim process adaptations alleviate steps for the insured and make it easier, overall, for them to know what benefits are available and be able to utilize them. They also help claimants to maximize the value of the benefits for which they are paying and enhance the customer experience that is top of mind for employers of all types, sizes, and industries.

¹ Spring Consulting Group.  2022-2023 Integrated Disability, Absence, and Health and Productivity Vendor Benchmarking Survey.