No Single Solution for Post-Pandemic Return to Workplace

Posted on May 28th, 2021

For employees who have been working from home since the start of the COVID-19 pandemic, the reopening of workplaces may mean it’s time to return — but return to what, exactly? 

“Return to work?” As anyone who’s been putting in more hours working from home than they did during pre-pandemic times in the office, “return to work” isn’t just insufficient; it’s inaccurate. You can’t return to something you never left. 

“Return to normal?” Forget about it. Whatever it is we’re returning to, “normal” — if by that we mean conditions as they existed before COVID-19 — is history. Regardless of how we’d like it to be, the workplace will never again be exactly as it was before March 2020. 

“Return to the office?” That may be accurate for some, inaccurate for others and somewhere in between for those planning to work a hybrid schedule. In short, it ignores the complexity of the workforce and conveys a simplicity that doesn’t exist. 

We — employers and employees — need to think about this differently. Instead of talking about a return to work or a return to the office, we should be talking about working in a way that is productive for both employer and employee.  

And, as Mental Health Awareness Month draws to a close, we need to remain mindful of how important employee well-being is to overall productivity. 

Aberration or Adaptation? 

During the first quarter of 2021, with about 90 percent of its employees working remotely, Goldman Sachs took in a reported $18 billion in revenue and $7 billion in profits. Yet it was a comment CEO David Solomon made in the middle of the quarter that brought the firm a sudden spike in media coverage. 

Speaking at a conference in February, Solomon called his company’s work-from-home policy “an aberration that we’re going to correct as soon as possible.” 

“I don’t think as we get out of the pandemic the overall operating mode of the way a business like our operates will be vastly different” from what it was before the pandemic, he added. 

Business leaders who share that outlook may be asking for trouble. 

According to Employee Benefit News, almost 60% of employees said in a survey conducted by the job listings platform Flexjobs that they would quit their job if their employer forced them to return to the office, while more than a third said they would like to continue working from home permanently. 

It appears many employers have been listening. 

In an April article headlined “Returning to the Office Sparks Anxiety and Dread for Some,” the New York Times reported: 

“Salesforce says its work-from-anywhere approach would ‘unlock new growth opportunities’ and ‘drive greater equality.’ Spotify describes its flexible work policy as a ‘jewel in our Talent Attraction crown.’ 

“Target, Ford Motor Co. and PricewaterhouseCoopers say they are going to let office workers work remotely more frequently. Even Wall Street banks where employees often while away hours at their desks to be seen by the boss are preaching the gospel of flexibility. JPMorgan Chase is telling some workers they can cycle in and out of the office.” 

Given the number of workers who have relocated during the pandemic, gambling that they would be allowed to continue remote working after their office reopened, approaches like the one adopted by Salesforce may be hugely beneficial to attracting and retaining talent. 

Varied Solutions for Varied Mental Health Challenges 

While many people report experiencing mental health challenges associated with the pandemic, reasons for those challenges vary – and so do attitudes about returning to the workplace. 

According to the mental health and brain performance self-care platform Total Brain, anxiety and depression became more prevalent in April after signs of improvement at the start of 2021. “Some workers’ anxiety may stem from their feelings about returning to an office after working remotely during the pandemic,” the platform reported. “This aligns with a recent Total Brain survey of 425 Americans who were temporarily working remotely that found two-thirds are ‘somewhat’ or ‘extremely’ anxious about returning to work in-person.” 

But not everyone who is experiencing mental health challenges is anxious about returning to the workplace. For some reporting feelings of depression brought on by isolation during the pandemic, the prospect of returning to the office and seeing colleagues in person  may be cause for eagerness rather than anxiety. 

Sheeta Verma, a 21-year-old employee of a Boston-based tech firm, told the Times, “Being the youngest in the office, I don’t get to connect with my colleagues and it’s important that I connect, to get to know them, understand their mind set, how they learn and grow their careers.” 

Those experiencing anxiety, meanwhile, cite various causes. Some fear for their health. Some dread resuming a long commute. Some have concerns about child or elder care. Others – especially the introverted and those who have reached a certain level or professional maturity – may simply enjoy the additional freedom, flexibility and control over social interactions that working from home affords them. 

Savvy employers will recognize that having empathy and acting with compassion aren’t just about being good; they’re good business. 

5 Approaches to Post-Pandemic Work Arrangements 

It isn’t just employees who vary in their needs and wishes for a safe, happy and productive work arrangements. Businesses vary, as well, and so the approach each employer takes has to take into consideration multiple factors.  

When considering remote work, on-site work or a hybrid, employers should pause and ask, “What’s our objective here?” The objectives likely won’t be to place employees in an enclosure, but rather to have a capable, productive, and reliable workforce engaged in achieving their mission. Many of the answers to questions about whether and how to allow or encourage (or require) remote work as part of their overall workforce strategy will emerge when a business understands their true objectives.   

In some industries — manufacturing and brick-and-mortar retail, to name a couple — working from home isn’t realistic for much of their workforce. In others, solutions may be as different as the businesses themselves. 

In others, remote work is emerging as an expectation among the labor force. Employers who understand that offer the option, and do it well will have a competitive advantage attracting and retaining top talent. They also potentially expand their labor market by realizing that geographic boundaries fall away or expand.   

There are cultural and practical considerations that employers and employees will want to consider before adopting remote work as a long-term part of their employment strategy — equipment and who pays for it, software and technological savvy, work schedules and availability, communications with co-workers and clients, performance measures, policy updates and training, to name a few.   

Employee Benefit News recently offered these five plans from business leaders who have prioritized the well-being of their employees

  1. Step by step — The Boston-based pharmacy benefits platform RxSense is taking a two-phased approach, beginning in June. In Phase 1, employees may return voluntarily, provided they’re fully vaccinated. Phase 2 will depend on vaccination and infection rates but is expected to have employees who previously worked in the office begin a hybrid schedule of two or three days at home per week.  
  2. One office, two companies — GEM, a Venice, CA-based make of dietary supplements, is exploring a work-from-anywhere approach with a two- or three-day-a-week hybrid option in a space shared another company. 
  3. Regional workspaces — The Mom Project, a national job-placement and recruiting firm based in Chicago, has implemented a remote-first model but is looking to open “studio locations” in centralized cities to allow regional groups to “collaborate together in a dedicated space.” 
  4. Shorter weeks — Based in San Francisco, Storq prides itself on work flexibility. It plans to experiment with a four-day work week this summer, with the possibility of implementing it year-round. 
  5. Increased safety — Owl Labs, a Somerville, MA-based designer and manufacturer of 360-degree video conferencing devices, does not currently require employees to work in-office but has taken extensive precautions to protect the health and safety of those who choose to do so. These include limiting capacity and requiring screening check-in forms. 

To assist employers with planning for employees’ return to the workplace, including the implementation of vaccination policies, Alera Group published the whitepaper “COVID-19 Vaccines: What Employers Need to Know.” The guide includes information on whether employers can require vaccination to return to the workplace, 10 steps for employers to take to prepare employees for vaccination, and questions and answers from the Centers for Disease Control and Prevention (CDC). To obtain the guide, click the link below. 


About the Author  

Thomas Showalter
HR Services Director
Alera ConnectHR 

As a trusted adviser, Thomas Showalter seeks to help businesses perform at their best by helping people perform at theirs. Thomas founded Alera ConnectHR to provide businesses the HR they want. Alera ConnectHR’s teams help business leaders envision the work culture, talent and engagement that will foster long-term success, then roll up our sleeves to make it happen. As the head of Alera ConnectHR Tom’s role is simple: provide his team with the guidance, support, and resources to deliver on that commitment. 

Contact information: 

Hurricane Insurance Coverage Gap: Wind-Driven Rain

Posted on May 25th, 2021

After a series of above-average years for storm activity culminated in a 2020 season that set records for both frequency and severity, many longtime property owners in hurricane-prone areas probably can recite storm-preparedness checklists and evacuation routes by memory. Whether they know what potential storm damage their insurance covers, however, may be another matter.

While most policyholders understand that standard property insurance policies do not cover damage caused by flood, many are unaware that policies also typically exclude damage caused by wind-driven rain or hail – unless the structure first sustained damage during the storm that enabled the precipitation to enter. If a storm is so intense that wind-driven rain penetrates the tiniest of openings, you might not be covered for any resulting damage.

The only way to know for certain is to read your policy. And with forecasters predicting another above-average year for severe storm activity, the time to check is now.

Looking Back, Looking Ahead 

In a 2018 commentary for the Washington Post, “Hurricane-proofing Florida homes is worth the cost, and then some,” University of Austin professor Kevin Simmons reported:

“Since 1980, wind storms have caused almost $1 trillion in damage, with 85 percent of that amount (having occurred) since 2000. Increased population in coastal areas combined with the effects of a warming climate suggest that damage exceeding even that number will occur during the next 40 years.”

And then came 2020.

Last hurricane season saw 30 named storms (winds of 39 mph or greater), of which 13 became hurricanes (74 mph or greater) and six reached major hurricane level (111 mph or greater). Twelve of those storms made landfall in the contiguous United States, topping the previous record of nine, set in 1916. It was the fifth consecutive year in which at least one Category 5 hurricane hit the U.S.

The 2021 hurricane season – which officially extends from June 1 through November – isn’t expected to be as severe as 2020, but the National Oceanic and Atmospheric Administration (NOAA) is forecasting a worse-than-normal year, with 13 to 20 named storms, of which six to 10 are predicted to reach hurricane level, including three to five classified as major hurricanes. Another leading forecaster, Colorado State University, offers a similar outlook: 17 named storms, including eight hurricanes, four of them major, in 2021.

Marketing and binding insurance coverage takes time, and most Flood Insurance policies include a 30-day waiting period between date of purchase and coverage activation, so make sure you’re properly insured as soon as possible.

Deductibles and the Limitations Provision 

As the Insurance Information Institute (III) states in its “Hurricane season insurance guide,” “Insurers in every coastal state from Maine to Texas include separate deductibles for hurricanes and/or windstorms in their homeowners policies, stated on the Declarations (front) page of your homeowners policy.”

A named stormed deductible is often a percentage of the property’s value, rather than a flat rate, with percentages ranging from 1% to 10%. Depending on the policy, deductibles may be per event or per calendar year. If the deductible is per event, you could wind up paying it more than once in a single season.

Homeowners policies and Commercial Property Insurance also include provisions that exclude coverage of some perils. Here’s what you’ll find in the most common Insurance Services Office (ISO) commercial property policies – the Building and Personal Property Coverage Form (CP 00 10) and the Condominium Association Coverage Form (CP 00 17):

C. Limitations 

The following limitations apply to all policy forms and endorsements, unless otherwise stated. 

1. We will not pay for loss of or damage to property, as described and limited in this section. In addition, we will not pay for any loss that is a consequence of loss or damage as described and limited in this section. 

c. The interior of any building or structure, or to personal property in the building or structure, caused by or resulting from rain, snow, sleet, ice, sand or dust, whether driven by wind or not, unless: 

(1) The building or structure first sustains damage by a Covered Cause of Loss to its roof or walls through which the rain, snow, sleet, ice, sand or dust enters; or 

(2) The loss or damage is caused by or results from thawing of snow, sleet or ice on the building or structure. 

Because of these exclusions, protecting yourself with adequate hurricane coverage typically requires riders or separate policies for Windstorm Insurance, as well as Flood Insurance.

Policy Options 

Insuring property in a hurricane-prone area offers several options, including:

  • Calendar Year Vs. Named Storm Deductible — Named storm deductibles typically are lower and come with lower premiums, but paying a deductible multiple times can be far more expensive. Not all carriers offer deductibles on a calendar-year basis, but, if available, it’s generally the preferable option.
  • Per Location Vs. Per Building — In some states, a commercial property insurance may include a per-building deductible or a per-location deductible, with blanket limits applying to multiple buildings. Location deductibles are based on a location’s total insured value while per-building deductibles apply only to the building hit by losses.
  • Actual Cash Value Vs. Replacement Value — Actual cash value (ACV) costs less, but it takes depreciation into account, and therefore pays less in the event of a claim. Replacement value is more expensive but pays more in coverage.

Work with your agent or broker to ensure your coverage is cost-efficient and customized to your needs.

What You Can Do 

Insuring property in hurricane-prone areas is expensive, but insurers do reward risk management and good claim histories. Here are steps you can take to mitigate the cost of hurricane insurance:

  • Hurricane-proof your building. Enhancements such as a new roof and impact-resistant glass can provide savings on your Commercial Property Insurance premium.
  • Adopt and administer a hurricane preparedness plan. This alone won’t earn you premium credits, but it will reduce the risk of claims, and the fewer claims in your loss history, the lower the cost of coverage. Your plan should include a home inventory of your valuables and other prized possessions, as well as digital storage of important documents.
  • Consider hiring a private weather service. Working with a professional meteorologist may provide you with highly specified forecasts for evaluating risk and determining what actions are necessary to prepare and safeguard your property.
  • Understand your commercial property’s insurance rating. Alera Group’s brief guide to commercial property ratings provides insights on contributing factors such as construction, occupancy, protection and exposure.

To receive the guide, click the link below.


About the Author

Aaron Weber
Director of Commercial Insurance Sales
A&B Insurance and Risk Management, An Alera Group Company

Aaron Weber has more than 15 years’ experience as a commercial insurance executive and sales leader. He is certified as a Construction Risk and Insurance Specialist (CRIS) by the International Risk Management Institute.

Contact information: 

Wellbeing Resources: Effective Sleep, Post-Pandemic Finances and More

Posted on May 24th, 2021

When it comes to wellbeing, employers often find themselves challenged by how to approach a shift from a traditional wellness model to a comprehensive and holistic program that supports the whole person. Below you’ll find this week’s curated list of wellbeing resources. Feel free to share these resources, as appropriate, with your team. Have a safe and healthy week!

Career Wellbeing

Social & Family Wellbeing

  • How to Talk to Someone You Find Intimidating – Whether in personal conversations or professional ones, it’s easy to find ourselves feeling insecure or intimidated when speaking to someone we perceive as exceptional, in one form or another.  Here, experts offer tips on how to hold your own with people that you find intimidating.

Financial Wellbeing

  • How to Avoid Post-Pandemic Overspending – Now that the country is re-opening, are you getting ready to do some revenge spending?  Revenge spending is buying things just to make up for all the spending you didn’t get to do during the pandemic.  Here are 7 tips to revenge spend responsibly.

Physical Wellbeing

  • How to Stop Making What You Eat a Big Deal – Some of us have had times in our lives where we have spent every waking moment thinking about food.  Our days were structured around what to eat when in relation to the ‘plan’ we were following at the time.  These messages tell you that moderation is not easy.  Here are 5 ways to make good health effortless.
  • Sleep to Solve a Problem – “Sleep on it”, while this phrase feels like just a piece of advice our parents give us, there are scientific reasons why it makes sense. The brain has a nighttime job of finding connections so that when we wake up, we have a different perspective. Here’s how it works.

Emotional Wellbeing

Community Wellbeing

  • This Browser Extension Helps You Buy More Sustainable Products on Amazon –Most consumers say that they want to buy products that are better for the environment. But it’s difficult to tell when sustainability claims on a package are true or false. Few of us have the time to do the research. But a new Chrome extension called Finch will help rank your potential purchases when you’re browsing on Amazon.

Employer Focused Wellbeing

  • Strategies to Support Trauma-Exposed Healthcare Workers – Throughout the pandemic, each new wave of COVID-19 infections presented additional challenges. At the worst points, healthcare employers watched as their care teams grappled with repeated exposure to trauma and witnessed their worsening mental health. In this webinar, USCF, Mon Health Systems, and Lyra discuss how to support your healthcare workers in managing the short-term and long-term trauma of COVID-19.  Don’t miss this event on Wednesday, May 26th at 1 PM CT.
  • Going Back to Work in the Office: It Has to Be Worth It – Some employees aren’t sure they ever want to go back to work in an office. This piece by Gallup discusses how you can enhance and communicate the benefits of working onsite and how you can focus on the four C’s to shape a compelling workplace value proposition.
  • How to Make Every Month Mental Health Month – Employers are interested in strategies to create a workplace culture of well-being. As we honor May as Mental Health Awareness month, this virtual town hall will highlight effective and high-impact strategies that can be used to support employee mental health every month of the year. You will learn about step-by-step guidance for creating a mental health initiative, how to expand and optimize mental health support and resources, how to build a culture that supports employee mental health, and how to ensure access to mental health services and supports. Register and join on May 26th at 1 PM ET.

Help Wanted: Need for Mental Health Care Exceeds Available Providers

Posted on May 21st, 2021

As we near the end of Mental Health Awareness Month, recognition of the psychological challenges many Americans face and efforts by employers to address employee wellbeing may be at all-time highs. Yet the number of U.S. residents in need of mental-health assistance also appears to be at a record level — in marked disproportion to the number of professionals available to help.

From January through June of 2019 — pre-pandemic times — 11% of American adults reported experiencing symptoms of anxiety or depression, according to the U.S. Centers for Disease Control and Prevention (CDC). By the time the agency revisited that subject in December 2020, the percentage had climbed to 42%.

Since December, the United States has made tremendous progress in combatting COVID-19, with more than 279 million vaccine doses administered and 126 million residents (38.1%) fully vaccinated as of May 20. But while vaccines are readily available for the vast majority of Americans who still need them, professional help for people experiencing anxiety or depression is not.

According to the National Alliance for Mental Illness (NAMI), 1 in 5 U.S. adults experiences mental illness in a given year, but fewer than half of adults with a mental health condition receive care, and the average time between the onset of symptoms and the delivery of treatment is 11 years. Based on a recent study by the Government Accountability Office (GAO) and a survey by the National Council for Behavioral Health (NCBH), that may be understating matters.

“In a February 2021 survey of its members, NCBH found that in the three months preceding the survey, about two-thirds of the member organizations surveyed reported demand for their services increasing and having to cancel or reschedule patient appointments or turn patients away,” the GAO said in an April 30 release. “The survey also found that during the pandemic, 27 percent of member organizations reported laying off employees, 45 percent reported closing some programs, and 35 percent decreased the hours of staff.”

In short, too many people are struggling and can’t get the help they need. Even mental health professionals find themselves at a loss.

“Every single person I see needs therapy right now,” Dr. Jessi Gold, a psychiatrist at Washington University in St. Louis whose patients are mostly college students and healthcare workers told the New York Times. “They come back and say, ‘I’ve called 20 people, and I don’t know what to do.’”

Referrals, Online Vendors and Pharmacies 

While mental health professionals are experiencing their own frustrations with the lack of available services, some may be able to provide referrals. Primary care physicians can be helpful in that regard as well, and some may be willing to prescribe medication for mild to moderate symptoms.

In addition, Psychology Today maintains an extensive online database that enables users to search by location, insurance carrier, specialty and more.

An employer-sponsored wellness program also may provide assistance. According to a 2021 survey by Alight Solutions, 85% of employees who use them find such programs easy to access, with 83% saying the programs enhance their employment experience.

And if you aren’t already able, you may soon be able to find mental health care at your local pharmacy. CVS, Walmart Health, Rite Aid and Walgreens recently introduced counseling services or other forms of support online or at pilot locations, as the Times reported earlier this month.

A Menu of Apps 

Increasingly, Americans are finding assistance on their devices through self-help apps – often at the advice of professionals. The website PsychCentral recently published its list of “The Best Apps for Depression in 2021,” along with descriptions and reviews for each of the following:

No app is a substitute for professional counseling or appropriate medication, but to decrease stress or mitigate depression, you may find one or more of these useful.

Concerned About Self-Harm? Have a Plan. 

If you are contemplating self-harm, contact the National Suicide Prevention Lifeline at 800-273-8255 or call 911. If you are prone to suicidal ideation but aren’t in immediate danger, have a plan in place for an emergency, and share it with a trusted friend or loved one. The plan may include warning signs or trigger words to let someone know urgent care is required.

NAMI’s resources include its weekday HelpLine, an online chat and, for crisis situations, 24/7 text-message access to trained crisis counselors – all accessible here. And the CDC’s How Right Now campaign offers specific resources and support for people experiencing emotions including anger, fear, grief, loneliness, sadness, stress, uncertainty and worry.

Finally, if work is a primary contributor to ongoing struggles with mental health but the need for help is not acute, you may find it helpful to watch the Alera Group webinar “Managing Stress and Burnout,” featuring Dr. Myra Altman of Modern Health. Recorded in October 2020, the webinar is available by clicking on the link below.


About the Author

Elizabeth Entin, MPH, RD, LDN
Director of Health Strategies and Solutions
SIG, An Alera Group Company

Elizabeth Entin is a health and wellness professional dedicated to building a thriving workplace culture to increase employee engagement and improve overall health and well-being. In addition to holding a Master of Public Health (MPH) degree from the Tulane University School of Public Health and Tropical Medicine, she is a Registered Dietitian (RD) and Licensed Dietitian-Nutritionist.

Contact information: 

IRS Releases its Much Anticipated Guidance on ARPA COBRA Premium Assistance

Posted on May 21st, 2021

This alert is of interest to all employers with plans subject to federal COBRA or state mini-COBRA.

On May 18, 2021, the IRS released Notice 2021-31, which contains its much-anticipated guidance on the American Rescue Plan Act (ARPA) COBRA premium assistance provisions.

In many respects, the guidance is consistent with previous IRS guidance under the American Recovery and Reinvestment Act of 2009 (ARRA), which is welcome news as many employee benefits experts referred to the prior guidance to assist employers with understanding their likely compliance obligations under ARPA as we awaited official IRS guidance.  Now that it’s here, we provide a general overview of the guidance in more detail below.

As many examples in the IRS guidance demonstrate whether an individual is an AEI depends on all relevant facts and circumstances and may require legal guidance.  For example, the nature of the employment relationship and the facts leading up to a termination can sway whether a seemingly voluntary termination was really involuntary, or the smallest shift in circumstances may dictate whether an individual is really “eligible” for other group health plan coverage.  Therefore, it is important for employers to engage counsel directly if there are any questions about an individual’s status as an AEI.

Finally, the IRS indicated that it is still continuing to consider certain issues and may issue additional guidance, specifically, which entity should claim the credit for certain coverage provided through the Small Business Health Options Program (SHOP) or where state rules require full payment of premiums by the employer.

IRS Guidance Related to ARPA COBRA Premium Assistance

Who is an AEI?

As set forth in ARPA, an AEI is an individual who: (1) loses eligibility for coverage due to a reduction in hours or involuntary termination employment (other than by reason of an employee’s gross misconduct); (2) is eligible for COBRA continuation coverage for some or all of the period beginning on April 1, 2021, through September 30, 2021; (3) elects COBRA continuation coverage; and (4) is not eligible for, or enrolled in, other group health plan coverage (excluding excepted benefits, a qualified small employer health reimbursement arrangement (QSEHRA), or a health FSA) or eligible for Medicare.  Spouses or dependents of employees who are AEIs are also AEIs themselves if they were covered under the group health plan on the day before the reduction in hours or involuntary termination of the covered employee’s employment and lost coverage as a result.  This is true even if the spouse or dependent did not elect coverage when first eligible for COBRA, and they may remain AEIs even if the employee should die during the subsidy eligibility period.

Individuals who are not qualified beneficiaries, such as a spouse or dependent (other than a newborn) who were not covered under the group health plan on the day before the reduction in hours or involuntary termination, or domestic partners or other individuals who may meet an expanded definition of qualified beneficiary under state law, but do not meet the definition of a qualified beneficiary under Federal COBRA, are not AEIs and are, therefore, not eligible for premium assistance.

As the law and guidance suggest, the burden for determining who is an AEI under the first 3 elements listed above largely falls on the employer.  The guidance states that employers may allow employees to attest whether their loss of coverage was due to a reduction in hours or involuntary termination of employment to assist in their determination of whether the individual is an AEI; however, the guidance does not suggest these attestations are dispositive.  Instead, the guidance provides that the employer may rely on attestations unless the employer has actual knowledge they are incorrect.  Furthermore, per the guidance, employers must maintain records, including the attestation, to support an individual’s eligibility for the premium assistance and the company’s eligibility for the tax credit. Therefore, employers should ensure their reliance on such attestations are reasonable and consistent with any of the employer’s general knowledge and employment records.

What further complicates the determination of AEI status is that the employee is responsible for understanding and accurately advising the employer as to whether the employee (or their spouse or dependents, as applicable) are eligible for or enrolled in other coverage that would disqualify them from receiving the subsidy.  This is highly fact-sensitive and may be confusing to employees, and employees may be subject to penalties for receiving premium assistance if they are not otherwise eligible for such assistance, although exceptions apply for failures due to reasonable cause and not willful neglect.

If an individual is enrolled in other group coverage or eligible for or enrolled in Medicare, then the answer is easy.  However, whether an individual is “eligible” for other group health coverage is more complicated.  For example, an individual may be an AEI/eligible for premium assistance if they are eligible for other group health plan coverage, but are not permitted to enroll in such other coverage.  Whether this is the case may depend on if there are HIPAA special enrollment rights or if the individual is in a waiting period.  These are complicated scenarios and are essentially left up to the employee to understand when completing their Request for Treatment as an Assistance Eligible Individual form or other attestation form provided by an employer, carrier, or administrator.  Employers, carriers, or administrators, as applicable, must rely on employee attestations in this regard as long as they do not have actual knowledge they are incorrect.

The guidance also clarifies the following scenarios:

  • If an individual was covered by, or eligible to enroll in, other group health plan coverage on April 1, 2021, then that disqualifies them from COBRA premium assistance even though it does not end the period of eligibility for COBRA.  One example of this would be if an AEI enrolled in COBRA declines coverage under a new employer’s plan and maintains their COBRA coverage, they remain eligible for COBRA, but they are not eligible for the premium subsidy.
  • If an employer was subject to federal COBRA in the year during which an AEI becomes eligible for COBRA, but is no longer subject to federal COBRA, the employer must still offer COBRA to any qualified beneficiaries who were previously eligible for COBRA. If the qualified beneficiaries are AEIs, they would be eligible for the premium assistance and the employer would be eligible for the premium credit.
  • The initial reason for the loss in coverage is a determinative factor in whether an individual is an AEI.  For example, if an employee and spouse divorce and the spouse loses coverage and several months later the employee is involuntarily terminated, the former spouse is not an AEI because the divorce, not the employee’s involuntary termination, resulted in the former spouse’s loss of coverage.

To Which Plans Does Premium Assistance Apply?

Consistent with ARPA and the DOL guidance, the IRS guidance confirms premium assistance is available for group health plans other than medical coverage, including dental and vision plans, and regardless of whether the employer contributes to the coverage for active employees.  Other benefits for which the subsidy may be available include onsite clinics, HRAs, ICHRAs, standalone EAPs or wellness programs.

Premium assistance and premium assistance tax credits are not available for health FSAs, QSEHRAs, non-group health plan coverage (such as life or disability benefits), or other plans not subject to COBRA continuation coverage as defined under ARPA, including temporary continuation coverage under the Federal Employee Health Benefits program, church plans or small employer plans not subject to state mini-COBRA.

State continuation coverage that is comparable to federal COBRA can have a different maximum coverage period than federal COBRA, as well as different qualifying events, different qualified beneficiaries, or different maximum premiums without being deemed to be non-comparable coverage; however, as discussed previously, different qualified beneficiaries may not be AEIs and, therefore, not eligible for premium assistance for coverage.

Additionally, the IRS clarified that premium assistance is not available for retirees on retiree health coverage that is not COBRA continuation coverage and is offered under a separate group health plan than the plan under which COBRA continuation is offered.  However, if retiree coverage is offered under the same group health plan coverage available to similarly situated active employees, even if the retiree pays more than active employees, premium assistance is available as long as the amount charged to a retiree does not exceed 102%.

When Does Premium Assistance Begin?

Per the IRS guidance, premium assistance is available as of an AEI’s first applicable period of coverage beginning on or after April 1, 2021.  A “period of coverage” is generally a monthly or shorter time period during which the plan or issuer normally charges employees or qualified beneficiaries their premiums.  This could be after April 1, 2021, if the normal period of coverage that would have been charged did not include April 1, such as for plans with biweekly premium obligations for COBRA and active continuation coverage.

An AEI can elect COBRA retroactively to the date they were first eligible for COBRA (if prior to April 1, 2021), as of April 1, 2021 (without regard to any time they were eligible before April 1, 2021), or prospectively beginning after April 1, 2021.  Furthermore, if an AEI is not eligible for COBRA until September 1, 2021, they could elect coverage after September 30, 2021 (as long as they elect COBRA and request to be treated as an AEI within 60 days of receiving their COBRA Election Notice) and receive the premium assistance for the month of September.

When Does Premium Assistance End?

Premium assistance ends on the earlier of (1) September 30, 2021, (2) the date an individual ceases to be an AEI because they are eligible for certain other group health coverage or Medicare, or (3) the last day of the employee’s maximum coverage period (or extended coverage period, where applicable).  If the employee remains eligible for COBRA after September 30, 2021, they will remain eligible until the last day of their maximum coverage (or extended coverage) unless they fail to pay their premiums (subject to any COVID-19 related extensions) or COBRA otherwise ends early.

What is an Involuntary Termination?

Consistent with the IRS’ guidance under ARRA, for purposes of ARPA, the IRS provides that an involuntary termination is “severance from employment due to the independent exercise of the unilateral authority of the employer to terminate the employment, other than due to the employee’s implicit or explicit request, where the employee was willing and able to continue performing services.”  Further, if an employee voluntarily resigns, it may still be an involuntary termination if the employee was constructively discharged or forced to resign due to a material negative change in the employment relationship.  Specifically, the IRS provided the following examples of involuntary terminations:

  • Where an employee resigns, but the facts demonstrated the employee was ready and willing to work; however, the employee knew they would have been terminated anyway absent their resignation, then the termination is involuntary. For example, where an employee resigns in lieu of termination.
  • Where an employee is terminated while they are absent due to illness or injury, but there is a reasonable expectation the employee will return after the illness or injury subsides.
  • Where an individual is forced to retire in lieu of being terminated.
  • Termination for cause (unless it is gross misconduct).
  • Voluntary resignation due to a material change in the geographic location of employment.  For example, if the company required the employee to move from Texas to California.
  • Termination as a result of an employee’s participation in a window program meeting the requirements of Treas. Reg. 31.3121(v)(2)-1(b)(4)(v), i.e., where an employer offers severance to an employee if he or she resigns by a specified period of time.
  • Resignation due to concerns about workplace safety only if the employer’s actions or inactions result in a material negative change in the employment relationship analogous to a constructive discharge.
  • Resignation due to personal circumstances, such as health condition of the employee or family member or inability to locate child care only if it is analogous to a constructive discharge (e.g., the employer fails to take a required action or provide a reasonable accommodation).
  • Resignation due to an involuntary reduction in hours.
  • An employer’s decision not to renew an employment contract if the employee was otherwise willing and able to continue the relationship and willing to execute a contract under similar terms or continue without a contract.

The IRS specified the following are not involuntary terminations:

  • Voluntary retirement (i.e., where the employment would have continued absent the employee’s decision to resign).
  • Resignation due to concerns about workplace safety if there is no material negative change in the employment relationship analogous to a constructive discharge.
  • Resigning because the employee’s child’s school or daycare is closed.
  • The employee’s death.
  • The end of an employment contract where both parties understood at the time the contract was entered that it was for specific services over a specified term and was not subject to renewal.

What is a Reduction in Hours?

Consistent with examples offered by the DOL in its ARPA FAQs, the IRS guidance includes several examples of what constitutes a reduction in hours, including:

  • A furlough initiated by the employer or an employee participates in a furlough process analogous to a window program.
  • Work stoppage due to a lawful strike or lockout as long as the employer and employee intend to maintain the employment relationship at the time the strike or lockout begins.
  • An employee’s voluntary reduction in hours, such as an employee’s request to go part-time.
  • Absence from work due to illness or injury (but the employee remains employed).
  • Temporary leave of absence (where employee intends to return to work and the employer and employee intend to maintain the employment relationship).

COBRA Continuation Extensions and Election Requirements

For plans subject to federal COBRA, ARPA extends the election period for federal COBRA coverage if the qualifying event occurred before April 1, 2021, and if the individual has not yet elected COBRA or still has an open election period (such as due to the COVID-19 extensions).   In these cases, coverage may be elected retroactive to the date coverage was lost.

The guidance affirms that premium assistance is available from April 1 through September 31, 2021 for AEIs who are in their 18-month maximum COBRA coverage continuation period, or a disability or second qualifying event extension period, or an extension under applicable state continuation, such as extensions applicable to fully insured plans in New York and California.

If an AEI is only eligible for state mini-COBRA and they reside in a state that has not opted to create a similar extended election right to COBRA (similar to the extended election period ARPA creates for federal COBRA), then they are not eligible for an extended election period.  In such case, they would only be eligible for premium assistance (if they are an AEI), if they have a resulting period of coverage between April 1, 2021, and September 30, 2021.

In order to be eligible for premium assistance, an AEI must elect COBRA and request treatment as an AEI within 60 days of receipt of the applicable notices.  This is the case regardless of whether any COVID-19 related extensions would otherwise apply to certain COBRA deadlines.  Moreover, employers, issuers, or multiemployer plans do not have the benefit of any COVID-19 related extensions for providing the ARPA-related notices to individuals.

Furthermore, an individual’s failure to pay premiums for COBRA continuation coverage elected before April 1, 2021, does not impact the individual’s eligibility for premium assistance beginning the first period of coverage on or after April 1, 2021.  This could leave gaps in coverage if an individual paid for only some periods of coverage prior to April 1, 2021.

Finally, if an individual fails to elect retroactive COBRA coverage at the time he or she elects COBRA coverage with premium assistance, his or her election cannot be changed after the end of the 60-day election period even where the COVID-19 related extensions would otherwise apply.

How Does Premium Assistance Work for ICHRAs and HRAs?

For HRAs, if the individual elects coverage under the ARPA extended election period, then the HRA cannot reimburse expenses incurred between the date coverage was lost and the first day of the first period of subsidy assistance beginning on or after April 1, 2021.  They will have access to the same level of reimbursements during COBRA continuation as was available immediately before the qualifying event, based on the amount originally available for the HRA plan year and reimbursements for expenses incurred before the qualifying event, reduced by the amount of any reimbursements made during the post-termination runout period.

If an AEI becomes eligible for another HRA (other than an HRA that qualifies as an FSA pursuant to Section 106(c)(2) of the Code), then this effectively ends an individual’s eligibility for premium assistance.

An AEI may also receive premium assistance for an individual coverage HRA (ICHRA) integrated with individual coverage; however, not if it is integrated with Medicare.  The premium assistance is limited to the ICHRA, and will not apply to the cost of the underlying individual coverage.

Employer Subsidized Continuation Coverage/Certain Severance

If the employer subsidizes some or all COBRA premium costs, the employer is not eligible for premium assistance credits for the amount for which the employer would not have charged the individual.  For example, if the employer subsidizes the COBRA costs for employees who lost coverage due to a reduction in hours by paying 50% of the cost of COBRA, the employer can only claim 50% of the cost of coverage as a premium assistance credit.  Or, if the employer subsidizes the cost for former employees at 100% for several months post-employment, the employer cannot claim the premium assistance credit for those months.

What are the Premium Assistance Credits and What are the Parameters for Credits?

For any coverage not subsidized by the employer, as discussed in the previous section, the credit for a quarter is the amount equal to the premiums not paid by AEIs for COBRA continuation coverage as well as administrative costs which, in sum, is 102% of the applicable premium. For ICHRAs, the premium assistance is equal to 102% of the amount actually reimbursed with respect to an AEI.

The plan can increase the COBRA premium amount (if it previously charged less than the maximum 100%) in accordance with Section 54.4980B-8, Q&A-2(b)(1), and the applicable notice requirements, and receive the premium assistance tax credit.  Moreover, if the plan provides a taxable severance payment to AEIs it does not reduce the premium assistance tax credit available to the employer.  However, as set forth above, the employer may not receive the premium assistance tax credit for employer-subsidized coverage.

Because only qualified beneficiaries as defined under federal law can be AEIs, if non-qualified beneficiaries are covered by continuation coverage, then premium assistance is only available for AEIs.  Therefore, if non-AEIs covered by continuation coverage increase the premium cost, then not all of the coverage cost is eligible for premium assistance.  For example, if the employee and one child are the only AEIs, but there is another individual covered under continuation coverage who is a non-AEI, then if the cost of COBRA is $800 for Employee+1 coverage and $1,000 for family coverage, only $800 would be eligible for premium assistance, and the employee would be required to pay the $200 difference.

If the plan allows individuals to change coverage to a different benefit, then the different benefit package cannot cost more than the premium for coverage that the individual was enrolled in at the time of the qualifying event; however, this does not apply in situations where changes are made at open enrollment or the former plan is no longer available and the AEI must be offered a plan available to similarly situated active employees that is most similar to the plan the AEI was previously covered under but it costs more than the prior plan.

If an employer is receiving tax credits pursuant to the CARES Act or FFCRA, such as the employee retention credit, among others, for any period during April 1, 2021, and September 30, 2021, then it cannot also claim a premium assistance credit under ARPA for the same period.

Finally, any premium assistance credit is included in the gross income of the entity claiming the credit for the taxable year, including the last day of any quarter with respect to which the credit is allowed.

Who Collects the Premium Assistance Credit?

Consistent with the ARPA, the IRS specifies the premium assistance credit is payable to:

  • the employer maintaining the plan for self-funded or fully insured plans subject to federal COBRA;
  • the insurer providing coverage subject to state continuation requirements (e.g., mini-COBRA); or
  • the multiemployer plan for group health plans that are multiemployer plans.

Unless additional, future guidance provides otherwise, an entity listed above cannot delegate responsibility for, or receipt of, the premium assistance or applicable premium assistance credit.

What about PEOs or Third Party Payers?

Unless, as described below, a PEO or other third-party payer is the premium payee, employers collect the premium assistance credit even if they use a third-party payer, such as a reporting agent, payroll service provider, or PEO to report and pay federal employment taxes.  A third-party payer may report the credit on behalf of the employer if it reports and pays the employer’s premiums on its behalf.  It is reported as follows depending on the type of third party entity:

  • Reporting agent:  If the employer uses a reporting agent to file its federal employment tax returns, then the agent will reflect the credit on those returns.
  • Certified Professional Employer Organization (CPEO):  If the employer uses a CPEO or a §3504 designated agent to report federal employment taxes on an aggregate form 941, the CPEO will report the credit on its aggregate Form 941 and Schedule R.
  • Non-certified PEOs or other third-party payers:  If the PEO or other third-party payer pays and reports the employer’s federal employment taxes under its own EIN (versus the employer’s) then the PEO or third party payer reports the credit on an aggregate Form 941 and separately report the credit allocable to the employer for which it is filing the Form 941 on an accompanying Schedule R.

Regardless of having a third-party payer of any kind, the employer must file its own Form 7200 to request an advance of the premium assistance credit and provide a copy of Form 7200 to its third-party payer.

The only time the PEO or third party payer can collect the premium assistance credit for itself is if it:

  • Maintains the group health plan,
  • Is considered the sponsor of the group health plan and is subject to the applicable DOL COBRA guidance, including providing the COBRA election notices to qualified beneficiaries, and
  • Would have received the COBRA premium payments directly from the AEI were it not for the COBRA premium assistance.

If these conditions are met, then the third party payer reports the credit on applicable lines of Form 941, and completes line 8 of Schedule R, and may also request an advance of the premium assistance credit using Form 7200 on its own behalf.  Similar to employers and other entities, the premium assistance credit is included in the gross income of the third-party payer, and cannot be claimed if the third-party payer receives other tax credits pursuant to the FFCRA or CARES Act for any client for whom it is the third-party payer.

The third-party payer must retain any substantiation records and obtain any information from its client that would ensure it is accurately administering the premium assistance and claiming the credit.

How do Entities Request an Advance of the Premium Assistance Credit?

Entities may reduce their deposits of federal employment taxes in anticipation of the credit for which the entity has become entitled with regard to a period of coverage. This is available as of the date they are entitled to the credit.  If the anticipated credit exceeds federal employment tax deposits available for reduction, then the entity can file a Form 7200 after the end of the payroll period in which they become entitled to the credit to request an advance; however, an advance cannot be requested for any credit period that has not yet begun.

Form 7200 must be filed before the earlier of (1) the day the employment tax return for the quarter in which the premium payee is entitled to the credit is filed, or (2) the last day of the month following that quarter. Form 7200 and IRS Notice 2021-24 provide more information about the advance.

State or local governments, or their political subdivisions, Indian tribal governments, agencies or instrumentalities of the federal government described in Section 501(c)(1) and exempt from taxation under 501(a) of the Code, as well as entities that do not have any employment tax liability (such as multiemployer plans with no employees) are entitled to a premium assistance credit for any period of coverage after the payee receives an AEI’s election, and for each period thereafter between April 1, 2021, and September 30, 2021.

The premium assistance credit is claimed by reporting the refundable and any non-refundable portions of the credit, as applicable, and the number of persons receiving premium assistance on the designated lines of its federal employment tax return (usually Form 941).  Advances of the premium assistance credit can also be requested using Form 7200 for governmental entities, while entities that do not have any employment tax liability can request the advance on Form 941.  When completing Form 941 for the advance (for entities without employment tax liability), the entity completes Form 941 and enters zero on all remaining non-applicable lines.  (See Question 77 in the IRS guidance for more information).

If an individual is no longer an AEI but fails to notify the entity providing the premium assistance, the entity is still entitled to the credit unless it knew the individual was no longer eligible.  Therefore, once an entity is aware, if it ever becomes aware, that an individual is eligible for other group health plan coverage or Medicare, it should stop providing premium assistance and should not apply for the credit.

What Does This Mean For Employers?

Employers should ensure they send all required notices by the applicable deadlines.  For individuals who are eligible for an extended election period, the deadline is May 31, 2021. If employers have not coordinated with carriers (if they offer a fully-insured plan and are subject to state mini-COBRA versus federal COBRA), they should do so to ensure processes are in place to comply with ARPA. Employers should also familiarize themselves with the guidance related to what constitutes an involuntary termination or reduction in hours to ensure all potential AEIs receive the required Notices and opportunity to be treated as an AEI, if eligible.  Finally, employers should be prepared to file Form 941 (or Form 7200 if an advance premium assistance credit is required) to receive their premium assistance credits.


About the Author.  This alert was prepared for Alera Group by Marathas Barrow Weatherhead Lent LLP, a national law firm with recognized experts on ERISA-governed and non-ERISA-governed retirement and welfare plans, executive compensation and employment law.  Contact Stacy Barrow or Nicole Quinn-Gato at or

The information provided in this alert is not, is not intended to be, and shall not be construed to be, either the provision of legal advice or an offer to provide legal services, nor does it necessarily reflect the opinions of the agency, our lawyers or our clients.  This is not legal advice.  No client-lawyer relationship between you and our lawyers is or may be created by your use of this information.  Rather, the content is intended as a general overview of the subject matter covered.  This agency and Marathas Barrow Weatherhead Lent LLP are not obligated to provide updates on the information presented herein.  Those reading this alert are encouraged to seek direct counsel on legal questions.

© 2021 Marathas Barrow Weatherhead Lent LLP.  All Rights Reserved.

Reducing Pharmacy Spending Without Compromising Care

Posted on May 20th, 2021

Prescription drug pricing is a hot-button issue in any discussion of healthcare reform, and no discussion of prescription drug pricing can be complete without examining the role of pharmacy benefit managers, or PBMs.

As described by the Commonwealth Fund, PBMs “are companies that manage prescription drug benefits on behalf of health insurers, Medicare Part D drug plans, large employers and other payers.” In this role, the Commonwealth Fund continues, PBMs:

  • Develop and maintain lists, or formularies, of covered medications on behalf of health insurers, which influence which drugs individuals use and determine out-of-pocket costs;
  • Use their purchasing power to negotiate rebates and discounts from drug manufacturers;
  • Contract directly with individual pharmacies to reimburse for drugs dispensed to beneficiaries.

PBMs vary, with key distinctions being the distribution of manufacturer rebates and the use of a practice known as “spread pricing.” Critics note that many PBMs retain rebates intended for health plan sponsors and their members, and use spread pricing to overcharge employers for medications.

PBM reform proposals include a requirement to pass through rebates to payers or patients. Some PBMs already do this.

For a full discussion of prescription drug pricing and PBMs, join Alera Group on Thursday, June 17, for “Dissecting Your Pharmacy Spend: Optimizing Your Health Plans, Part 2,” a one-hour webinar on how businesses and their employees can save money on prescription drugs without compromising the quality of care. Scheduled for 2 p.m. EDT, the webinar will feature:

  • Pharmacist Dondi Ballard, RPh, Senior Vice President-Operations of PharmAvail, an industry leader in pass-through pharmacy benefit management
  • Tom Burgess, Executive Consultant at Alera Group Relph Benefit Advisors
  • Ellen Lindahl, RN, MPA, Director of Clinical Review, Alera Group.

During the session, we’ll discuss:

  • Pharmacy trends and focus
  • The role of PBMs
  • Rising players and strategies
  • Best practices
  • Case studies.

Dissecting ‘Rising Drug Costs’ 

In a May 5, 2021, statement prepared for testimony before the U.S. House of Representatives Committee on Education and Labor Subcommittee on Health, Employment, Labor and Pensions, Douglas Holtz-Eakin — president of the American Action Forum, a center-right think tank – made the case that “rising drug costs” is an ambiguous term.

“For example, ‘rising drug costs’ might refer to a narrow definition focused on the sales prices (or ‘list price’) set by drug developers and manufacturers,” Holtz-Eakin’s statement reads. “Alternatively, the problem might not be with all drugs, but instead the high prices of some drugs. Finally, the problem may be the increasing cost of prescription drugs borne by individuals at the pharmacy counter, which has resulted from an increase in high-deductible health plans and greater use of co-insurance, rather than flat copays.”

While much of Holtz-Eakin’s statement may have been politically motivated — the day after its release, American Action Forum launched a $4 million-plus advocacy campaign aimed at defeating H.R. 3 (117), the drug-pricing negotiation bill House Speaker Nancy Pelosi and other Democrats have tied to President Biden’s $4 trillion infrastructure proposal — few would argue that certain drugs skew pricing averages.

Since the mid-1990s, the number of specialty drugs on the market has increased by 1,200%, with another 7,000 new specialty drugs in varying stages of development. New drugs on the market are for treatment related to oncology, neurology, immunology, blood disorders, cardiovascular disease and more. Drugs in the pipeline for 2021-2022 include medication for Alzheimer’s, gene therapy, Duchenne muscular dystrophy and multiple sclerosis.

Such specialty drugs come at a hefty price.

The average out-of-pocket (OOP) cost for specialty drugs is $219.45 — and that’s with 95% of the cost covered by a plan sponsor. Compare that to traditional drugs, for which plan members cover 19% of costs, but at an average OOP expense of only $12.92.

This is where PBMs and Advanced Healthcare Strategies — an Alera Group program of customized, data-driven solutions – can help.

Role of PBMs 

In addition to the functions outlined by the Commonwealth Fund, pharmacy benefit managers administer clinical oversight and monitor fraud, waste and abuse.

There are three basic types of PBMS:

  • Traditional — These have multiple sources of revenue, including rebates, and no administrative fee;
  • Pass-through — Their only revenue is through administration fees, with pharmacy costs and rebates are passed through to plan sponsor;
  • Reinvestment — They offer no rebates, but provide deeper brand discounts.

During our June 17 webinar, we’ll go deeper into the differences between PBMs, highlight the importance of strong clinical oversight and explain the value of Advanced Healthcare Strategies in helping to control the “rising cost of drugs.”

 Real Companies, Real Savings 

The savings PBMs make possible aren’t merely theoretical. During the webinar, we’ll present case studies of companies who achieved significant cost savings through management of pharmacy benefits. Examples of Alera Group clients achieving such savings include:

  • A company that excluded a particular narcolepsy drug, ensured the availability of a clinical alternative and saved $180,000 per year;
  • An oversight vendor’s use of alternative funding and acquisition strategies for high-cost medications that enabled members to routinely fill specialty medications and provided the employer with annualized savings of $141,040;
  • An independent pharmacy consultant who put a client’s pharmacy coverage out to bid and wound up with improved pricing terms from the incumbent carrier and annual savings of $300,000.

To register, click on the link below.


About the Author

Gretchen Day, MPH, MCHES
VP of Health Innovations and Advanced Strategies
AIA, Alera Group

Through her role at Alera Group, Gretchen Day satisfies her passion for public health by working with businesses and their employees to improve workplace culture and influence change in their healthcare delivery system. Ultimately, her goal is to help individuals access better quality healthcare, while advancing innovative thinking to bring about change in the way healthcare is delivered. Gretchen earned her Master of Public Health degree from the Penn State College of Medicine and Master Certified Health Education Specialist certification from the National Commission for Health Education Credentialing.

Contact information:  

Ergonomics and Work-From-Home Risk Management

Posted on May 19th, 2021

Like many business executives, Brian Parker is a fairly engaged user of LinkedIn. An Alera Group vice president and the company’s National Practice Leader for Benefits Technology and Services, he uses the business-oriented social media platform to post and share content of value to clients and colleagues, as well as to potential customers.

One of Brian’s posts appears to have registered more than any other. In mid-April, he shared an article from the Boston Globe titled “After a year of working from home at a card table, I’m paying the price at the physical therapist.”

“As we know with the pandemic, working from home became more than temporary,” Brian said in his post. “Make sure you are set up for success, as well as taking care of your wellness …”

The response was immediate: likes, shares, messages and lots of comments — more than 80 at last count. Of course it didn’t hurt that LinkedIn featured the post among its April 20 editors’ picks, under the headline “Work from home is pinching a nerve.” By the middle of that day, Brian’s post had received more than 17,000 views.

It’s been well over a year since people accustomed to doing most of their work in a company office began working from home due to the spread of COVID-19, and it’s clear that, for many, the experience has been physically painful. Most employers have tried to encourage and support healthy work-from-home (WFH) arrangements, but, for various reasons, many employees still find themselves in positions similar to the ones that led the author of the Globe piece to a physical therapist.

Workstation Injuries, Workers’ Comp Costs

To gauge the effect of working from home the healthcare network management company One Call earlier this year compared claims from Quarter 4 of 2020 with Q4 of 2019, the last quarter before the pandemic. The results show substantial increases in claims received for injuries associated with poorly designed workstations and improper ergonomics:

  • Lower back pain — 24.6%
  • Carpal tunnel syndrome — 17.9%
  • Cervical radiculopathy (nerve root damage in spine) — 16.2%
  • Pain in hand — 13.2%
  • Wrist or forearm sprain/strain/contusion — 10.3%.

One Call cites data from the Occupational Safety and Health Administration (OSHA) and the National Council on Compensation Insurance to demonstrate the cost of such injuries when they result in a Workers’ Compensation claim:

  • Occupational disease/cumulative injury — $35,779
  • Carpal tunnel — $30,510-$64,953
  • Sprain/strain — $31-851.

It’s obvious that, under the wrong conditions, working from home can cause all sorts of pain — financial as well as physical.

Managing Risk, Preventing Injury

The online health information provider Healthline cites three categories of risk factors for people in “sedentary work environments involving computer use,” with those in the first category leading to the greatest number of injuries.

  1. Contact stresses
    • Forearms resting on edge of desk
    • Resting wrists on a wrist rest while typing or using a mouse
    • Chair arms are too high
    • Seat pressing into the back of knees
    • Chair height causes feet to dangle, pressing seat into thighs.
  2. Postures
    • Sitting in a slouched position with a flattened lower back curve, forward head and rounded shoulders
    • Using a keyboard or mouse with hands in a non-neutral posture, which can cause hand or wrist discomfort
    • Using a laptop with prolonged bending of the neck, overstretching muscles in the back of the neck, and overstretching muscles in the front of the neck and chest.
  3. Static positions
  • Sitting without changing positions for extended periods
  • Working at non-traditional workstations, such as a dining table, couch, bed, floor … or card table.

For information on how to minimize these risk factors, we turn back to the folks at One Call, who provide three downloadable PDF’s:

Here’s a related tip: Take a break.

When you’re in the office, you’re getting up from your desk, going to the printer, grabbing a cup of coffee, stopping by to talk with a co-worker. When you’re working from home, especially in a setting not prone to distractions, it’s easy lock in and remain essentially in the same position for long periods of time. You need to take those breaks.

And when you do walk away from your desk, make sure to avoid slips, trips and falls. This requires keeping any area in which you may step free of cables and cords, boxes, briefcases, slick spots and anything else that may turn step into misstep.

Resource for Human Resources

If you’re an employer or human resources professional, your concern for your employees goes well beyond ergonomics. We invite you to join us on Thursday, May 20, for a webinar designed enhance your employee benefits program in ways that not will only enhance your offerings but also help you improve efficiency and strengthen your bottom line. To register for Strengthen Your Benefits with EB Technology, click on the link below:


About the Author                             

Fran Sierotowic
Loss Control Manager, Property & Casualty
AIA Alera Group

Fran Sierotowicz is the Loss Control Manager/Safety Consultant within AIA, Alera Group, where she focuses on helping organizations evaluate the risk and cost of their insurance programs. Her focus in on Workers’ Compensation, with an emphasis on establishing cost-effective compliance and loss-cost reduction programs. Fran works with a variety of stakeholders in various aspects of business – financial, operational, human resources, training – on formal safety programs and culture, ergonomic evaluations and strategies, health and safety training, safety program auditing and fleet management services. In addition to holding a master’s degree in safety management from the West Virginia University, she is certified as a Fire Protection Specialist by the National Fire Protection Association (NFPA) and authorized as an inspector by OSHA.

Contact information:

REMINDER: PCORI Fees Due By July 31, 2021

Posted on May 18th, 2021

This alert is of interest to all employers that sponsor self-insured group health plans, including Health Reimbursement Arrangements (HRAs).  Note that the PCORI fee does not apply to most health FSAs.

Employers that sponsor self-insured group health plans, including health reimbursement arrangements (HRAs) should keep in mind the upcoming July 31, 2021 deadline for paying fees that fund the Patient-Centered Outcomes Research Institute (PCORI).  As background, the PCORI was established as part of the Affordable Care Act (ACA) to conduct research to evaluate the effectiveness of medical treatments, procedures and strategies that treat, manage, diagnose or prevent illness or injury.  Under the ACA, most employer sponsors and insurers are required to pay PCORI fees until 2029, as it only applies to plan years ending on or before September 30, 2029.

The amount of PCORI fees due by employer sponsors and insurers is based upon the number of covered lives under each “applicable self-insured health plan” and “specified health insurance policy” (as defined by regulations) and the plan or policy year end date.  This year, employers will pay the fee for plan years ending in 2020.

The fee is due by July 31, 2021 and varies based on the applicable plan year as follows:

  • For plan years that ended between January 1, 2020 and September 30, 2020, the fee is $2.54 per covered life.
  • For plan years that ended between October 1, 2020 and December 31, 2020, the fee is $2.66 per covered life.

For example, for a plan year that ran from July 1, 2019 through June 30, 2020 the fee is $2.54 per covered life. The fee for calendar year 2020 plans is $2.66 per covered life. The insurance carrier is responsible for paying the PCORI fee on behalf of a fully insured plan.  The employer is responsible for paying the fee on behalf of a self-insured plan, including an HRA.  In general, health FSAs are not subject to the PCORI fee.

Employers that sponsor self-insured group health plans must report and pay PCORI fees using the newly released (Rev. June 2021) IRS Form 720, Quarterly Federal Excise Tax Return.  Employers indicate on Form 720 and Form 720-V (the payment voucher) that the form and payment are for the 2nd quarter of 2021.  If this is an employer’s last PCORI payment and they do not expect to owe excise taxes that are reportable on Form 720 in future quarters (e.g., because the plan is terminating), they may check the “final return” box above Part I of Form 720.

Also note that because the PCORI fee is assessed on the plan sponsor of a self-insured plan, it generally should not be included in the premium equivalent rate that is developed for self-insured plans if the plan includes employee contributions.  However, an employer’s payment of PCORI fees is tax deductible as an ordinary and necessary business expense.

Historical Information for Prior Years

  • For plan years that ended between October 1, 2019 and December 31, 2019, the fee is $2.54 per covered life and was due by July 31, 2020.
  • For plan years that ended between January 1, 2019 and September 30, 2019, the fee is $2.45 per covered life and was due by July 31, 2020.
  • For plan years that ended between October 1, 2018 and December 31, 2018, the fee is $2.45 per covered life and was due by July 31, 2019.
  • For plan years that ended between January 1, 2018 and September 30, 2018, the fee is $2.39 per covered life and was due by July 31, 2019.


Explanation of Counting Methods for Self-Insured Plans

Plan Sponsors may choose from three methods when determining the average number of lives covered by their plans.

Actual Count method.  Plan sponsors may calculate the sum of the lives covered for each day in the plan year and then divide that sum by the number of days in the year.

Snapshot method.  Plan sponsors may calculate the sum of the lives covered on one date in each quarter of the year (or an equal number of dates in each quarter) and then divide that number by the number of days on which a count was made. The number of lives covered on any one day may be determined by counting the actual number of lives covered on that day or by treating those with self-only coverage as one life and those with coverage other than self-only as 2.35 lives (the “Snapshot Factor method”).

Form 5500 method.  Sponsors of plans offering self-only coverage may add the number of employees covered at the beginning of the plan year to the number of employees covered at the end of the plan year, in each case as reported on Form 5500, and divide by 2.  For plans that offer more than self-only coverage, sponsors may simply add the number of employees covered at the beginning of the plan year to the number of employees covered at the end of the plan year, as reported on Form 5500.

Special rules for HRAs. The plan sponsor of an HRA may treat each participant’s HRA as covering a single covered life for counting purposes, and therefore, the plan sponsor is not required to count any spouse, dependent or other beneficiary of the participant. If the plan sponsor maintains another self-insured health plan with the same plan year, participants in the HRA who also participate in the other self-insured health plan only need to be counted once for purposes of determining the fees applicable to the self-insured plans.


About the Author. This alert was prepared for Alera Group by Marathas Barrow Weatherhead Lent LLP, a national law firm with recognized experts on the Affordable Care Act.  Contact Stacy Barrow or Nicole Quinn-Gato at or

The information provided in this alert is not, is not intended to be, and shall not be construed to be, either the provision of legal advice or an offer to provide legal services, nor does it necessarily reflect the opinions of the agency, our lawyers or our clients.  This is not legal advice.  No client-lawyer relationship between you and our lawyers is or may be created by your use of this information.  Rather, the content is intended as a general overview of the subject matter covered.  This agency and Marathas Barrow Weatherhead Lent LLP are not obligated to provide updates on the information presented herein.  Those reading this alert are encouraged to seek direct counsel on legal questions.

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Direct Benefits, Inc. Joins Alera Group in Latest Acquisition

Posted on May 18th, 2021

Online insurance marketplace allows customers to shop, compare and bundle a variety of insurance plans

Alera Group, a top independent, national insurance and wealth management firm, today announced the acquisition of Direct Benefits, Inc., an agency insuring individuals, families, retirees and small businesses with dental, vision, pet, travel, short-term medical and ID theft coverage.

“We take a customized approach to insurance because we know not every insurance plan fits everyone,” said Dave Bortnem, CEO of Direct Benefits. “Alera Group’s unique entrepreneurial culture, combined with our innovative mindset, will allow us to expand on delivering more valuable, robust insurance protection plans and take customer experience to new levels.”

Direct Benefits online marketplace provides one-stop insurance shopping to nearly 17,000 independent agents, brokers, consultants and general agents in all 50 states. The agency is located in Saint Paul, Minnesota, and has been protecting clients for two decades.

“Since its founding in 2001, Direct Benefits, Inc. has been a leader in direct to consumer marketing. The innovative online marketplace compares dental, vision, pet and other insurance quotes from multiple providers, allowing clients to find the specific coverage that fits their needs,” said Alan Levitz, CEO of Alera Group. “We are pleased to welcome Direct Benefits to Alera Group and look forward to helping Dave and the team continue to build and leverage their platform nationwide.”

The Direct Benefits team will continue serving clients in its existing roles. MarshBerry served as the sole financial advisor to Direct Benefits throughout the transaction. Terms of the transaction were not disclosed.


About Alera Group

Alera Group is an independent, national insurance and wealth management firm with more than $500 million in annual revenue, offering comprehensive employee benefits, property and casualty, retirement services and wealth management solutions to clients nationwide. By working collaboratively across specialties and geographies, Alera Group’s team of more than 2,000 professionals in more than 100 offices provides creative, competitive services that help ensure a client’s business and personal success. For more information, visit, or follow us on LinkedIn or Twitter.


Wellbeing Resources: The Joy of Budgeting, Mental Health at Work and More

Posted on May 17th, 2021

When it comes to wellbeing, employers often find themselves challenged by how to approach a shift from a traditional wellness model to a comprehensive and holistic program that supports the whole person. Below you’ll find this week’s curated list of wellbeing resources. Feel free to share these resources, as appropriate, with your team. Have a safe and healthy week!

Career Wellbeing

  • How to Ask for Help at Work – Putting in a bit of extra legwork when asking for help can make a big difference.  When it comes to asking your question, style can be as important as substance. Don’t just ask your question; share all the hard work you’ve done to help yourself before involving other people.

Social & Family Wellbeing

  • The Six Keys to Positive Communication – Improving communication skills can help you achieve your goals and deepen your relationships.  Based on research, here are six concrete behaviors that you can put in place today to improve your communication.

Financial Wellbeing

  • Essentials of Investing: Building for Retirement – In this webinar, Principal will dive into what investing is, how it works, and what strategies can help you meet your future goals.  The webinar will wrap up with a discussion on how you can make money from investing.  Wednesday, May 19th at 12PM ET.
  • Build a Budget That Brings You Joy – Forget the dreaded ‘b’ word.  This approach is about building a budget that loves you back by creating a plan that brings you joy while letting you accumulate wealth.

Physical Wellbeing

  • Timing is Everything for Fast, Lasting Fat Loss – Research has verified what celebrity nutritionist JJ Virgin has been telling clients and readers for decades: to hit your fat loss goals and maintain that success, timing is everything.  Put another way, what you eat is just as important as when you eat. The timing of your meals can either set you up to burn fat or store it away. Learn JJ’s top tips.

Emotional Wellbeing

  • There’s a Name for the Blah You’re Feeling: It’s Called Languishing – The neglected middle child of mental health can dull your motivation and focus — and it may be the dominant emotion of 2021.  What is the antidote to languishing?  Adam Grant, organizational psychologist at Wharton, shares his views.
  • We All Really Need a Vacation.  Here’s How to Make the Most of It.  After the challenges of the last year, taking time away from work and your responsibilities is especially important. Rest and time away increase resilience, which makes people better able to deal with the inevitable setbacks at work. It provides a perspective that can help people see new solutions to problems, and it gives people a chance to pursue other life goals. Being deliberate about how you plan your vacation will maximize its many benefits.

Community Wellbeing

  • How to Help India Amid the COVID Crisis – Donors around the world are giving money for meals, medical expenses, P.P.E. and oxygen tanks, among other essential supplies. Here’s how you can help.

Employer Focused Wellbeing