On Aug. 3, 2018, the Departments of Labor, Health and Human Services (HHS) and the Treasury (Departments) published final regulations amending the definition of short-term, limited-duration insurance for purposes of the Affordable Care Act (ACA). These regulations:
- Provide a maximum coverage period of up to 12 months; and
- Amend the notice to provide additional specificity, including a list of benefits that might not be covered.
In addition, the final regulations allow short-term, limited-duration insurance to continue for up to 36 months in total, taking into account renewals or extensions.
As a result of these final regulations, issuers can now offer short-term, limited-duration insurance policies that last up to 12 months. According to the Departments, this will provide consumers with more affordable options for health coverage.
Short-term, limited-duration insurance is a type of health insurance coverage that is designed to fill temporary gaps in coverage when an individual is transitioning from one plan or coverage to another plan or coverage. Specifically, existing regulations defined short-term, limited-duration insurance as “health insurance coverage provided pursuant to a contract with an issuer that has an expiration date specified in the contract (taking into account any extensions that may be elected by the policyholder without the issuer’s consent) that is less than 12 months after the original effective date of the contract.”
Although short-term, limited-duration insurance is not an excepted benefit, it is specifically exempt from the definition of “individual health insurance coverage” and, therefore, is not subject to the ACA’s market reform requirements. However, the Departments have become aware that short-term, limited-duration insurance is being sold as a primary form of health coverage, in some instances.
2016 Final Regulations
On Oct. 31, 2016, the Departments published final regulations revising the definition of short-term, limited-duration insurance for purposes of the exclusion from the definition of individual health insurance coverage. Under this revised definition, short-term, limited-duration insurance coverage was required to be less than three months in duration, including any period for which the policy may be renewed. The final regulations eliminated the ability for the coverage period to take into account extensions made by the policyholder “with or without the issuer’s consent.”
In addition, a notice must be prominently displayed in the contract and in any application materials provided in connection with enrollment in short-term, limited-duration insurance coverage with the following language:
THIS IS NOT QUALIFYING HEALTH COVERAGE (“MINIMUM ESSENTIAL COVERAGE”) THAT SATISFIES THE HEALTH COVERAGE REQUIREMENT OF THE AFFORDABLE CARE ACT. IF YOU DON’T HAVE MINIMUM ESSENTIAL COVERAGE, YOU MAY OWE AN ADDITIONAL PAYMENT WITH YOUR TAXES.
The revised definition of short-term, limited-duration insurance applied for policy years beginning on or after Jan. 1, 2017. However, HHS stated that it would not take enforcement action against an issuer with respect to the sale of short-term, limited-duration insurance before April 1, 2017, on the ground that the coverage period is three months or more, provided that the coverage:
- Ends on or before Dec. 31, 2017; and
- Otherwise complies with the definition of short-term, limited-duration insurance in effect under the final regulations.
States were also permitted to elect not to take enforcement actions against issuers with respect to this type of coverage sold before April 1, 2017.
2018 Final Regulations
Following the 2016 final regulations, there was concern that shortening the permitted length of short-term, limited-duration insurance would drastically reduce affordable coverage options for consumers. As a result, the Departments issued the 2018 final regulations to lengthen the maximum period of short-term, limited-duration insurance, in an effort to provide more affordable consumer choice for health coverage.
These final regulations were issued as a result of the following recent developments:
- On Oct. 12, 2017, President Donald Trump issued Executive Order 13813, which directed the Departments to consider proposing regulations or revising guidance to expand the availability of short-term, limited-duration insurance by allowing it to cover longer periods and be renewed.
- On Dec. 22, 2017, President Trump signed a tax reform bill, called the Tax Cuts and Jobs Act, into law, which reduces the ACA’s individual mandate penalty to zero, effective beginning in 2019.
In light of these developments, the final regulations amended the definition of short-term, limited-duration insurance so that it may offer a maximum coverage period of less than 12 months after the original effective date of the contract, consistent with the original definition (that is, the final rule expanded the potential maximum coverage period by nine months). Under this definition, the expiration date specified in the contract takes into account any extensions that may be elected by the policyholder without the issuer’s consent, provided that it has a duration of no longer than 36 months in total (taking into account renewals or extensions).
In addition, the final rule revised the required notice that must appear in the contract and any application materials, due to concern that short-term, limited-duration insurance policies lasting almost 12 months may be more difficult to distinguish from ACA-compliant coverage (which is typically offered on a 12-month basis). Accordingly, one of two versions of the following notice must be prominently displayed (in at least 14-point type) in the contract and in any application materials provided in connection with enrollment:
This coverage is not required to comply with certain federal market requirements for health insurance, principally those contained in the Affordable Care Act. Be sure to check your policy carefully to make sure you are aware of any exclusions or limitations regarding coverage of pre-existing conditions or health benefits (such as hospitalization, emergency services, maternity care, preventive care, prescription drugs, and mental health and substance use disorder services).
Your policy might also have lifetime and/or annual dollar limits on health benefits. If this coverage expires or you lose eligibility for this coverage, you might have to wait until an open enrollment period to get other health insurance coverage. Also, this coverage is not “minimum essential coverage.” If you don’t have minimum essential coverage for any month in 2018, you may have to make a payment when you file your tax return unless you qualify for an exemption from the requirement that you have health coverage for that month.
Due to the elimination of the individual mandate penalty beginning in 2019, the final two sentences of the notice are only required to be included with respect to policies that have a coverage start date before Jan. 1, 2019.
The notice should be in sentence case (rather than all capital letters), and may contain any additional information, as required by applicable state law.
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To prepare for open enrollment, group health plan sponsors should be aware of the legal changes affecting the design and administration of their plans for plan years beginning on or after Jan. 1, 2019. Employers should review their plan documents to confirm that they include these required changes.
In addition, any changes to a health plan’s benefits for the 2019 plan year should be communicated to plan participants through an updated summary plan description (SPD) or a summary of material modifications (SMM).
Health plan sponsors should also confirm that their open enrollment materials contain certain required participant notices, when applicable—for example, the summary of benefits and coverage (SBC). There are also some participant notices that must be provided annually or upon initial enrollment. To minimize costs and streamline administration, employers should consider including these notices in their open enrollment materials.
Grandfathered Plan Status
A grandfathered plan is one that was in existence when the Affordable Care Act (ACA) was enacted on March 23, 2010. If you make certain changes to your plan that go beyond permitted guidelines, your plan is no longer grandfathered.
- If you have a grandfathered plan, determine whether it will maintain its grandfathered status for the 2019 plan year. Grandfathered plans are exempt from some of the ACA’s requirements. A grandfathered plan’s status will affect its compliance obligations from year to year. If your plan will maintain its grandfathered status, make sure you provide the notice of grandfathered status in your open enrollment materials. See the “ACA Disclosure Requirements” section below for more information on this notice.
- If your plan will lose its grandfathered status for 2019, confirm that the plan has all of the additional patient rights and benefits required by the ACA. This includes, for example, coverage of preventive care without cost-sharing requirements.
ACA Affordability Standard
Under the ACA’s employer shared responsibility rules, applicable large employers (ALEs) are required to offer affordable, minimum value health coverage to their full-time employees (and dependent children) or risk paying a penalty. These employer shared responsibility requirements are also known as the “employer mandate” or “pay or play” rules.
Under the ACA, an ALE’s health coverage is considered affordable if the employee’s required contribution to the plan does not exceed 9.5 percent of the employee’s household income for the taxable year (as adjusted each year). The adjusted percentage is 9.56 percent for 2018.
For plan years that begin on or after Jan. 1, 2019, the affordability percentage is 9.86 percent. This means that employer-sponsored coverage for the 2019 plan year will be considered affordable under the employer shared responsibility rules if the employee’s required contribution for self-only coverage does not exceed 9.86 percent of the employee’s household income for the tax year.
- If you are an ALE, confirm that at least one of the health plans offered to full-time employees (and their dependent children) satisfies the ACA’s affordability standard (9.86 percent for 2019 plan years). Because the affordability percentage significantly increases from 2018, employers may have additional flexibility to increase the employee share of the premium while still avoiding a penalty under the pay or play rules.
Out-of-pocket Maximum
Effective for plan years beginning on or after Jan. 1, 2014, non-grandfathered health plans are subject to limits on cost sharing for essential health benefits (EHB). The ACA’s out-of-pocket maximum applies to all non-grandfathered group health plans, including self-insured health plans and insured plans.
The annual limit on total enrollee cost sharing for EHB for plan years beginning on or after Jan. 1, 2019, is $7,900 for self-only coverage and $15,800 for family coverage.
- Review your plan’s out-of-pocket maximum to make sure it complies with the ACA’s limits for the 2019 plan year ($7,900 for self-only coverage and $15,800 for family coverage).
- If you have a high deductible health plan (HDHP) that is compatible with a health savings account (HSA), keep in mind that your plan’s out-of-pocket maximum must be lower than the ACA’s limit. For 2019 plan years, the out-of-pocket maximum limit for HDHPs is $6,750 for self-only coverage and $13,500 for family coverage.
- If your plan uses multiple service providers to administer benefits, confirm that the plan coordinates all claims for EHB across the plan’s service providers or divides the out-of-pocket maximum across the categories of benefits, with a combined limit that does not exceed the maximum for 2019.
Preventive Care Benefits
The ACA requires non-grandfathered health plans to cover certain preventive health services without imposing cost-sharing requirements (that is, deductibles, copayments or coinsurance) for the services. Health plans are required to adjust their first-dollar coverage of preventive care services based on the latest preventive care recommendations. If you have a non-grandfathered plan, you should confirm that your plan covers the latest recommended preventive care services without imposing any cost sharing.
More information on the recommended preventive care services is available through the U.S. Preventive Services Task Force and www.HealthCare.gov.
Health FSA Contributions
The ACA imposes a dollar limit on employees’ salary reduction contributions to a health flexible spending account (FSA) offered under a cafeteria plan. An employer may impose its own dollar limit on employees’ salary reduction contributions to a health FSA, as long as the employer’s limit does not exceed the ACA’s maximum limit in effect for the plan year.
The ACA’s limit on employees’ pre-tax health FSA contributions first became effective for plan years beginning on or after Jan. 1, 2013. The ACA set the health FSA contribution limit at $2,500. For years after 2013, the dollar limit is indexed for cost-of-living adjustments. For 2018 plan years, the health FSA limit is $2,650. The IRS has not yet announced the health FSA limit for 2019 plan years.
- Monitor IRS guidance for the health FSA limit for 2019 plan years.
- Once the 2019 health FSA limit is announced, confirm that your health FSA will not allow employees to make pre-tax contributions in excess of that limit.
- Communicate the health FSA limit to employees as part of the open enrollment process.
HDHP and HSA Limits for 2019
If you offer an HDHP to your employees that is compatible with an HSA, you should confirm that the HDHP’s minimum deductible and out-of-pocket maximum comply with the 2019 limits. The IRS limits for HSA contributions and HDHP cost-sharing increase for 2019. The HSA contribution limits will increase effective Jan. 1, 2019, while the HDHP limits will increase effective for plan years beginning on or after Jan. 1, 2019.
- Check whether your HDHP’s cost-sharing limits need to be adjusted for the 2019 limits.
- If you communicate the HSA contribution limits to employees as part of the enrollment process, these enrollment materials should be updated to reflect the increased limits that apply for 2019.
The following table contains the HDHP and HSA limits for 2019 as compared to 2018. It also includes the catch-up contribution limit that applies to HSA-eligible individuals who are age 55 or older, which is not adjusted for inflation and stays the same from year to year.
|
Type of Limit |
2018
|
2019
|
Change
|
| HSA Contribution Limit
|
Self-only
|
$3,450
|
$3,500
|
Up $50
|
| Family
|
$6,900
|
$7,000
|
Up $100
|
| HSA Catch-up Contributions (not subject to adjustment for inflation)
|
Age 55 or older
|
$1,000
|
$1,000
|
No change
|
| HDHP Minimum Deductible
|
Self-only
|
$1,350
|
$1,350
|
No change
|
| Family
|
$2,700
|
$2,700
|
No change
|
| HDHP Maximum Out-of-pocket Expense Limit (deductibles, copayments and other amounts, but not premiums)
|
Self-only
|
$6,650
|
$6,750
|
Up $100 |
| Family
|
$13,300
|
$13,500
|
Up $200
|
Summary of Benefits and Coverage
The ACA requires health plans and health insurance issuers to provide an SBC to applicants and enrollees to help them understand their coverage and make coverage decisions. Plans and issuers must provide the SBC to participants and beneficiaries who enroll or re-enroll during an open enrollment period. The SBC also must be provided to participants and beneficiaries who enroll other than through an open enrollment period (including those who are newly eligible for coverage and special enrollees).
The SBC template and related materials are available from the Department of Labor (DOL).
- In connection with a plan’s 2019 open enrollment period, the SBC should be included with the plan’s application materials. If coverage automatically renews for current participants, the SBC must generally be provided no later than 30 days before the beginning of the new plan year.
- For self-funded plans, the plan administrator is responsible for providing the SBC. For insured plans, both the plan and the issuer are obligated to provide the SBC, although this obligation is satisfied for both parties if either one provides the SBC. Thus, if you have an insured plan, you should confirm that your health insurance issuer will assume responsibility for providing the SBCs. Please contact your representative at Scurich Insurance for assistance.
Grandfathered Plan Notice
If you have a grandfathered plan, make sure to include information about the plan’s grandfathered status in plan materials describing the coverage under the plan, such as SPDs and open enrollment materials. Model language is available from the DOL.
Notice of Patient Protections
Under the ACA, non-grandfathered group health plans and issuers that require designation of a participating primary care provider must permit each participant, beneficiary and enrollee to designate any available participating primary care provider (including a pediatrician for children). Also, plans and issuers that provide obstetrical/gynecological care and require a designation of a participating primary care provider may not require preauthorization or referral for obstetrical/gynecological care.
If a non-grandfathered plan requires participants to designate a participating primary care provider, the plan or issuer must provide a notice of these patient protections whenever the SPD or similar description of benefits is provided to a participant. If your plan is subject to this notice requirement, you should confirm that it is included in the plan’s open enrollment materials. Model language is available from the DOL.
Group health plan sponsors should consider including the following enrollment and annual notices with the plan’s open enrollment materials.
Initial COBRA Notice
The Consolidated Omnibus Budget Reconciliation Act (COBRA) applies to employers with 20 or more employees that sponsor group health plans. Group health plan administrators must provide an initial COBRA notice to new participants and certain dependents within 90 days after plan coverage begins. The initial COBRA notice may be incorporated into the plan’s SPD. A model initial COBRA notice is available from the DOL.
Notice of HIPAA Special Enrollment Rights
At or prior to the time of enrollment, a group health plan must provide each eligible employee with a notice of his or her special enrollment rights under the Health Insurance Portability and Accountability Act (HIPAA). This notice may be included in the plan’s SPD.
Summary Plan Description
Plan administrators must provide an SPD to new participants within 90 days after plan coverage begins. Any changes that are made to the plan should be reflected in an updated SPD booklet or described to participants through an SMM. Also, an updated SPD must be furnished every five years if changes are made to SPD information or if the plan is amended. Otherwise, a new SPD must be provided every 10 years.
HIPAA Privacy Notice
The HIPAA Privacy Rule requires covered entities (including group health plans and issuers) to provide a Notice of Privacy Practices (or Privacy Notice) to each individual who is the subject of protected health information (PHI). Health plans are required to send the Privacy Notice at certain times, including to new enrollees at the time of enrollment. Also, at least once every three years, health plans must either redistribute the Privacy Notice or notify participants that the Privacy Notice is available and explain how to obtain a copy.
Self-insured health plans are required to maintain and provide their own Privacy Notices. Special rules, however, apply for fully insured plans. Under these rules, the health insurance issuer, and not the health plan itself, is primarily responsible for the Privacy Notice.
| Self-insured plans |
Must maintain and provide their own Privacy Notices |
Fully insured plans |
Health insurance issuers have primary responsibility for Privacy Notices |
Special Rules for Fully Insured Plans: The plan sponsor of a fully insured health plan has limited responsibilities with respect to the Privacy Notice.
- If the sponsor of a fully insured plan has access to PHI for plan administrative functions, it is required to maintain a Privacy Notice and to provide the notice upon request.
- If the sponsor of a fully insured plan does not have access to PHI for plan administrative functions, it is not required to maintain or provide a Privacy Notice.
A plan sponsor’s access to enrollment information, summary health information and PHI that is released pursuant to a HIPAA authorization does not qualify as having access to PHI for plan administration purposes.
Model Privacy Notices are available through the Department of Health and Human Services.
Annual CHIPRA Notice
Group health plans covering residents in a state that provides a premium subsidy to low-income children and their families to help pay for employer-sponsored coverage must send an annual notice about the available assistance to all employees residing in that state. The DOL has provided a model notice.
WHCRA Notice
Plans and issuers must provide notice of participants’ rights to mastectomy-related benefits under the Women’s Health and Cancer Rights Act (WHCRA) at the time of enrollment and on an annual basis. Model language for this disclosure is available on the DOL’s website.
Medicare Part D Notices
Group health plan sponsors must provide a notice of creditable or non-creditable prescription drug coverage to Medicare Part D eligible individuals who are covered by, or who apply for, prescription drug coverage under the health plan. This creditable coverage notice alerts the individuals as to whether or not their prescription drug coverage is at least as good as the Medicare Part D coverage. The notice generally must be provided at various times, including when an individual enrolls in the plan and each year before Oct. 15 (when the Medicare annual open enrollment period begins). Model notices are available on the Centers for Medicare and Medicaid Services’ website.
Summary Annual Report
Plan administrators that are required to file a Form 5500 must provide participants with a narrative summary of the information in the Form 5500, called a summary annual report (SAR). Group health plans that are unfunded (that is, benefits are payable from the employer’s general assets and not through an insurance policy or trust) are not subject to the SAR requirement. The plan administrator generally must provide the SAR within nine months of the close of the plan year. If an extension of time to file the Form 5500 is obtained, the plan administrator must furnish the SAR within two months after the close of the extension period.
Michelle’s Law Notice
Group health plans that condition dependent eligibility on a child’s full-time student status must provide a notice of the requirements of Michelle’s Law in any materials describing a requirement for certifying student status for plan coverage. Under Michelle’s Law, a plan cannot terminate a child’s coverage for loss of full-time student status if the change in status is due to a medically necessary leave of absence. Due to the ACA’s age 26 mandate for dependent coverage, most health plans no longer condition dependent eligibility on full-time student status and, thus, are not subject to Michelle’s Law.
HIPAA Opt-out for Self-funded, Nonfederal Governmental Plans
Sponsors of self-funded, nonfederal governmental plans may opt out of certain federal mandates, such as the mental health parity requirements and the WHCRA coverage requirements. Under an opt-out election, the plan must provide a notice to enrollees regarding the election. The notice must be provided annually and at the time of enrollment. Model language for this notice is available for sponsors to use.
Wellness Program Notices
Group health plans that include wellness programs may be required to provide certain notices regarding the program’s design. As a general rule, these notices should be provided when the wellness program is communicated to employees and before employees provide any health-related information or undergo medical examinations.
- HIPAA Wellness Program Notice—HIPAA imposes a notice requirement on health-contingent wellness programs that are offered under group health plans. Health-contingent wellness plans require individuals to satisfy standards related to health factors (for example, not smoking) in order to obtain rewards. The notice must disclose the availability of a reasonable alternative standard to qualify for the reward (and, if applicable, the possibility of waiver of the otherwise applicable standard) in all plan materials describing the terms of a health-contingent wellness program. Final regulations provide sample language that can be used to satisfy this requirement.
- ADA Wellness Program Notice—Employers with 15 or more employees are subject to the Americans with Disabilities Act (ADA). Wellness programs that include health-related questions or medical examinations must comply with the ADA’s requirements, including an employee notice requirement. Employers must give participating employees a notice that tells them what information will be collected as part of the wellness program, with whom it will be shared and for what purpose, the limits on disclosure and the way information will be kept confidential. The Equal Employment Opportunity Commission (EEOC) has provided a sample notice to help employers comply with this ADA requirement.
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Everyone feels stressed from time to time. But what is stress? How does it affect your health? And what can you do about it?
Stress is how the brain and body respond to any demand. Every type of demand or stressor – such as exercise, work, school, major life changes, or traumatic events – can be stressful.
Stress can affect your health. It is important to pay attention to how you deal with minor and major stress events so that you know when to seek help.
Here are five things you should know about stress:
1 Stress affects everyone.
Everyone feels stressed from time to time. Some people may cope with stress more effectively or recover from stressful events more quickly than others. There are different types of stress – all of which carry physical and mental health risks. A stressor may be a one time or short term occurrence, or it can be an occurrence that keeps happening over a long period of time.
Examples of stress include:
- Routine stress related to the pressures of work, school, family, and other daily responsibilities
- Stress brought about by a sudden negative change, such as losing a job, divorce, or illness
- Traumatic stress experienced in an event like a major accident, war, assault, or a natural disaster where people may be in danger of being seriously hurt or killed. People who experience traumatic stress often experience temporary symptoms of mental illness, but most recover naturally soon after.
2 Not all stress is bad.
Stress can motivate people to prepare or perform, like when they need to take a test or interview for a new job. Stress can even be life-saving in some situations. In response to danger, your body prepares to face a threat or flee to safety. In these situations, your pulse quickens, you breathe faster, your muscles tense, your brain uses more oxygen and increases activity – all functions aimed at survival.
3 Long-term stress can harm your health.
Health problems can occur if the stress response goes on for too long or becomes chronic, such as when the source of stress is constant, or if the response continues after the danger has subsided. With chronic stress, those same life-saving responses in your body can suppress immune, digestive, sleep, and reproductive systems, which may cause them to stop working normally.
Different people may feel stress in different ways. For example, some people experience mainly digestive symptoms, while others may have headaches, sleeplessness, sadness, anger or irritability. People under chronic stress are prone to more frequent and severe viral infections, such as the flu or common cold. Routine stress may be the hardest type of stress to notice at first.
Because the source of stress tends to be more constant than in cases of acute or traumatic stress, the body gets no clear signal to return to normal functioning. Over time, continued strain on
your body from routine stress may contribute to serious health problems, such as heart disease, high blood pressure, diabetes, and other illnesses, as well as mental disorders like depression or anxiety.
4 There are ways to manage stress.
The effects of stress tend to build up over time.Taking practical steps to manage your stress can reduce or prevent these effects.The following are some tips that may help you to cope with stress:
- Recognize the Signs of your body’s response tostress, such as difficulty sleeping, increased alcoholand other substance use, being easily angered,feeling depressed, and having low energy.
- Talk to Your Doctor or Health Care Provider.Get proper health care for existing or newhealth problems.
- Get Regular Exercise. Just 30 minutes perday of walking can help boost your moodand reduce stress.
- Try a Relaxing Activity. Explore stress copingprograms, which may incorporate meditation,yoga, tai chi, or other gentle exercises. For somestress-related conditions, these approaches areused in addition to other forms of treatment.Schedule regular times for these and other healthyand relaxing activities. Learn more about thesetechniques on the National Center forComplementary and Integrative Health (NCCIH)website at (www.nccih.nih.gov/health/stress).
- Set Goals and Priorities. Decide what must getdone and what can wait, and learn to say no tonew tasks if they are putting you into overload.Note what you have accomplished at the end ofthe day, not what you have been unable to do.
- Stay Connected with people who can provideemotional and other support.To reduce stress, askfor help from friends, family, and community orreligious organizations.
-
Consider a Clinical Trial. Researchers at theNational Institute of Mental Health (NIMH), NCCIH,and other research facilities across the country arestudying the causes and effects of psychologicalstress, and stress management techniques.Youcan learn more about studies that are recruitingby visiting www.nimh.nih.gov/joinastudy orwww.clinicaltrials.gov (keyword: stress).
5 If you’re overwhelmed by stress, ask for help from a health professional.
You should seek help right away if you have suicidal thoughts, are overwhelmed, feel you cannot cope, or are using drugs or alcohol to cope.Your doctor may be able to provide a recommendation.You can find resources to help you find a mental health provider by visiting www.nimh.nih.gov/findhelp.
Call the National Suicide Prevention Lifeline
Anyone experiencing severe or long-term, unrelenting stress can become overwhelmed. If you or a loved one is having thoughts of suicide, call the toll-free National Suicide Prevention Lifeline (http:// suicidepreventionlifeline.org/) at 1-800-273-TALK (8255), available 24 hours a day, 7 days a week. The service is available to anyone.All calls are confidential.
For More Information
For more information on conditions that affect mental health, resources, and research, visit www.mentalhealth.gov, or the NIMH website at www.nimh.nih.gov. In addition, the National Library of Medicine’s MedlinePlus service has information on a wide variety of health topics, including conditions that affect mental health.
National Institute of Mental Health
Office of Science Policy, Planning and Communications
Science Writing, Press, and Dissemination Branch
6001 Executive Boulevard
Room 6200, MSC 9663
Bethesda, MD 20892-9663
Phone: 301–443–4513 or
Toll-free: 1–866–615–NIMH (6464)
TTY: 301–443–8431 or TTY Toll-free: 1–866–415–8051
Fax: 301–443–4279
E-mail: [email protected]
Website: www.nimh.nih.gov
NIH Publication No. OM 16-4310
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According to OSHA, a Maine-based roofing contractor has ignored numerous safety standards and exposed workers to significant fall risks for a number of years. OSHA cited the contractor – which has operated under the names Lessard Roofing & Siding and Lessard Brothers Construction – for safety violations at 11 different worksites between 2000 and 2011. However, the contractor failed to address the citations or pay any of the issued fines.
In 2011- after Lessard initially failed to address the OSHA citations – the 1st Circuit Court of Appeals ordered the contractor to correct the worksite violations, implement appropriate safety measures and pay accumulated fines with interest. Now, the court has held Lessard’s owner in civil contempt for defying the original 2011 order.
As a part of the recent court ruling, Lessard must do the following:
- Provide financial documentation to demonstrate the contractor’s ability to pay the $389,685 in outstanding OSHA fines.
- Ensure that employees and contractors use required safety equipment and fall protection.
- Conduct worksite safety analyses and meetings.
- Employ a competent person to ensure work proceeds according to OSHA regulations.
- Give OSHA details about each of the contractor’s worksites so the agency can conduct safety inspections.
Falls from ladders and roofs still account for the majority of injuries at work. In fact, fall protection violations are one of OSHA’s most frequent citations every year, with 6,072 issued in 2017 alone. Identifying fall hazards and deciding how to protect workers is the first step in eliminating or reducing fall hazards. Contact us at 831-661-5697 for OSHA programs, presentations and training materials you can use to protect your employees and avoid costly fines.
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Why is job safety and health important?
In 2013, 4,585 employees died from occupational incidents, and there were a staggering 3.0 million total recordable cases of workplace injury and illness. On average, each of these 3.0 million cases required eight days away from work, which means U.S. employers as a whole paid for millions of days of lost work time. Experts estimate that workplace injuries and illnesses cost U.S. businesses more than $125 billion annually. Effective job safety and health programs not only help reduce worker injuries and illnesses, they save employers money in the long run.
How does OSHA contribute to job safety and health?
The primary goal of the Occupational Safety and Health Administration (OSHA) is to carry out the Occupational Safety and Health Act (OSH Act), which Congress originally passed in 1970. The OSH Act has undergone several amendments and revisions since its inception, but it is still in place “to assure so far as possible every working man and woman in the Nation safe and healthful working conditions and to preserve our human resources.” OSHA contributes to job safety and health by enacting regulations that forward this ideal.
Title 29 of the Code of Federal Regulations (CFR), Parts 1902-1990, houses all the OSHA standards, though OSHA also allows states to enact occupational safety and health laws of their own under federally-approved plans. State-run programs are at least as strict, and sometimes more so, than federal standards. This ensures a minimum standard of job safety and health that all employers must follow to protect employees.
Are all employees covered by the OSH Act?
The OSH Act covers all employees except public employees in state and local governments and those who are self-employed. Public employees in state and local governments are covered by their state’s OSHA-approved plan, if applicable.Federal employees are covered under the OSH Act’s federal employee occupational safety and health programs, which are outlined in 29 CFR Part 1960.
United States Postal Service employees, however, are subject to the same OSH Act coverage provisions as those in the private sector.Other federal agencies that have issued requirements affecting job safety or health include the Mine Safety and Health Administration (MSHA) and some agencies of the Department of Transportation (DOT), including the Federal Motor Carrier Safety Administration (FMCSA).
Employees in these industries are subject to their respective regulations.Additionally, businesses in the retail, service, finance, insurance and real estate sectors that are classified as low-hazard are exempt from most OSHA requirements, as are small businesses with 10 or fewer employees. Exceptions are discussed in 29 CFR Part 1904, which also explains which OSHA regulations exempt employers are still required to follow.
What are your responsibilities as an employer?
If you are an employer covered by the OSH Act, you must provide your employees with jobs and a place of employment free from recognized hazards that are causing, or are likely to cause, death or serious physical harm. You must also comply with the OSHA statutory requirements, standards and regulations that require you to:
- Provide well-maintained tools and equipment, including appropriate personal protective equipment (PPE)
- Provide medical assistance and guidance for employees sustaining workplace injuries/illnesses
- Provide required OSHA training
- Report accidents that result in fatalities to OSHA within eight hours
- Report accidents that result in the hospitalization of three or more employees to OSHA within eight hours
- Keep records of work-related accidents, injuries, illnesses and their causes
- Post annual injury/illness summaries for the required period of time
What are your rights as an employer?
When working with OSHA, you may do the following:
- Request identification from OSHA compliance officers
- Request an inspection warrant
- Receive a reason for inspection from compliance officers
- Have an opening and closing conference with compliance officers
- Accompany compliance officers on inspections
- Request an informal conference after an inspection
- File a notice of contest to citations or proposed penalties
- Apply for a variance from a standard’s requirements under certain circumstances
- Be assured of the confidentiality of trade secrets
- Submit a written request to the National Institute for Occupational Safety and Health (NIOSH) for information on potentially toxic substances in your workplace
What are employees’ responsibilities?
All employees are obligated to help prevent exposure to workplace safety and health hazards by becoming familiar with and adhering to all applicable OSHA requirements.
What are employees’ rights?
With regards to OSHA regulations, employees have the right, among other actions, to:
- Review employer-provided OSHA standards, regulations and requirements
- Request information from the employer on emergency procedures
- Receive adequate, OSHA-required safety and health training on toxic substances and emergency action plan(s)
- Ask the OSHA area director to investigate hazardous conditions or violations of standards in the workplace
- Have his or her name withheld from the employer when filing a complaint with OSHA
- Know what actions OSHA took as a result of the employee’s complaint and have an informal review of any decision not to inspect or issue a citation
- Have an employee representative accompany the OSHA compliance officer on inspections
- Observe monitoring and measuring of toxic substances or harmful physical agents and review related records (including medical records)
- Review the Log of Work-Related Injuries and Illnesses (OSHA 300 Form), if applicable, at a reasonable time
- Request a closing discussion following an inspection
- Object a citation’s set abatement period
- Seek safe and healthful working conditions without your employer retaliation
Why is OSHA important to your business?
OSHA plays a key role in making your facility a safe, healthy place to work. Beyond providing the tools and guidance to work toward an injury- and illness-free workplace, OSHA is important in identifying businesses that are not committed to safety. Employers that do not carefully follow OSHA regulations often face hundreds of thousands, if not millions, of dollars in fines.
How can you get more information on safety and health?
OSHA provides free publications, standards, technical assistance and compliance tools to help you understand the nuances of the regulations. OSHA’s website also offers extensive assistance by way of workplace consultation, voluntary protection programs, grants, strategic partnerships, state plans, training and education to guide you in your quest for workplace safety. To learn more about OSHA and the critical elements of a successful safety and health management system in your workplace, visit www.osha.gov.
This document is an introductory guideline. It does not address all potential compliance issues with OSHA standards. It is not meant to be exhaustive or construed as legal advice. Contact your licensed commercial property and casualty representative at Scurich Insurance or legal counsel to address applicable compliance requirements. © 2009-2012, 2015 Zywave, Inc. All rights reserved.
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You’ve probably heard a lot about opioids lately, and for good reason—the CDC estimates that more than 115 people die from opioid overdoses every day.
One of the biggest reasons for widespread misuse of these drugs is that they’re both effective at short-term pain management and highly addictive.
Luckily, to combat what some now call the “opioid epidemic,” researchers from the American College of Physicians (ACP) have published guidelines that promote alternative noninvasive and therapy-based pain treatments.
Although these guidelines recommend the use of opioids and other medications as a last resort, therapeutic treatments may help strengthen your body and help you heal naturally. However, you should always consult your physician for the best way to treat your pain.
Here are some common pain treatments based on the ACP’s guidelines:
- Use heat or ice packs to reduce pain and swelling. Regulating how much blood flows into affected areas can be a simple and effective way to reduce pain.
- Avoid overexertion. Rest will allow any injured tissue and nerve roots to begin to heal. However, too much rest can cause your muscles to weaken.
- Exercise when possible. Although exercising to relieve pain may sound strange, even low-intensity activity like stretching or walking can help strengthen your muscles and relieve pain. Consult with a health care or fitness professional to customize a safe and effective exercise routine for any severe or chronic pain.
- Engage in relaxing activities such as yoga and meditation. Research has shown that the mental aspect of physical pain can cause it to be much more intense than it would be otherwise.
- Explore your options. Talk with your doctor about alternative pain relievers and anti-inflammatory medications. You could also discuss when to use or how to wean off strong narcotics. Opioids should only be considered as a last resort.
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