Employers plan to target health care costs, mental health in 2024

Sixty-two percent of U.S. employers are implementing initiatives to address health care costs and enhance mental health programs as they set their health and well-being strategy for 2024, according to recent research from WTW. The 2023 Best Practices in Healthcare Survey found that 69 percent of employers are focused on managing health care plan costs. This follows a projected cost increase next year of 6.4 percent, compared with the average 6.0 percent increase employers are experiencing this year. Almost as many employers (63 percent) are focused on enhancing mental health and emotional wellbeing programs. Other priorities include employee experience (40 percent); communication (38 percent); diversity, equity and inclusion (37 percent); and employee affordability (34 percent).

“As companies face steep health care cost increases, they are not losing sight of the importance of addressing employees’ needs,” said Courtney Stubblefield, managing director, Health & Benefits at WTW. “However, it’s not a simple challenge for employers to navigate. Each employer needs to find the unique portfolio of programs and solutions that will best control its costs while meeting the healthcare and specific needs of its organization.”

According to the survey, employers are increasingly taking action to manage costs and enhance affordability through health plan and vendor efficiencies. While 37 percent of employers are currently implementing programs or using vendors that will reduce costs, 50 percent are planning or considering doing so in the next two years. And while less than one-third (32 percent) put vendor/health plans out to bid, 47 percent are planning or considering doing so.

For controlling costs at the point of care, 24 percent of companies are planning or considering offering a narrow network of higher-quality and/or lower-cost providers in the next two years, while 19 percent are planning or considering using centers of excellence within health plans. Other actions include carving out specialty pharmacy services (16 percent) and offering plan options that restrict or eliminate out-of-network coverage for non-emergency services (13 percent).

Employers are focused on prescription drug costs. While just 16 percent of employers require employees to switch to biosimilars when available by 2025, 27 percent are planning or considering doing this in the next two years. Additionally, more employers are planning or considering evaluating and addressing specialty drug costs and utilization that are paid through the medical benefit (26 percent) and having plan coverage exclusions or higher cost sharing for high-cost/low-value medications (14 percent). Regarding anti-obesity medications, 38 percent of employers cover them today, while 6 percent plan to cover them in 2024 and more than double that (16 percent) are considering doing so in 2025.

WTW found that employers are also embracing navigation and virtual care strategies for managing costs that can improve the quality and access to care for employees and their families. While nearly half (43 percent) of employers currently offer plan advocacy or navigation solutions, 23 percent are planning to do so in the next few years. Additionally, more employers are planning or considering offering virtual primary care through a third party or carrier (18 percent).

In addition to virtual care visits, employers are taking other measures to address mental health issues. Nearly half of employers (48 percent) have engaged or plan to engage with their employee resource groups to address population-specific mental health issues. Other actions include evaluating mental health networks from a diversity lens to ensure diverse representation and providing mental health days offs. Some are still evaluating cost sharing for mental health care. According to the survey, more than half of employers (53 percent ) have conducted or plan to conduct a mental health parity audit. Not only do these audits ensure employers are following laws and recent regulations, but they also provide important mental health plan design and program recommendations.

“Aligning business priorities, from workforce transformation to health care costs to employee wellbeing, requires a constant evolution of benefit programs, culture and employee experience,” said Regina Ihrke, senior director, Health & Benefits at WTW. “By doing so, companies can alleviate strains on attracting and retaining talent, enhance worker health and productivity, and gain competitive advantage.”

SOURCE: www.wtwco.com

The Maryland Department of Labor announced today the initial contribution rate for the new Family and Medical Leave Insurance State Plan. The rate will be 0.90% of covered wages, and will be equally divided between employees and employers with 15 or more workers.

The contribution rate is the rate applicable to employers and self-employed individuals choosing coverage under the State Plan. Employers will need to make a plan selection for Family and Medical Leave Insurance coverage. Employers may choose coverage under the State Plan, under an approved commercially insured plan sold by insurers in the state, or under an approved self-insured plan.

Employers participating in the State Plan will begin making contributions on wages paid to employees starting October 1, 2024. The total rate of 0.9% of covered wages up to the Social Security wage base (currently $160,200) will be evenly split between employees and employers, who will each contribute 0.45%. Small businesses with 14 or fewer employees are exempt from the employer’s portion of the contributions. Employees of those small businesses will continue to contribute their 0.45% share.

Starting in 2026, Maryland workers will receive job protection and up to $1000 a week for up to 12 weeks to take time away from work to care for themselves or a loved one, to bond with a child, and for certain military-related events. The 0.90% contribution rate will continue through at least June 30, 2026.

When benefits start in January 2026, either the employer’s private plan or the State Plan will provide partial wage replacement to the worker while they are on leave. (Maryland Department of Labor Announcement, September 29, 2023.)

Number of Organizations Offering Juneteenth as a Paid Holiday Doubles

ASE has released its annual Holiday Schedule & Practices Survey, which assesses an organization’s policies and practices related to holiday leave and pay practices associated with time worked during recognized holidays. Highlights of the ASE 2024 Holiday Schedule & Practices Survey include:

  • Most organizations (25 percent) surveyed report offering 10 paid holidays each year; 14 percent report offering 11 paid holidays each year. The most common paid holidays include New Year’s Day (100 percent), Memorial Day (99 percent), Independence Day (100 percent), Labor Day (100 percent), Thanksgiving Day (100 percent), and Christmas Day (100 percent). Twenty one percent of employers report Juneteenth as a paid holiday, compared to just 12 percent last year.

  • Regarding holiday pay for employees that are part-time, data has shifted slightly since last year. 22 percent of employers report that part-time employees are given the day off with pro-rated pay (up four percentage points from last year) and 41 percent of employers report that part-time employees are not given holiday pay (up five percentage points from last year).

  • Up two percentage points from last year, 70 percent of employers plan on having an in-person holiday party at the end of the year.

“The year-over-year data changes showed minimal differences, yet we did observe a significant uptick in the number of companies offering Juneteenth as a paid holiday, which is now a federal holiday,” said ASE President and CEO, Mary E. Corrado.

It's 2023: Do you know where your workers are? Key considerations for managing a remote workforce 

Even with an increasing number of employers calling their workers back into the office following the pandemic, many employees across the United States are still working from home or otherwise working remotely. While many employers tout the flexibility of work-from-home as a benefit for employees, managing a remote workforce can raise a number of multistate compliance challenges. In particular, remote and hybrid work has significant implications for employers' state and local tax withholding and unemployment insurance contribution obligations. Planning ahead with appropriate policies and procedures can help employers ensure compliance with federal, state, and local laws.

Quick Hits

  • Employers may have state or local income tax obligations, and unemployment insurance contribution obligations for remote employees in the states and municipalities where remote employees perform their work, even if an employer has no other connection to that jurisdiction.

  • Implementing a clear remote and hybrid work policy is key to ensuring compliance with state and local laws, fostering uniformity in the treatment of workers and performance standards, and providing a groundwork for individualized remote work plans.

State and Local Income Tax Withholding

The general rule is that an employer has an income tax withholding obligation for the jurisdiction where services are performed by each of its employees. This may require employers to be up to speed on state and local withholding requirements in each jurisdiction in which they have one or more employees working, whether the workers are in the office or working remotely. For example, if an employer is based in South Carolina, but has an employee working from home in Georgia, the employer is likely to have an income tax withholding obligation in Georgia even if the only connection to that state is the employee working there.

Some states have bilateral reciprocal agreements with other states where each state effectively agrees to tax only their own residents even if a nonresident from a state with which they have an agreement were to perform services within its borders. Some states have also implemented the "convenience of the employer" rule that enables the state to tax nonresidents who work for in-state employers when the employee is working outside of the state (not at the in-state employer's place of business) for their own convenience rather than due to a business necessity.

An employer may have tax withholding obligations even if employees fail to inform the employer that they have relocated and are performing services from a different jurisdiction. An employer's lack of knowledge of an employee's move likely will not excuse the employer's tax withholding obligations because employers are expected to know the location from which their employees are working. If an employee has been working remotely from another state without the employer's knowledge (or permission), the employer may be obligated to retroactively correct the tax reporting for that employee.

To keep tabs on employees, employers may look at so-called digital breadcrumbs (e.g., IP login information) to determine if the employee is working from where they say that they are. Regardless of whether an employee asks the employer for permission to work at a new location before doing so or forgiveness only after being caught, states may hold employers accountable for tax withholdings.

Unemployment Insurance Contributions

Unfortunately for employers, the analysis to determine to which state unemployment insurance contributions are made is a more complex process. There is a four-part test that each state has passed to determine to which state contributions should be made. First, the employer must look at where the employee's services are localized, meaning the place where the predominant amount of their service is performed such that service provided elsewhere would be considered transitory or incidental in nature. Second, if an employee's services are not localized, then the employer must look to where the base of operations is, meaning the place where the employees start and end their day. Third, if an employee has no base of operations, the employer must look at the place of direction and control, basically, where the employee's manager or boss sits. Fourth, the catchall looks at the state of residence of the employee.

Hybrid Workers Between States

Having a hybrid workforce, meaning employees are permitted to work part-time from their assigned office and part-time from home, adds another layer of complexity. Often for income tax withholding purposes, employers will be required to allocate the wages earned by the employee between the two jurisdictions based on the amount of time spent in each state. Whereas with unemployment insurance, contributions should only be made to one jurisdiction, even if an individual works in more than one state; typically, unemployment contributions are made to the state where the employee is providing more service.

Further, an employer may incur tax-withholding obligations when an employee works remotely in a new jurisdiction for only a temporary period. Technically, tax-withholding obligations are triggered even when employees travel and work for only a short period of time (e.g., one day). In general, a majority of states do not have a minimum threshold for earnings required before a nonresident traveler working in their state is subject to income tax withholding. For example, the issue may arise when an employee travels out of state for two weeks to visit family and takes vacation time for a week but works remotely for another week. The employer may have tax-withholding obligations for that other state. Moreover, a growing number of municipalities and localities are implementing taxes on earnings in those jurisdictions so employers may have local withholding obligations as well.

Remote Work Policies

These types of issues make it important for employers to consider implementing a strong workplace policy governing remote work and hybrid schedules. Among other provisions, a remote work policy can set forth:

  • the process by which employees request permission to work remotely;

  • the factors considered by the employer in the approval process;

  • which positions in the company are eligible to work remotely;

  • when, where, and how often employees are allowed to work remotely;

  • where workers are expected to work when working remotely;

  • information security measures employees are expected to take; and

  • communication expectations with managers and other members of their team.

Such a policy can guide not only employees but managers and human resource professionals who have to manage a remote workforce. The policy can ensure that employees understand the attendance and sick leave policy and know what is required of them in terms of performance and productivity targets. A policy can further serve as the groundwork for individualized remote working arrangements, particularly if remote work is provided as a reasonable accommodation for an employee with a qualifying disability under the Americans with Disabilities Act (ADA).

Next Steps

While many employers believe remote and hybrid work schedules can be a win-win for employers and their employees, this can be overwhelming and create a number of issues that employers may not have considered prior to allowing remote work. Employers may want to confirm where their employees are performing work to ensure compliance with any state and local income tax withholding or unemployment insurance obligations, and to have specific policies in place in advance of allowing remote work to address situations in which employees will be permitted to work someplace other than their assigned office.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

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