Medical Price Transparency Update 08-19-19

Proposed Law Can Help Lower Your Medical Costs By Allowing You to Shop Around! On July 29, 2019, the Centers for Medicare & Medicaid Services (CMS) proposed policies that follow directives in President Trump’s Executive Order, entitled “Improving Price and Quality Transparency in American Healthcare to Put Patients First,” that lay the foundation for a patient-driven healthcare system by making prices for items and services provided by all hospitals in the United States more transparent for patients so that they can be more informed about what they might pay for hospital items and services. Included in this proposal is also a redefinition of what “Preventative Care” means. Why is this… Read More

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Senators Call for Closing “Loopholes” That Make Health Care Fraud Easy

Following a detailed account of how scam artists can easily gain access to health care cash, six Democratic senators this week sent a letter to federal regulators urging them to “close loopholes” that allow “bad actors” to commit fraud. The letter came in response to a recent story by ProPublica and Vox that traced the brazen scam of a Texas personal trainer, who despite having no medical credentials was able to submit a blizzard of fake bills with some of the biggest insurance companies in the country and recoup millions. The story revealed not only how David Williams exploited weaknesses at each step, but how slowly the insurers responded to his ongoing fraud.… Read More

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Health insurance premiums to drop under Affordable Care Act

  Health insurance premiums are set to drop next year under the Affordable Care Act. The Department of Financial Services (DFS) announced Premium Rates for 2020 on Monday. According to a news release issued by the department, “rates for individuals are more than 55% lower than prior to the establishment of the NY State of Health in 2014, adjusting for inflation but not counting federal financial assistance that the ACA makes available to many consumers purchasing insurance. Approximately 326,000 New Yorkers are currently enrolled in individual commercial plans.” The DFS, “reduced overall Insurers’ Requested Rate for Individual Coverage from 9.2% to 6.8%, saving consumer over $50million.” Overall, according to DFS,… Read More

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NEW HRA RULES FOR 2020

New Rules for 2020 to Pay Attention To Many Employers offer things such as HRAs, FSAs or HSAs to help Employees offset the out-of-pocket costs and gaps in their Health Benefits. I’ll give a quick summary of each: -A Health Reimbursement Arrangement (HRA) is an employer-funded account that helps employees pay for qualified medical expenses not covered by their health plans. HRAs are compatible with all types of health insurance plans and since they are solely funded by the employer, they also own it. -A health savings account (HSA) is a tax-advantaged medical savings account available to people  enrolled in a high-deductible health plan (HDHP). The funds contributed to an account are not… Read More

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2020 ACA Plans PLUS A New Insurer Enters the Five County Area

Important Update! 2020 ACA Plans Offer Consumers More Choice, Modest Requested Increases Harrisburg, PA – Insurance Commissioner Jessica Altman today released the 2020 requested rate filings for health insurance plans under the Affordable Care Act, highlighting that consumers in all Pennsylvania counties will now have more options, markets will have greater competition, and average rate increase requests are modest in comparison to some previous years. “As filed, all 67 counties will maintain the insurers currently offering coverage in 2019 for the 2020 coverage year,” Altman said. “Pennsylvania’s market has seen great increases in competition and choices for consumers in recent years, and the trend will continue into 2020. Based on their… Read More

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New Executive Order Addresses Healthcare Issues

On June 24, 2019, President Trump issued an Executive Order (“EO”) directing the relevant federal agencies to issue regulations or other guidance to make available more meaningful information related to the price and quality of healthcare. This summary highlights aspects of the EO that may be relevant to employer-sponsored group health plans and their covered participants.   • By October 22, 2019, the Treasury shall issue guidance to expand the ability of patients to select a qualified high deductible health plan (“QHDHP”) that can be used alongside a health savings account (“HSA”), and that cover low-cost preventive care, before the deductible, for medical care that helps maintain health status for… Read More

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The Exact Types of Insurance You Need In Your 20s, 30s, and 40s..

Insurance isn’t the most thrilling to think about, but it’s necessary for protecting yourself, your family, and your wealth. Accidents, illness, and disasters happen all the time. At worst, events like these can plunge you into deep financial ruin if you don’t have insurance to fall back on. Some insurance policies are unavoidable (think: car insurance in most US states), while others are simply a smart financial decision (think: life insurance). Insurance is largely personal, though, and the type of policy or amount of coverage that’s right for you and your financial situation usually won’t match your friend’s or relative’s. Plus, as your life changes (say, you get a new job or have… Read More

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Vision and Dental Insurer, Dominion National’s Security Breach Compromises Information of Almost 2.9+ Million People

Delaware’s insurance department says social security numbers and other personal data of more than 2,900,000 people may have been comprised over nearly a decade due to a breach at a large vision and dental insurer. The Delaware News Journal reports someone may have obtained bank account and routing numbers, social security numbers and insurance and tax information from the insurer Dominion National. The company says the information may have been compromised when a server was accessed by an “unauthorized third party” in 2010. Dominion National says there’s “no evidence that any information was in fact accessed.” The Department of Health and Human Services breach reporting tool listed 2.96 million patients have been notified their… Read More

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Can You Still File an Appeal for a Medicare Coverage After the Deadline?

Did Medicare deny you coverage on a service or medication you need? What happens if for one reason or another, you miss the deadline they give to appeal their decision? Is there anything you can do? The good news is, you may still be able to appeal Medicare’s decision to deny coverage for your care. For all levels of appeals through Medicare, there is a limited time to file. However, if the deadline has passed and you can show good cause for not filing on time, your late appeal may still be considered. It’s called “a good cause extension”  Extension requests are considered on a case-by-case basis, so there is… Read More

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How Big Data Can Help You Choose Better Health Insurance

There are plenty of easy consumer choices. Paper clips: easy. Dish sponges: easy. Those products sit at one end of the spectrum. At the other end, impossibly distant, is health insurance. That’s difficult. “Tons of evidence suggests that people have a hard time making choices when it comes to health insurance,” says Kate Bundorf, associate professor at Stanford School of Medicine with a courtesy appointment at Stanford Graduate School of Business. The complexity can be overwhelming and, as a result, people often choose sub-optimal plans that punish them with higher costs and create inefficient markets. “So we wanted to figure out what types of tools would help people make decisions,” says… Read More

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Bipartisan Bill to Address ‘Surprise’ Billing Moves Forward (and hospitals aren’t happy)..

    The Senate Health, Education, Labor and Pensions (HELP) Committee on Wednesday voted 20-3 to advance a bipartisan legislative package to address so-called “surprise” medical bills, but senators have suggested the bill could undergo more changes before it reaches the Senate floor next month. Background Sens. Lamar Alexander (R-Tenn.), the committee’s chair, and Patty Murray (D-Wash.), the ranking member on the committee, last week unveiled the Lower Health Care Costs Act. The wide-ranging bill contained nearly three dozen proposals to lower prescription drug prices, bolster transparency and data sharing in the U.S. health care system, and address surprise medical bills. Alexander and Murray had considered several ways to curb… Read More

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Final Rule Issued Allowing HRAs to be used for Individual Coverage

On June 13, the U.S. Departments of the Treasury, Labor, and Health and Human Services (tri-agencies) issued a final rule allowing employees to use the dollars in employer-funded Health Reimbursement Arrangements (HRAs, also called Health Reimbursement Accounts) to purchase individual coverage both on and off the public Marketplace (or Exchange). The rule also creates a new excepted benefit HRA (EBHRA) to enable employees to be reimbursed for excepted benefit costs. This finalizes a proposed rule issued in Oct. 2018 largely as proposed, but with some modifications. The rule follows through on an Executive Orderthat directed the tri-agencies to consider ways to expand the flexibility of HRAs. Individual Coverage HRAs Beginning Jan. 1, 2020,… Read More

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Health Plan PCORI Fees Are Due July 31

From our partners at Think HR: Do you offer coverage to your employees through a self-insured group health plan? Do you sponsor a Health Reimbursement Arrangement (HRA)? If so, do you know whether your plan or HRA is subject to the annual Patient-Centered Research Outcomes Institute (PCORI) fee? This article answers frequently-asked questions about the PCORI fee, which plans are affected, and what you need to do as the employer sponsor. PCORI fees for 2018 health plans and HRAs are due July 31, 2019. What is the PCORI fee? The Affordable Care Act (ACA) created the Patient-Centered Outcomes Research Institute to study clinical effectiveness and health outcomes. To finance the nonprofit… Read More

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PA. House panel advances bill to create state health insurance exchange

HARRISBURG, Pa. (KYW Newsradio) — A Pennsylvania House committee has advanced legislation that would require the state to create its own health insurance exchange under the Affordable Care Act.  Health care advocates celebrated the news that the Pennsylvania House Insurance Committee has approved a bill that would put oversight of Pennsylvania’s health insurance marketplace in control of the state, instead of Washington. No one is more pleased than Gov. Tom Wolf. Click here for the story

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HSA/HDHP Limits Increase for 2020

On May 28, 2019, the IRS released Revenue Procedure 2019-25 to announce the inflation-adjusted limits for health savings accounts (HSAs) and high deductible health plans (HDHPs) for 2020. These limits include: The maximum HSA contribution limit; The minimum deductible amount for HDHPs; and The maximum out-of-pocket expense limit for HDHPs. These limits vary based on whether an individual has self-only or family coverage under an HDHP.  The IRS limits for HSA contributions increase for 2020. Eligible individuals with self-only HDHP coverage will be able to contribute up to $3,550 for 2020, while eligible individuals with family HDHP coverage will be able to contribute up to $7,100 for 2020. The HDHP… Read More

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SSA/RRB Premium Deduction Issue

Members who requested premiums to be deducted from their Social Security -SSA/RRB for 2019 plans will need to send payment directly to Humana due to a system issue with the Social Security Administration. What Happens Next?  Affected members will need to pay their insurance company directly for any deductions that did not take place as scheduled.  These members will not be disenrolled from the plan due to non-payment, but do need to begin paying the balances due to avoid a possible future disenrollment.  Their insurer has mailed affected members a letter with instructions on the various ways to pay their premium.  Please contact your Total Benefit Solutions representative at (215)355-2121… Read More

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IBC: The enhanced Care Cost Estimator tool is now available!

From IBC: The Care Cost Estimator tool is now available for members. This tool is designed to help them better understand their estimated out‑of‑pocket health care costs for a wide range of common inpatient, outpatient, laboratory, and diagnostic procedures, as well as office visits. We are excited to offer members this new tool, which is designed to help them save money and avoid unplanned expenses. Using the Care Cost Estimator, members can search for up to 1,600 procedures and compare providers by estimated price, based on their specific health plan. The tool displays provider details and quality information, such as reviews, allowing members to make more informed decisions about how to… Read More

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Massachusetts Publishes Family & Medical Leave Rules

The Massachusetts Department of Family and Medical Leave (“DFML”) has recently published regulations forpublic comment and a guide for employers. A synopsis of significant, new, and clarifying information follows… In 2018, Massachusetts enacted legislation to create a statewide Paid Family and Medical Leave (“PFML”) program providing benefits beginning in January 1, 2021 and July 1, 2021. With limited exception, all employers with employees in Massachusetts will be required to providepaid family and medical leave benefits to their employees through: • The state program; or• An approved private plan. If providing benefits through the state program, employers will begin to remit premium payments to the state beginning July 1, 2019. Employers… Read More

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Medicare expands telehealth services

The Centers for Medicare & Medicaid Services (CMS) on Friday finalized new guidance that will allow Medicare Advantage plans to expand coverage of telehealth services. Beginning in plan year 2020, Medicare Advantage providers can include telehealth services as part of their basic benefits to enrollees, moving remote doctor visits from an optional add-on to a core service directly funded by the federal government. “Today’s policies represent a historic step in bringing innovative technology to Medicare beneficiaries,” CMS administrator Seema Verma said in a statement. “With these new telehealth benefits, Medicare Advantage enrollees will be able to access the latest technology and have greater access to telehealth. By providing greater flexibility… Read More

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Understanding Medicare Part D’s True Out-of-Pocket Limit

Of all the reasons to enroll in Medicare coverage, making health care more affordable is perhaps the biggest for millions of beneficiaries. One of the benefits found in Medicare Advantage plans is a maximum-out-of-pocket (MOOP) limit, but is there anything similar that will help with out-of-pocket costs for Medicare Part D? https://living.medicareful.com/understanding-medicare-part-ds-true-out-of-pocket-limit Questions? As always contact your Total Benefit Solutions Inc, health insurance specialists at (215)355-2121!

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Can Employers Pay Medicare Premiums for Active Employees?

Companies with fewer than 20 employees that offer group health coverage that pays secondary to Medicare (those not subject to the MSP rules) may be able to pay for the Medicare Part B, Part D, and Medicare Supplement Insurance premiums for their active employees. This is known as a Medicare Premium Reimbursement Arrangement. However, this is not an option for companies with 20 or more workers that are subject to the Medicare Secondary Payer provisions. All companies, regardless of size, can pay the health insurance or Medicare premiums for their retired employees, but no company can payfor individual health insurance coverage for their active employees . Our best practice: A… Read More

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Court Strikes Down Association Health Plan Rules

On March 28th, 2019, a Federal District Court in the District of Columbia struck down significant portions of the Department of Labor’s (DOL’s) Association Health Plan (AHP) Final Rule. Specifically, the Court found the DOL “failed to reasonably interpret” ERISA when issuing these rules: • expanding the definition of “employers” to include disparate groups of employers with no other commonality of interest other than geographic location; and • bringing working owners without employees within ERISA’s framework. This ruling effectively eliminates the expansion of AHPs to certain employers and working owners who do not meet the original parameters to be a part of an AHP. Click below to download the complete… Read More

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New Rules Could Increase Premiums & Out of Pocket Cost

The Wall Street Journalrecently reported on proposed changes by the Trump Administration “that could raise health insurance costs for millions of Americans who get coverage on the job or receive subsidies under the Affordable Care Act.” As they explain, the two sides continue to bicker about the Affordable Care Act: “Republicans say subsidies for consumers are inflated; Democrats see another effort to sabotage the health law.” The proposed changes they are referring to are found in the Notice of Benefit and Payment Parameters for 2020. This is an annual notice released by the Centers for Medicare and Medicaid Services (CMS) that sets the standards for issuers and exchanges for the coming year.… Read More

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