2022 Patient-Centered Outcomes Research Trust Fund (“PCORTF”) Fees

  2022 Patient-Centered Outcomes Research Trust Fund (“PCORTF”) Fees May 23, 2022     This Allied Update serves as a reminder that the annual Patient-Centered Outcomes Research Trust Fund (“PCORTF”) fees are due by July 31, 2022. By way of background, at the end of 2019, the Federal Government reauthorized the annual payment of fees by health insurers and group health plans into the PCORTF until 2029. (Such payments were previously set to expire for plan years ending on or after October 1, 2018 and before October 1, 2019, and beyond.) The fee is due by July 31 of the calendar year immediately following the last day of the plan year in which… Read More

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Notice Requirements for Group Health Plans

ERISA requires plan administrators to give plan participants in writing the most important facts they need to know about their group health plans, including plan rules, financial information, and documents on the operation and management of the plan. Some of these facts must be provided to participants regularly and automatically by the plan administrator. Others must be made available upon request, free-of-charge or for copying fees.

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Fully Insured vs Level Funding: What’s the Difference?

With fully insured plans, premiums are paid directly to the insurer. Claims accountA claims account is exactly what it sounds like. A portion of the monthly payment is used to pay for claims submitted by plan members. Stop-loss InsuranceStop-loss is an employer’s safety net. This protects the employer against higher-than-expected claims. With level-funding, employers will never have to pay more than the amount they are responsible for funding the claims account each year. After that, stop-loss insurance kicks in. Administrative costsAdministrative services are provided to the employer so they can spend their time focusing on their business while a third-party administrator handles plan management such as paying claims, customer service,… Read More

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Support for your emotional health

Virtual care visits from MDLIVE® IBC members pay $0 cost-share* You have access to care from therapists, psychologists, and psychiatrists who can help with concerns likeanxiety, depression, and panic disorders. With telebehavioral health from MDLIVE, you pay $0 costshare* for a confidential visit in the comfort of yourhome, or wherever you are. Choose to have your virtual care visit by video chat, using the MDLIVE website or mobile app, or by phone.

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2023 Inflation Adjusted Amounts for HSAs

The IRS released the inflation adjustments for health savings accounts (“HSAs”) and their accompanying high deductiblehealth plans (“HDHPs”) effective for calendar year 2023, and the maximum amount that may be made newly available forexcepted benefit health reimbursement arrangements (“HRAs”). All limits have increased from the 2022 amounts, somesignificantly.

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Proposed Regulations to Fix ACA’s Affordability “Family Glitch”

individuals are not eligible for premium tax credits in the Marketplace

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Medicare Coverage for Treatment of PTSD

Post-traumatic stress disorder (PTSD) is a mental condition that can develop after someone directly or indirectly experiences a traumatic event. It doesn’t always occur immediately following the event and may not be caused by an event some would traditionally consider traumatic. This can make identifying or diagnosing PTSD difficult. But, if PTSD isn’t identified and treated, it can be a part of the sufferer’s life for potentially the rest of their life. To Learn more Click Here, or for more information on how Medicare can help with coverages call Total Benefits Solutions at (215) 355-2121

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HealthCare.gov Notices New Class of Individual Employer Policies

hCare.gov managers are signaling that they think individual coverage health reimbursement arrangements matter. The regulators in charge of the federal Affordable Care Act public exchange system today gave ICHRAs official attention, by adding an ICHRA use reporting requirements for the insurers that sell coverage through HealthCare.gov. Click here for the full story on Think Advisor.com

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Medicare Freezes Late Enrollment Penalties for Qualifying Enrollees

Many people enroll in Medicare as soon as they can, unless they have creditable coverage from an employer or other source. Why? Often, it’s because they’re looking to avoid Medicare late enrollment penalties. This year, due to ongoing issues at the Social Security Administration, Medicare has decided to extend a grace period for anyone who isn’t enrolled in Parts A and B but is eligible to do so. This will assist a number of people who would have otherwise been hit with a late enrollment penalty.Click Here For more info on this Article! Or call into Total Benefits Solutions at (215) 355-2121

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Annual Out-Of-Pocket Maximum Adjustments Announced for 2023

On December 28, 2021, the Department of Health and Human Services (“HHS”) published the “payment parameters” portion of its Annual Notice of Benefit and Payment Parameters for 2023 (“the Notice”). HHS historically publishes the Notice as a proposed rule and then finalizes the rule. The guidance clarifies that, beginning with the 2023 calendar year, the payment parameters portion of the Notice will be published by January of the year preceding the applicable calendar year. This guidance is considered a final rule that addresses certain provisions of the Affordable Care Act (“ACA”). For more information contact your friends at Total Benefits Solutions! Reach out to us at (215)355-2121

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HHS Extends Public Health Emergency until July 15

On April 12, 2022, the Secretary of Health and Human Services renewed the COVID-19 pandemic Public Health Emergency, effective April 16, 2022. This will once again extend the Public Health Emergency period for an additional 90 days and as a result, numerous temporary benefit plan changes will remain in effect. Please download the bulletin below and contact your health insurance experts at Total Benefit Solutions, Inc at (215)355-2121 Download Bulletin

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Free or Nearly Free Health Coverage Through New Jersey’s Expanded Access”

The new Expanded Access Special Enrollment Period allows qualifying consumers with an annual household income of up to 200% of the federal poverty level to enroll in a health plan throughout the year. New Jersey’s Governor Phil Murphy and Department of Banking and Insurance Commissioner Marlene Caride have introduced a new “Expanded Access” initiative, which allows residents at certain income levels to continue to enroll in free or nearly free health coverage through Get Covered New Jersey.     The new Expanded Access Special Enrollment Period allows qualifying consumers with an annual household income of up to 200% of the Federal Poverty Level (FPL) to enroll in a health plan throughout the year. This population will… Read More

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Temporary Telehealth Relief for HSA Plans

On March 15, 2022, the President signed government funding legislation, the Consolidated Appropriations Act, 2022 (“CAA-22”), into law. The legislation includes a prospective extension of relief that allows first dollar coverage of telehealth servicesfrom April 1, 2022 through December 31, 2022. This relief allows individuals with High Deductible Health Plans (“HDHPs”)to receive free telehealth services prior to the satisfaction of their minimum deductible and remain eligible to make HealthSavings Account (“HSA”) contributions….

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New Qualifying Life Event through Pennie for New Customers!

Depending on a customer’s household income, they may qualify to enroll in coverage through a new Special Enrollment Period and receive financial assistance offered through Pennie! If a customer’s income is equal to or below 150% Federal Poverty Level (see table below), they can enroll in coverage through Pennie at any time of the year. New enrollees will need to take these steps to enroll in coverage under this qualifying life event: Submit a new Pennie application  If they meet the criteria in the table below, a Special Enrollment Period (SEP) will automatically open!  Once the SEP opens, they will have 60-days to enroll in a plan through Pennie. Once enrolled, coverage will begin the start of… Read More

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Employers in Philadelphia Are Required to Provide Paid COVID Relief  

Employers in Philadelphia, PA with 25 or more employees must provide up to 40 hours of additional paid sick leave to eligible employees when they are unable to work for certain COVID-19 related reasons. The new measure became effective on March 9, 2022 and will extend through the end of 2023. It covers employees who are unable to work for the following reasons: To care for self or a family member showing symptoms of COVID-19 To care for self or a family member exposed to COVID-19, in order to self-isolate As a result of childcare or school closures To obtain a COVID-19 test or vaccine, or to recover from injury,… Read More

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Family Glitch Solution Proposed

Family Glitch Solution Proposed The Biden Administration announced today that it would release a proposed rule to fix the family glitch. This proposed rule is a result of President Biden’s Executive Order from 2021 calling on the federal agencies to strengthen the Affordable Care Act. The Department of Treasury is using the proposed rule to revise the definition of “affordability” of employer sponsored coverage as it applies specifically to family members of the employee.   Current regulations define employer-based health insurance as “affordable” if the coverage solely for the employee, not for family members, is affordable, making family members ineligible for a premium tax credit. The proposed changes would allow… Read More

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Philadelphia Passes New COVID-19 Paid Leave Law

Philadelphia has enacted a new law that requires employers to provide paid time off for COVID-19 purposes. The ordinance, which took effect March 9, 2022, applies to employers with at least 25 employees. Covered EmployeesThe ordinance covers employees who: Work in Philadelphia; Normally work in Philadelphia but currently telework from any other location as a result of COVID-19; or Work from multiple locations or from mobile locations, provided that 51% or more of their time is in Philadelphia. There is no waiting period or accrual requirement for leave. Permitted Purposes for COVID-19 LeaveLeave must be allowed for specified COVID-19 reasons relating to an employee’s (or their family members’) exposure to, symptoms of or diagnosis with COVID-19. Leave… Read More

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IRS Raises ACA Mandate Penalties for 2022

The IRS penalty amounts for non-compliance of the ACA’s Employer Mandate are rising in 2022.  Below is a list of the new penalty amounts and how the IRS will assess them.  4980H(a) Penalty For the 2022 tax year, the 4980H(a) penalty amount is $229.17 a month or $2,750 annualized, per employee. The IRS issues the 4980H(a) penalty when: An employer doesn’t offer Minimum Essential Coverage (MEC) to at least 95% of its full-time employees (and their dependents) for any month during the tax year, and  At least one full-time employee receives a Premium Tax Credit (PTC) for purchasing coverage through the Marketplace. Here’s an illustration of how the IRS calculates the penalty: If an organization in 2022has 300 full-time employees, and one of these employees receives a PTC for 12 months,… Read More

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Independence: Changes to the Value and Select formularies for April 1

Changes to the Value and Select formularies for April 1 Independence Blue Cross is making changes to the Value and Select Drug Program® (Select) formularies effective April 1, 2022. Updates are made to the Value and Select formularies quarterly.The updated lists for April 1 are available now on our website. Select the appropriate link to view the Value or Select formulary. The updated list can be found under “Formulary drug documents.” Changes that result in positive member experiences happen quarterly in January, April, July, and October. Examples of these changes include new drugs and generics being added to the formularies, tier changes that can result in lowering member cost‑share, and utilization management removal.Negative formulary changes… Read More

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HHS Adjusts Civil Monetary Penalties Again for HIPAA, MSP, and SBC Violations

HHS has announced adjustments of civil monetary penalties for statutes within its jurisdiction. The latest amounts are based on a cost-of-living increase of 1.06222%. These adjustments are effective for penalties assessed on or after March 17, 2022, for violations occurring on or after November 2, 2015. Here are highlights of the adjustments potentially affecting employer-sponsored health plans: HIPAA Administrative Simplification. HIPAA administrative simplification encompasses standards for privacy, security, breach notification, and electronic health care transactions. HIPAA has four tiers of violations that reflect increasing levels of culpability, with minimum and maximum penalty amounts within each tier and an annual cap on penalties for multiple violations of an identical provision. The indexed… Read More

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Temporary Telehealth Relief for HSA Plans

On March 15, 2022, the President signed government funding legislation, the Consolidated Appropriations Act, 2022 (“CAA-22”), into law. The legislation includes a prospective extension of relief that allows first dollar coverage of telehealth services from April 1, 2022 through December 31, 2022. This relief allows individuals with High Deductible Health Plans (“HDHPs”) to receive free telehealth services prior to the satisfaction of their minimum deductible and remain eligible to make Health Savings Account (“HSA”) contributions….

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What is reference-based pricing?

What is reference-based pricing? Some employers are moving away from offering conventional health coverage with a provider network and instead are using reference-based pricing for some or all of services they cover. Under reference-based pricing, the employer (supported by a third party administrator [TPA] or other vendor) pays a set a price for each health care service instead of negotiating prices with providers. When a provider bills for the service, the payer remits the set amount. Some payers use reference-based pricing software to determine the price they will pay for a health care service. Although reference-based pricing software programs vary, the methodology includes collecting data on prevailing costs for medical… Read More

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