Prescription drug list updates effective January 1, 2023

The Blue Cross and Blue Shield of Kansas City (Blue KC) Medical and Pharmacy Management Committee has reviewed the Prescription Drug Lists (PDLs) and other pharmacy programs for drug safety, effectiveness, clinical outcomes, and cost. As a result, ACA small employer groups, non-ACA small employer groups (including level funded ASO) large employer groups, and ACA individual and family plan members will see the following formulary updates, effective January 1, 2023. Click here to read for more information. As always, please contact your Total Benefit Solutions health insurance specialists today with any questions at (215)355-2121.

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What is medical underwriting?

A process used by insurance companies to try to figure out your health status when you’re applying for health insurance coverage to determine whether to offer you coverage, at what price, and with what exclusions or limits. As always, please contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.

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Blue KC: Employer/Group Open Enrollment Dates – Mark Your Calendar

Blue KC is pleased to offer two open enrollment deadlines – one for physical ID cards and one for digital ID cards – to provide flexibility to new and renewing groups. Benefit information and open enrollment files/eligibility updates must be submitted to Blue KC based on the following schedule to ensure new ID cards are available to members by January 1, 2023: November 1, 2022 – Paperwork Deadline November 21, 2022 – Eligibility File – Physical ID Card December 16, 2022 – Eligibility File – Digital ID Card Please note: Small groups that make plan changes after this timeframe will receive updated ID cards once their plan changes have been… Read More

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Additional Guidance on New Prescription Drug Reporting Requirement

As previously reported in 2021, Section 204 of the Consolidated Appropriations Act, 2021 (“CAA”) requires plan sponsors of group health plans to submit information annually about prescription drugs and health care spending to Centers for Medicare and Medicaid Services (“CMS”) on behalf of the Departments of Health and Human Services (“HHS”), Labor (“DOL”), and the Treasury (collectively, the “Departments”). The first deadline is December 27, 2022. CMS recently updated guidance related to this reporting requirements that proves some helpful clarification. Have any questions regarding this notice? Please contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.

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What is an expected benefit Health Reimbursement Arrangement?

An excepted benefit Health Reimbursement Arrangement (HRA) allows employers to finance additional medical care, like vision or dental coverage, coinsurance and copayments for individual health insurance coverage, short-term limited-duration insurance, or other health care costs not covered by their primary group plan. Excepted benefit HRAs cannot be used to reimburse individual health insurance coverage premiums, group health plans premiums (other than COBRA or other group continuation coverage), or Medicare premiums. However, an excepted benefit HRA can be used to reimburse premiums for individual health insurance coverage or group health plan coverage that consists solely of excepted benefits. This type of HRA, like the individual coverage HRA, allows rollover of unused… Read More

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Open Enrollment Tips!

As always, please contact your Total Benefit Solutions health insurance specialists at today at (215)355-2121.

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The Employer Shared Responsibility Provision Estimator

The Taxpayer Advocate Service developed the Employer Shared Responsibility Provision (ESRP) Estimator to help employers understand how the provision works and learns how the provision may apply to them. The provision applies to applicable large employers – generally, that means employers that had an average of at least 50 full-time employees (including full-time equivalent employees-FTEs), during the preceding calendar year. If you are an employer, you can use the estimator to determine: The number of your full-time employees, including FTEs, Whether you might be an applicable large employers, and If you are an applicable large employer, an estimate of the maximum amount of the potential liability for the employer shared… Read More

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Further Guidance Issued on Contraceptive Coverage

On July 28, 2022, the Departments of Labor, Health and Human Services and the Treasury (collectively, “the Departments”) issued FAQ Part to clarify protections for contraceptive coverage under the Affordable Care Act (the “ACA”). In January 2022, the Departments had issued guidance on the ACA Preventive Care Mandate, including contraception. The Departments issued FAQ Part 54: In response to reports that individuals continue to experience difficulty accessing contraceptive coverage without cost sharing; To clarify application of the contraceptive coverage requirements to fertility awareness-based methods and to emergency contraceptive; and To address federal preemption of state law. Employers sponsoring non-grandfathered group health plans should review the various preventive care requirements effective… Read More

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IRS Health Savings Account Adjusted Amounts for 2023

The IRS has released the 2023 cost-of-living adjustments for Health Savings Account (HSA) contribution limits, HDHP deductibles, and out-of-pocket maximums. To read the official IRS release, click here. As always, please contact your Total Benefit Solutions health insurance specialists at (215)355-2121.

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Defined Contribution Plans

The Issue As one of our long-time group insurance customers grew over the years, their workforce became more diverse and the management team found it difficult to accommodate each employee’s unique insurance needs. As much as the team wanted to provide the necessary coverage for the employees, they also required some control over the employee benefits budget. They came to us for advice. The Solution We proposed that this employer consider a defined contribution strategy. Defined contribution plans build benefit portfolios around a specific dollar amount, rather than around a specific plan or plans. In this way, the management team could select an amount that the company would contribute toward… Read More

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Important Info! HSA Limits for 2019

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