Benefits Buzz – Health Plans Must Expand Price Comparison Tool for 2024
Beginning in 2024, group health plans and health insurance issuers must expand the internet-based price comparison tool they make available to participants, beneficiaries and enrollees so that it includes all covered items, services and drugs. The purpose of this tool is to provide consumers with real-time estimates of their cost-sharing liability from different providers for covered items and services so they can shop and compare prices before receiving care.
Benefits Buzz – FDA Approves First Over-the-Counter Daily Oral Contraceptive
On July 13, 2023, the U.S. Food and Drug Administration (FDA) announced that it approved the first nonprescription daily oral contraceptive to prevent pregnancy. This drug is expected to become available to consumers without a prescription from stores and online retailers in early 2024.
Insurance Coverage
The Affordable Care Act (ACA) requires most group health plans and health insurance issuers to provide first-dollar coverage of certain specified preventive services for women, including all FDA-approved contraceptives, as prescribed by a health care provider.
Benefits Buzz – Gag Clause Attestations Are Due by Dec. 31, 2023
On Feb. 23, 2023, the Departments of Labor, Health and Human Services and the Treasury (Departments) issued FAQs on the prohibition of gag clauses under the transparency provisions of the Consolidated Appropriations Act, 2021 (CAA). These FAQs require health plans and health insurance issuers to submit their first attestation of compliance with the CAA’s prohibition of gag clauses by Dec. 31, 2023.
Effective Dec. 27, 2020, the CAA prohibits health plans and issuers from entering into contracts with health care providers, third-party administrators (TPAs) or other service providers that would restrict the plan or issuer from providing, accessing or sharing certain information about provider price and quality and deidentified claims.
Benefits Buzz – White House Announces End of COVID-19 Emergency
On Jan. 30, 2023, the Biden administration announced that it plans to end the COVID-19 public health emergency (PHE) and national emergency on May 11, 2023.
The COVID-19 PHE and national emergency were declared in early 2020 and have been extended numerous times since then. The Biden administration intends to extend the emergency periods until May 11, 2023, and then end both periods on that date. According to the White House, this timeline supports an orderly wind-down of emergency measures and aligns with its commitment to give at least 60 days’ notice before the termination of the PHE.
Benefits Buzz – Congress Extends Telehealth Relief for HDHPs
The Consolidated Appropriations Act, 2023 (CAA) extends the ability of high deductible health plans (HDHPs) to provide benefits for telehealth or other remote care services before plan deductibles have been met without jeopardizing health savings account (HSA) eligibility. This extension applies for plan years beginning after Dec. 31, 2022, and before Jan. 1, 2025.
Background
In general, telehealth programs that provide free or reduced-cost medical benefits before the HDHP deductible is satisfied are disqualifying coverage for purposes of HSA eligibility. However, the Coronavirus Aid, Relief and Economic Security Act (CARES Act) allowed HDHPs to provide benefits for telehealth or other remote care services before plan deductibles were met, effective for plan years beginning before Jan. 1, 2022.
Benefits Buzz – IRS Finalizes Deadline Extension for Furnishing ACA Statements
On Dec. 12, 2022, the IRS released a final rule that extends the annual furnishing deadlines for Sections 6055 and 6056 reporting under the Affordable Care Act (ACA). This rule finalizes guidance that was proposed by the IRS in December 2021 with minor clarifications. Specifically, the rule:
Finalizes the 30-day automatic extension to the due date for furnishing statements to individuals under Sections 6055 and 6056.
Confirms the availability of an alternate method for furnishing statements to individuals under Section 6055 for every year in which the individual mandate penalty is zero.
Benefits Buzz – Prescription Drug Reporting Due by Dec. 27, 2022
A new transparency provision requires employer-sponsored health plans and health insurance issuers to annually report information about prescription drugs and health care spending to the federal government. This reporting process is referred to as the “prescription drug data collection” (or “RxDC report”).
The first RxDC report is due by Dec. 27, 2022, and covers data for 2020 and 2021. Going forward, the annual deadline for the RxDC report is June 1. This means that the second RxDC report is due by June 1, 2023, covering data for 2022
Benefits Buzz – IRS Changes Family Coverage Affordability Rules
On Oct. 11, 2022, the IRS released a final rule that changed the premium tax credit (PTC) eligibility rules for family members. This change is effective for taxable years beginning after Dec. 31, 2022.
The PTC is available to eligible individuals who purchase health insurance coverage through an Exchange. Individuals are not eligible for the PTC if they have access to employer-sponsored health coverage that is affordable and provides minimum value.
Effective for 2023, the final rule changes the PTC rules for determining whether employer-sponsored coverage is affordable for family members. Currently, this determination is based on the lowest-cost self-only coverage available to the employee. Under the final rule, an employer-sponsored plan is affordable for family members if the portion of the annual premium the employee must pay for family coverage (the employee’s required contribution) does not exceed 9.5% (as adjusted annually) of household income.
Benefits Buzz – Medicare Part D Notices Due Before Oct. 15, 2022
Each year, Medicare Part D requires group health plan sponsors to disclose whether the health plan’s prescription drug coverage is creditable to individuals eligible for Medicare Part D and the Centers for Medicare and Medicaid Services (CMS).
Plan sponsors must provide the annual disclosure notice to Medicare-eligible individuals before Oct. 15, 2022—the start date of the annual enrollment period for Medicare Part D. CMS has provided model disclosure notices for employers to use.
Medicare beneficiaries who do not have creditable prescription drug coverage and do not enroll in Medicare Part D when first eligible will likely pay higher premiums if they enroll at a later date. Although no specific penalties are associated with the notice requirement, failing to provide the notice may be detrimental to employees.
Client and Employee Resources
The more your employees understand your benefit plans the more they become educated, empowered consumers. The programs you provide will also gain an enhanced value.
As your strategic partners in employee benefits, we can provide multiple avenues of ongoing support, including:
- Employee Meetings (English and Spanish)
- Webcasts
- Payroll Stuffers
- Poster Campaigns
- Newsletters
Carrier Directories
E-Verify is a web-based system that allows enrolled employers to confirm the eligibility of their employees to work in the United States. Click the image below to begin.
