Help for Smaller Groups 

An analysis released by the Urban Institute and the Robert Wood Johnson Foundation shows that even though small businesses were hardest hit by the pandemic, the vast majority of those that survived were able to maintain health benefits. Nonetheless, maintaining health benefit programs has been increasingly difficult for small employers, especially in industries such as travel and hospitality. 

One option that small groups continue to find workable is level funding, which offers self-funded features like lower premium taxes, plan design flexibility and access to valuable claims data. By including stop-loss insurance, level funded plan sponsors can establish a monthly budget for health benefits. Stop loss reimburses the plan when claims exceed employer funding but in contrast to fully insured options, the plan retains the savings when claims are lower than anticipated. If your organization is searching for a way to attract and retain workers in a tough job market, talk to us to learn more about level funding. 


Quality Health Benefits Can Be Affordable

health-benefitsLast Fall, COVID-19 was weighing so heavily on our minds that simply keeping health benefits available during the Pandemic was the top priority. Today, with many people needing medical care they may have postponed and pressure to maintain sufficient staffing, keeping your health plan both effective and affordable is a must.

The fact is that after a year unlike any other, your organization needs to huddle with its broker/advisor and TPA to do all it can to fight back against rising healthcare costs. Remember that your organization transitioned to self-funding to take control of rising costs and gain the flexibility needed to compete successfully in a rapidly changing world. So, with 2022 right around the corner, let’s revisit a few steps that could keep your organization on the path to high quality, affordable healthcare.

Question Everything – For self-funded employer groups, there are no off the shelf plan designs. When a plan year was successful, we want our clients to know what made the difference. If claims were higher than expected, we help you understand where your healthcare dollars went and what your plan can do to bend the curve.

Be a Disruptor – Annual rate increases of 5 to 7 percent should never be accepted as being par for the course. Solutions to rising costs are in your claims data and the right advisors can help you explore new options. Carve-outs for Specialty Pharmacy and Referenced Based Pricing are just two of the ways we’re helping health plans achieve significant savings.

Blocking & Tackling – Monitoring claims and utilization data day in and day out takes industry-leading technology and skilled claims analysts. Digging deeper into claims will help your plan uncover billing errors and find hidden revenue in your health plan.

Communicate, Educate, Advocate – Because managing the cost and quality of employee healthcare is a year-round responsibility, we do our best to keep employers, plan members and broker advisors informed and supported throughout the year. This is especially critical given the costs associated with chronic healthcare conditions and the rising frequency of high-dollar claims.

These measures may not be new, but when implemented consistently, they will produce significant savings, not only for your health plan but also for the members your business depends on.


Goodbye Haven, Hello Morgan

Only a few months after Amazon, JPMorgan Chase and Berkshire Hathaway ended their “Haven” healthcare experiment, JPMorgan Chase introduced a new unit dedicated to collaborating with outside organizations to accomplish its healthcare objectives. Morgan Health is expected to partner with leading health plans and provider groups to improve access, quality and cost for its nearly 300,000 employees and dependents.


Price Transparency Rules Issued

90-price-transparencyNew guidelines issued by CMS earlier this Spring state that all files uploaded by health plans and insurance carriers must be in formats the public can use. Before issuing this guidance, some files included coding that kept Google and other search engines from indexing names and prices listed by hospitals on their websites, making it very hard for consumers to access the data.

The American Hospital Association lost a suit to block the rule on the basis that HHS lacks the authority to oversee its regulation and such rates are not useful to consumers. According to CMS, hospitals are expected to comply  with these requirements to provide pricing information that is searchable and accessible without barriers.


2022 HSA Contribution Limits

hsa-contribution-limitsThe IRS has announced that contribution limits for 2022 are increasing by $50 for individual coverage and $100 for family coverage, to $3,650 and $7,300 respectively. This represents an increase of 1.4% from 2021 levels and those age 55 and older can still contribute an additional $1,000 per year. While minimum annual deductible levels will remain unchanged at $1,400 for individual coverage and $2,800 for family coverage, maximum out-of-pocket expense limits for HDHPs will increase to $7,050 for individual coverage and $14,100 for family coverage.

Overall, enrollment in HSAs continues to grow. Advisory firm Devenir reports that approximately 30 million Americans currently own health savings accounts with overall balances totaling more than $82 billion.


Regs Coming for No Surprise Billing Act

regs-erWhile former President Trump signed the No Surprises Act into law as part of the Consolidated Appropriations Act of 2021, CMS is still working on regulations that will become effective for insured and self-funded health plan years that begin on or after Jan. 1, 2022. Implementing this law will be interesting, experts say. While many of its provisions were designed to protect people from getting unexpected bills for care from out-of-network providers at in-network hospitals and surprise bills from out-of-network emergency care providers including air ambulance services, many types of bills that “surprise” consumers may indeed be outside the scope of the Act.

There are other concerns as well. One of these is a part of the law that requires health plans and out-of-network providers who disagree about charges to seek arbitration. Another is a provision that lets some providers offer care on an out-of-network basis if they advise the patient about potential billing and get a consent form signed. Even though there will be challenges to work through once the law is implemented, policymakers are confident that the No Surprises Act will be a great help to consumers.


More Employers Open to Change

employeesWith healthcare costs expected to rise by some 6.5% this year and growing concerns over hospital price transparency, many employers are open to new ideas. Some who have looked at Self-Funding or Reference Based Pricing (RBP) in the past are now revisiting these options in an effort to keep healthcare affordable for their organization and their employees.

Alternative ways of funding employee health benefits have always been a concern for HR directors, charged with helping employees adapt to change. The fact is that these strategies are becoming more and more widespread every year. In most cases, moving away from a fully insured plan with a traditional PPO can often result in a health plan that is not only stronger but more cost-effective as well. If your broker has failed to speak with you about self-funding or reference based pricing, contact us to learn more.


Receiving Healthcare Data

healthcare-dataIn early April, a federal rule took effect enabling patients to view their medical records without paying any fees and without waiting days or weeks. As a result, many patients will be able to find test results, clinical notes from their doctor and other medical information posted to their electronic portal as soon as they are available. While most physicians and patients view this as long overdue, a few obstacles have arisen. In some cases, test results can be made available to a patient before their physician has seen them. This can be a problem if further explanation or comments are appropriate. Doctors are also concerned about sensitive comments being seen by a parent of an adolescent who wants to keep the information confidential.

The AMA is pushing for modifications that would provide for brief delays when results involve a difficult diagnosis, such as cancer. Representatives of the Office of the National Coordinator for Health Information Technology, the federal agency overseeing the rule, have emphasized that patients can always decide whether they want to look at results or wait and review them with their doctor. Also, the rule does not require that parents be given access to protected health information if they did not already have that right under HIPAA. Some electronic health records enable doctors to withhold results, a step the doctor can discuss with their patient prior to ordering the test. While the overall response is positive, discussions will likely continue as patients become better informed about the tools available.


Unemployed to Get Help with COBRA

cobraIn the American Rescue Plan Act (ARPA), which was signed into law by President Biden on March 11, 2021, there are several provisions for healthcare plans, including a 100% subsidy of coverage premiums for eligible COBRA enrollees. The subsidies, which will run from April 1, 2021 through September 30, 2021, will be paid to employers by the federal government as payroll tax credits.

The subsidy will last for six months at most, ending on the earlier of the individual’s maximum period of COBRA coverage (generally 18 months) or September 30, 2021. Subsidies will also end early for individuals who become eligible for coverage under another group health plan or Medicare. Those employees who terminate employment voluntarily are not eligible for the subsidy.

Notices are Required

Employers should talk with their TPA about notice requirements and to determine who may be eligible for the subsidy. As a result of the eligibility period running through April, 2021, a list must be compiled including individuals who terminated employment as far back as November of 2019. A Notice of Assistance must be provided to individuals who become eligible to elect COBRA coverage between April 1 and September 30, 2021. Eligible workers who haven’t elected COBRA by April 1 and those who elected COBRA but then discontinued it must also be notified, since former employees have an extended election period running for 60 days after April 1, 2021.

Finally, a Notice of Expiration must be provided between 45 and 15 days prior to the subsidy expiring, unless the subsidy is expiring because the individual has become eligible for coverage by another group health plan or Medicare. The DOL is expected to issue new model COBRA forms within 30 days of the March 11, 2021 enactment date. In addition, individuals are required to notify the group health plan if they forfeit eligibility because they have become eligible for another group health plan or Medicare.

To learn more about the American Rescue Plan notice requirements, visit or contact us at your convenience.