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<< Older News  |  December 5, 2020

News

All News > Health Plan Costs

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Actors Sue SAG-AFTRA Health Plan; 12,000 to Lose Coverage
National Public Radio [NPR] Link to more items from this source
Dec. 4, 2020

"The plaintiffs say that nearly 12,000 people will lose their health care next month -- about a third of those participating in the union's plan. Moreover, they say, many of those losing coverage are senior citizens who in many cases have paid into the plan for decades. Members will have to prove earnings of at least $25,950 to get health coverage through the union. Under the new rules, however, that income cannot include pensions or residuals[.]"

Tags: Health Plan Costs  •  Health Plan Design

IRS Explains 'Qualified Health Plan Expenses' for Purposes of FFCRA Tax Credit
The Wagner Law Group Link to more items from this source
[Guidance Overview]
Dec. 3, 2020

"The IRS explains that the amount of qualified health plan expenses taken into account in determining the credits generally includes both the portion of the cost paid by the employer and the portion of the cost paid by the employee through pre-tax salary reduction contributions, but not amounts that the employee paid with after-tax contributions."

Tags: Health Plan Costs

Text of CMS Draft 2022 Actuarial Value Calculator Methodology (PDF)
Center for Consumer Information & Insurance Oversight [CCIIO], Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS] Link to more items from this source
[Official Guidance]
Dec. 3, 2020

24 pages. "The AV Calculator represents an empirical estimate of the AV calculated in a manner that provides a close approximation to the actual average spending by a wide range of consumers in a standard population. This document is meant to detail the specific methodologies used in the AV calculation.... The draft 2022 AV Calculator is available [online].... [T]he 2022 AV Calculator does not affect any 2021 plans, and will only be applicable for 2022 plans.... [CMS] will accept comments on the draft 2022 AV Calculator, as well as the draft 2022 AV Calculator User Guide and the draft 2022 AV Calculator Methodology until ... December 24, 2020."

Tags: Health Plan Costs  •  Health Plan Design

HHS Issues Final Rule on Transparency in Coverage for Health Care Services
Seyfarth Shaw LLP Link to more items from this source
[Guidance Overview]
Dec. 3, 2020

"The final Rule requires certain disclosures regarding prices and cost-sharing information for certain healthcare items and services provided by non-grandfathered group health plans and insurance issuers. The Rule generally applies to traditional health plan coverage, and does not apply to account-based group health plans (such as HRAs, including individual coverage HRAs, or health FSAs), excepted benefits, or short-term limited-duration insurance. The Rule requires two categories of disclosures: disclosures to the public, and disclosures to plan participants."

Tags: Health Plan Administration  •  Health Plan Costs

Healthcare Cost Transparency Rules Finalized
Mercer Link to more items from this source
[Guidance Overview]
Dec. 3, 2020

"The new rules require most employer-sponsored group health plans and health insurance issuers to disclose price and cost-sharing information up front, giving enrollees estimates of any out-of-pocket expense they will have to pay to meet their plan's cost-sharing requirements. Health plan sponsors and insurance issuers will also have to give patients and other stakeholders access to previously unavailable pricing information, using a standardized format that allows easy cost comparisons."

Tags: Health Plan Administration  •  Health Plan Costs

Improving Payment Accuracy in Health Insurance Marketplaces
National Institute for Health Care Management [NIHCM] Link to more items from this source
Dec. 2, 2020

"Despite real differences in how the three study countries administer risk adjustments, ... even the sophisticated risk adjustment methods they currently use fail to accurately compensate health plans for the risks represented by specific enrollees.... This study demonstrated the important payment improvements that can be achieved across the board by reinsuring against losses for the small portion of enrollees whose care is grossly undercompensated and suggests this reinsurance will not weaken plan incentives to effectively manage care for these very high cost patients."

Tags: Health Plan Costs

Pandemic Lowers Employer Health Care Costs for First Time in Decades
PLANSPONSOR; free registration may be required Link to more items from this source
Dec. 2, 2020

"2020 medical claims are projected to decrease at a rate that is on average 5 percentage points lower than initially projected. The COVID-19 impacts for 2020 dental and vision benefit claims will also decrease budgeted costs further. Insurance carriers expect average downward cost impacts of 15% for dental benefits and 8% for vision benefits. One factor in lower health care cost trends is the deferral of non-essential care by Americans during the pandemic."

Tags: Health Plan Costs

SAG-AFTRA Health Plan Facing Class Action Over Cuts to Coverage
The Hollywood Reporter Link to more items from this source
Dec. 2, 2020

"The SAG-AFTRA health plan is at the center of a putative class action brought by a group of actors who say premiums have skyrocketed and medical coverage is being stripped from elderly guild members under the guise of a COVID-19-related restructuring ... The actors -- led by the iconic Ed Asner -- are suing the SAG-AFTRA Health Fund and its board of trustees for allegedly breaching their fiduciary duties." [Asner v. The SAG-AFTRA Health Fund, No. 20-10914 (C.D. Cal. complaint filed Dec. 1, 2020)]

Tags: Coronavirus (COVID-19)  •  Health Plan Costs  •  Retiree Health Plans

Private Industry Employer Health Benefits Costs Rise for Year Ending September 2020
U.S. Bureau of Labor Statistics [BLS] Link to more items from this source
Nov. 30, 2020

"Health benefits costs for private industry employers increased 1.8 percent for the 12 months ending in September 2020. Employer health benefits costs have increased by 2.3 percent or less in every 12-month period since March 2017. These data begin in 1982."

Tags: Health Plan Costs

Text of HHS Final Regs: HHS-Operated Risk Adjustment Data Validation Under the ACA's HHS-Operated Risk Adjustment Program
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS] Link to more items from this source
[Official Guidance]
Nov. 30, 2020

83 pages. "This final rule adopts certain changes to the risk adjustment data validation error estimation methodology beginning with the 2019 benefit year for states where [HHS] operates the risk adjustment program. This rule is finalizing changes to the HHS-RADV error estimation methodology, which is used to calculate adjusted risk scores and risk adjustment transfers, beginning with the 2019 benefit year of HHS-RADV. This rule also finalizes a change to the benefit year to which HHS-RADV adjustments to risk scores and risk adjustment transfers would be applied beginning with the 2020 benefit year of HHS-RADV."

Tags: Health Plan Administration  •  Health Plan Costs

Text of IRS Final Regs Clarifying Premium Tax Credit Unaffected by Suspension of Personal Exemption Deduction
Internal Revenue Service [IRS] Link to more items from this source
[Official Guidance]
Nov. 30, 2020

14 pages. "This document includes final regulations under sections 36B and 6011 of the Internal Revenue Code that clarify that the reduction of the personal exemption deduction to zero for taxable years beginning after December 31, 2017, and before January 1, 2026, does not affect an individual taxpayer's ability to claim the premium tax credit. These final regulations affect individuals who claim the premium tax credit."

Tags: Health Plan Administration  •  Health Plan Costs

The 2022 Proposed Payment Notice: Risk Adjustment
Katie Keith, via Health Affairs Blog Link to more items from this source
[Guidance Overview]
Nov. 30, 2020

"This post considers the proposed changes to the risk adjustment program related to user fees, recalibration of the risk adjustment models, the model itself, enrollment duration factors, and changes to risk adjustment data validation (RADV) requirements[.]"

Tags: Health Plan Administration  •  Health Plan Costs

Text of Updated IRS FAQs: Determining the Amount of Allocable Qualified Health Plan Expenses for Purposes of Coronavirus Economic Impact Payments
Internal Revenue Service [IRS] Link to more items from this source
[Official Guidance]
Nov. 25, 2020

Questions 31-36, updated Nov. 25, 2020.

  1. Does the amount of qualified health plan expenses include both the portion of the cost paid by the Eligible Employer and the portion of the cost paid by the employee?
  2. For an Eligible Employer that sponsors more than one plan for its employees (for example, both a group health plan and a health flexible spending arrangement (health FSA)), or more than one plan covering different employees, how are the qualified health plan expenses for each employee determined?
  3. For an Eligible Employer that sponsors a fully-insured group health plan, how are the qualified health plan expenses of that plan allocated to the qualified sick or family leave wages on a pro rata basis?
  4. For an Eligible Employer who sponsors a self-insured group health plan, how are the qualified health plan expenses of that plan allocated to the qualified leave wages on a pro rata basis?
  5. For an Eligible Employer who sponsors a health savings account (HSA), or Archer Medical Saving Account (Archer MSA) and a high deductible health plan (HDHP), are contributions to the HSA or Archer MSA included in the qualified health plan expenses?
  6. For an Eligible Employer who sponsors a health reimbursement arrangement (HRA), a health flexible spending arrangement (health FSA), or a qualified small employer health reimbursement arrangement (QSEHRA), are contributions to the HRA, health FSA, or QSEHRA included in the qualified health plan expenses?

Tags: Coronavirus (COVID-19)  •  FFCRA  •  Health Plan Costs

Text of IRS Notice 2020-84: Adjusted Applicable Dollar Amount for Fee Imposed by §§ 4375 and 4376 (PDF)
Internal Revenue Service [IRS] Link to more items from this source
[Official Guidance]
Nov. 25, 2020

"The applicable dollar amount that must be used to calculate the fee imposed by Sections 4375 and 4376 for policy years and plan years that end on or after October 1, 2020, and before October 1, 2021, is $2.66. The increase from the prior amount is calculated by multiplying the adjusted applicable dollar amount for policy years and plan years ending in the previous Federal fiscal year, $2.54, by the percentage increase of the projected per capita amount of National Health Expenditures published by HHS on March 19, 2020."

Tags: Health Plan Administration  •  Health Plan Costs

CMS Issues Final Rule to Amend HHS Risk Adjustment Data Validation Program
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS] Link to more items from this source
[Official Guidance]
Nov. 24, 2020

"The final rule addresses stakeholder feedback and will provide states and issuers with more stability and predictability, promote program integrity, and foster increased competition.... [T]he rule finalizes changes to two technical aspects of the HHS-RADV program, the error rate calculation and the application of HHS-RADV results."

Tags: Health Plan Costs

State Trends in Employer Premiums and Deductibles, 2010-2019
The Commonwealth Fund Link to more items from this source
Nov. 23, 2020

"Premium contributions and deductibles in employer plans accounted for 11.5 percent of median household income in 2019, up from 9.1 percent a decade earlier. Premium contributions and deductibles were 10 percent or more of median income in 37 states in 2019, up from 10 states in 2010. Nine states have combined costs of 14 percent or more of median income. The total cost of premiums and potential spending on deductibles across single and family policies ranged from a low of $5,535 in Hawaii to a high of more than $8,500 in nine states."

Tags: Health Plan Costs

Will New Health Care Transparency Requirements Lower Cost and Improve Quality?
Epstein Becker Green Link to more items from this source
[Guidance Overview]
Nov. 20, 2020

"[C]onsumers looking to compare hospital prices will have both the hospital and plan data to look to, beginning in 2023. However, there are several key differences between the new price transparency rule for plans and issuers and the price transparency rule for hospitals, as outlined in [a chart.]"

Tags: Health Plan Costs

Managing Use of Health Care Services After People Satisfy Their Deductible: What Do Copayments and Coinsurance Do?
Employee Benefit Research Institute [EBRI] Link to more items from this source
Nov. 20, 2020

"Coinsurance reduces use of inpatient care and specialist physician office visits more than copayments do. However, while most employers already use coinsurance for inpatient care, only 44 percent use coinsurance for office visits.... [E]mployers seeking to manage use of health care services and spending -- especially among high users of health care services -- may look to moving from copayments to coinsurance for office visits as a way to do so."

Tags: Health Plan Costs  •  Health Plan Design

Better Prediction of Rising Health Spending to Improve Cost Containment
National Institute for Health Care Management [NIHCM] Link to more items from this source
Nov. 20, 2020

"Spending patterns over two years were best described by classifying patients into five groups: minimal users comprised 11 percent of the population; low-, moderate- and high-cost patients accounted for 15, 25, and 41 percent, respectively; and patients with rising costs were 8 percent of the population.... Across patients with similar baseline spending, the odds of subsequently incurring rising spending were higher for patients using fewer medications, having fewer office visits, seeing a larger number of different physicians and using tobacco. These factors suggest patients to target for intervention."

Tags: Health Plan Administration  •  Health Plan Costs  •  Health Plan Design

AMA Prescribes Actions to Ease Negative Effects of High-Deductible Health Plans
American Medical Association [AMA] Link to more items from this source
Nov. 19, 2020

"The new AMA policy encourages employers to: [1] Provide robust education to help patients make good use of their benefits to obtain the care they need. [2] Take steps to collaborate with their employees to understand employees' health insurance preferences and needs. [3] Tailor their benefit designs to the health insurance preferences and needs of their employees and their dependents. [4] Pursue strategies to help enrollees spread the costs associated with high out-of-pocket costs across the plan year."

Tags: Health Plan Costs  •  Health Plan Design

Editor's Pick Final Health Plan Transparency Regs to Phase In (2022-2024)
HUB International Link to more items from this source
[Guidance Overview]
Nov. 18, 2020

"[If] an employer with a self-funded plan enters into a contract with a TPA to have the TPA handle these disclosures, the employer, through its group health plan, is still ultimately responsible. By contrast, employers with insured plans may contract with their health insurance carrier to provide these disclosures and the carrier will ultimately be responsible. Therefore, contractual amendments will likely be coming in 2021."

Tags: Health Plan Administration  •  Health Plan Costs

Start Planning for the New Healthcare Price Transparency Rules Now
MZQ Consulting, LLC Link to more items from this source
Nov. 18, 2020

"These price transparency rules: [1] will up-end almost every type of contract out there in the health insurance industry, [2] will release a treasure trove of data into the marketplace, and [3] will take an enormous amount of effort and money to implement. Love them, hate them, or somewhere in between, you'd be hard-pressed to say they aren't bold and disruptive, and they are coming at the employee benefits industry fast!"

Tags: Health Plan Administration  •  Health Plan Costs

Final Transparency Rule Adds to Health Plans’ Disclosure Requirements
HR Daily Advisor Link to more items from this source
Nov. 18, 2020

"[T]hese cost estimates will at first be required for only 500 of the most shoppable items and services, which are listed in the final rule. For the remainder, plans will have until January 1, 2024. This disclosure must include ... [1] Estimated cost-sharing liability; [2] Accumulated amounts; [3] Negotiated rates, expressed as dollar amounts ... [4] Out-of-network allowed amounts; [5] A list of items and services included in any bundled payment arrangement; [6] A notice of prerequisites (such as prior authorization), if applicable; and [7] A disclosure notice."

Tags: Health Plan Administration  •  Health Plan Costs

ACA Round-Up: Record-High Medical Loss Ratio Rebates, Pass-Through Funding, Preventive Services
Katie Keith, via Health Affairs Blog Link to more items from this source
Nov. 18, 2020

"Overall, insurers owe record-high rebates of nearly $2.46 billion to more than 11.2 million consumers. This represents an average of $219 in rebates per person. Consistent with prior years, the rebates are most significant in the individual market, where insurers owe $1.7 billion to an estimated 5.1 million consumers. These rebates are up significantly from the $1.37 billion owed to nearly 9 million consumers last year, which was a record high relative to prior years."

Tags: Health Plan Costs

New Transparency Rules Require Health Insurers to Disclose Health Care Cost and Cost-Sharing Information
Frost Brown Todd LLC Link to more items from this source
[Guidance Overview]
Nov. 17, 2020

"The Departments have already finalized requirements for hospitals to disclose their standard charges, including negotiated rates with third-party payers, which take effect on January 1, 2021. ... The insurance pricing transparency final rule has three major aspects to making pricing information more available for consumers while incentivizing consumers to shop for services from lower-cost, higher-value providers."

Tags: Health Plan Administration  •  Health Plan Costs


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