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<< Older News  |  September 25, 2020

News

All News > Health Plan Costs

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Nationwide Evaluation of Health Care Prices Paid by Private Health Plans
RAND Corporation Link to more items from this source
Sept. 18, 2020

"In 2018, across all hospital inpatient and outpatient services, employers and private insurers ... paid 247 percent of what Medicare would have paid for the same services at the same facilities.... Some states ... had relative prices under 200 percent of Medicare; others ... had relative prices that approached 350 percent of Medicare.... High-value hospitals -- those offering low prices and high safety -- do exist."

Tags: Health Plan Costs  •  Medicare

How Payers Are Doing Financially This Year
PwC Link to more items from this source
Sept. 18, 2020

"Payers have moved into a strategic phase. They are considering strategic initiatives that were put on the back burner when COVID-19 hit in March and also working to stabilize near-term and long-term performance. Top of mind are initiatives that mitigate MLR rebates while simultaneously improving other aspects of the business. For example, payers are looking at provider partnerships to ensure members get the care they need this year and stop deferring needed care."

Tags: Health Plan Costs

San Francisco Required Contribution for Healthcare Goes Up in 2021
HUB International Link to more items from this source
[Guidance Overview]
Sept. 16, 2020

"San Francisco recently released its updated contribution requirement for 2021.... The ordinance applies to any employer that has one or more employees working regularly at least 8 hours per week (104 hours per calendar quarter) within the City/County Limit of San Francisco. This is so, even if all of the employer's other workers are located outside of San Francisco "

Tags: Health Plan Administration  •  Health Plan Costs  •  Local Regulation

Allocation of Medical Loss Ratio Rebates and Premium Refunds
Verrill Dana LLP Link to more items from this source
[Guidance Overview]
Sept. 16, 2020

"Generally, rebates attributable to premium payments made by participants or out of trust assets will be considered plan assets, and rebates attributable to employer-paid premiums will not be considered plan assets.... [DOL] Technical Release 2011-04 recognizes three approaches to dealing with the allocation of the 'plan asset' portion of the rebate. The fiduciary can: [1] pay a direct cash refund to participants; [2] provide participants with a premium discount or premium holiday; or [3] use the assets to enhance plan benefits (e.g., add a disease management or wellness program)."

Tags: Health Plan Administration  •  Health Plan Costs

Attacking Out-of-Network Spending
EPIC Link to more items from this source
Sept. 16, 2020

"[United HealthCare is] partnering with its sister company, Naviguard ... to provide the member advocacy around negotiating the balance bill levels should the provider deem the reimbursement too low. This clever tactic has been deployed by reference-based pricing companies ... to eliminate provider networks in general. UHC is now introducing it to support Medicare-based reimbursements for out-of-network services."

Tags: Health Plan Costs  •  Health Plan Design

Policies to Address Surprise Billing Could Reduce Health Insurance Premiums
American Journal of Managed Care Link to more items from this source
Sept. 14, 2020

"More than 10% of health plan spending is attributable to ancillary and emergency services that commonly surprise-bill. Reducing payment for these services by 15% would reduce premiums by 1.6% ($67 per member per year), and reducing average payment to 150% of traditional Medicare rates -- the high end of payments to other specialists -- would reduce premiums by 5.1% ($212 per member per year). These savings would reduce aggregate premiums for the nation's commercially insured population by approximately $12 billion and $38 billion, respectively."

Tags: Health Plan Costs

Sirens and Flashing Lights: With No Legal Guardrails for Patients, Ambulances Drive Surprise Medical Billing
Kaiser Health News Link to more items from this source
Sept. 14, 2020

"[S]tudies show the majority of ambulance rides leave patients saddled with hundreds of dollars in out-of-network medical bills. Yet ground ambulances have mostly been left out of federal legislation targeting 'surprise' medical bills, which happen when out-of-network providers charge more than insurers are willing to pay, leaving patients with the balance."

Tags: Health Plan Costs  •  Health Plan Design

Most Employers Intend to Offer Same Health Care Coverage in 2021
PLANSPONSOR; free registration may be required Link to more items from this source
Sept. 9, 2020

"86% of employers did not reduce their health plan benefits this year, and 79% expect to offer the same coverage in 2021. Since the start of the pandemic, more than eight in 10 employers (83%) say they have more strongly emphasized the role of specific benefits, including emotional well-being benefits (65%), leave policies (47%), medical benefits (39%) and physical well-being benefits (36%)."

Tags: Health Plan Costs  •  Health Plan Design  •  Misc. Benefits

Washington State Public Option Fails to Deliver Savings to Consumers
U.S. Chamber of Commerce Link to more items from this source
[Opinion]
Sept. 9, 2020

"As a perilous test case for the nation, the state of Washington is unfortunately experiencing firsthand the harms of the public option. Despite the utopian promise envisioned by allowing consumers to choose a health insurance program run by the government rather than purchasing private insurance on their own or offered by their employer, premiums associated with this new option are even higher."

Tags: Health Plan Costs  •  Health Plan Design

Health Care Costs for 2020 Likely to Be Lower Than Expected
Wolters Kluwer; free registration required Link to more items from this source
Sept. 8, 2020

"Direct costs related to COVID-19 varied widely among plans, but a significant amount of care was delayed or cancelled in the first half of the year. Even accounting for unplanned expenses due to COVID-19 testing and treatment, overall health care costs are likely to be lower in 2020 than was projected prior to the pandemic[.]"

Tags: Health Plan Costs

How Should Employers Think About Resetting Health Benefits Post-Pandemic?
Willis Towers Watson Link to more items from this source
Sept. 4, 2020

"[U]nit cost pressure ... utilization pressure ... [and] the rapid expansion in digital health ... point to the emergence of a stronger seller's market in health care, even more than before COVID-19. That's if employers and others representing the payers' and patients' interests fail to act. So what can we do to prepare in anticipation of a potential spike in both unit cost and utilization in the coming years?"

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

New 'Care Compare' from CMS Empowers Patients when Making Important Health Care Decisions
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS] Link to more items from this source
Sept. 3, 2020

"Today, ... [CMS] launched Care Compare ... [which] provides a single user-friendly interface that patients and caregivers can use to make informed decisions about healthcare based on cost, quality of care, volume of services, and other data. With just one click, patients can find information that is easy to understand about doctors, hospitals, nursing homes, and other health care services instead of searching through multiple tools."

Tags: Health Plan Costs  •  Health Plan Information for Employees  •  Medicare

Some COVID Cost-Sharing Waivers Would Expire Soon
AISHealth Link to more items from this source
Sept. 3, 2020

"80% of enrollees in the individual and fully insured group insurance markets were in plans that voluntarily waived out-of-pocket costs for COVID-19 at some point during the pandemic.... 20% of individual and fully insured group plan enrollees are in plans where a cost-sharing waiver for COVID-19 treatment has already expired, and another 16% are in plans where the waiver is scheduled to expire by the end of September."

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

Controlling the Rising Costs of Health Benefits
HealthEquity Link to more items from this source
Sept. 3, 2020

"The COVID-19 pandemic promises to constrain budgets while driving healthcare costs even higher.... [One analysis] projects that rising healthcare claims could drive benefits cost increases as high as 7 percent -- outpacing the 5 percent increase previously anticipated for the year.... [1] Create a culture of wellbeing ... [2] Help your people make better benefits decisions ... [3] Evaluate your programs with data ... [4] implement cost-saving strategies in your benefits program."

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

What Does the NJ Health Insurance Tax Mean for Employers?
Corporate Synergies Link to more items from this source
Sept. 1, 2020

"New Jersey Governor Phil Murphy recently signed a new law levying a 2.5% health insurance tax on net premiums collected for individual and large business plans across the state. Premiums for small businesses ... [and] certain self-funded coverages are not included.... It is expected to raise more than $200 million each year, funding a reinsurance program ... and subsidies for consumers. Both are designed to help low- and middle-income families who have limited access to affordable health insurance."

Tags: Health Plan Costs  •  Local Regulation

San Francisco Posts 2021 Health Care Expenditure Rates
Mercer Link to more items from this source
[Guidance Overview]
Sept. 1, 2020

"Large employers with 100 or more employees will pay a 2021 HCE rate of $3.18, up from $3.08 in 2020. Medium employers with 20-99 workers and nonprofits with 50-99 employees will pay a 2021 HCE rate of $2.12, up from $2.05.... [E]mployers cannot use a COBRA-equivalent rate to determine their quarterly expenditures for employees enrolled in self-funded plans. Instead, these plans must use one of two options to determine expenditures: fixed expenditures or paid healthcare claims."

Tags: Health Plan Administration  •  Health Plan Costs  •  Local Regulation

Comparing Commercial and Medicare Professional Service Prices
Health Care Cost Institute [HCCI] Link to more items from this source
Aug. 31, 2020

"[F]rom 2014 to 2018, prices accounted for about 75 percent of the increase in spending above inflation.... [C]ommercial prices for professional services were, on average, 122% of Medicare rates nationally in 2017. Average commercial prices varied dramatically across states, from below Medicare rates in Alabama (98% of Medicare) to nearly twice Medicare rates in Wisconsin (188% of Medicare).... [T]he difference between commercial and Medicare prices was largest in northwestern states."

Tags: Health Plan Costs  •  Health Plan Design  •  Medicare

ERIC Appeals Seattle Employer Health Care Mandate Decision to Ninth Circuit Court of Appeals
The ERISA Industry Committee [ERIC] Link to more items from this source
[Opinion]
Aug. 28, 2020

"Companies affected by Seattle's health ordinance already provide health benefits to their workers in Seattle in compliance with federal law. The ordinance would require those companies to amend their federally regulated health plan, a mandate that violates [ERISA] ... [ERIC is] taking this case to the Ninth Circuit so it will reverse the district court's decision, ending the Ninth Circuit's deviation from the Supreme Court and other courts' recognition that ERISA preempts state and local laws that seek to mandate the substance, value, or structure of employer-sponsored health benefits." [The ERISA Industry Committee v. City of Seattle, No. 20-35472 (notice of appeal to 9th Cir. filed Aug. 27, 2020)]

Tags: ERISA Preemption  •  Health Plan Costs  •  Health Plan Design  •  Local Regulation

San Francisco Releases 2021 HCSO Expenditure Rates
ABD Insurance & Financial Services Link to more items from this source
[Guidance Overview]
Aug. 27, 2020

"Under the HCSO, Covered Employers with 20 or more employees (50 or more employees for nonprofits) in any quarter are required to make a minimum level of health care expenditures for that quarter for employees who: [1] Have been employed by the employer for at least 90 days, [2] Have performed at least 8 hours of work per week in San Francisco, and [3] Do not meet one of the five exemption criteria ... Even though the April 2020 reporting for 2019 HCSO expenditures was cancelled, employers are still required to make the 2020 quarterly expenditures."

Tags: Health Plan Costs  •  Local Regulation

Temporary Premium Credits: New Rule Clarifies Risk Adjustment and Medical Loss Ratio Standards
Katie Keith, in Health Affairs Blog Link to more items from this source
[Guidance Overview]
Aug. 27, 2020

"[C]urrent CMS regulations would require insurers to report premium credits as part of their full earned premium for purposes of the 2020 medical loss ratio (MLR) and the risk adjustment program.... As expected, the new interim final rule addresses those areas with the goal of ensuring accurate reporting of premiums, including premium reductions, for 2020."

Tags: Health Plan Costs  •  Health Plan Policy

Retired Hollywood Actors Protest Changes to SAG-AFTRA Health Plan
Portside Link to more items from this source
Aug. 27, 2020

"As a result of pandemic-fueled financial troubles, SAG-AFTRA on August 12 announced significant raises to premiums and minimum earnings requirements that it says are necessary to keep the entire plan afloat.... Members under 65 will ... have to earn $25,950 or work at least 100 days during a 12-month base earnings period to qualify for coverage. But the biggest change for seniors is that they will no longer be able to count residuals -- which many Hollywood retirees rely on as a fixed income -- towards that minimum earnings count."

Tags: Health Plan Costs  •  Health Plan Design  •  Retiree Health Plans

The Tradeoff Between Employer Premium Contributions and Wages
UC Berkeley Labor Center Link to more items from this source
[Opinion]
Aug. 27, 2020

"[T]he bulk of the research literature indicates that, one way or another, most of the burden of ever-increasing health care costs falls on the shoulders of workers. That burden may come in the form of lower wages, higher premium contributions, or higher out-of-pocket costs. All these impacts are likely to have more severe consequences for low- and moderate-income workers, but rising health care costs affect the economic well-being of all workers with job-based coverage."

Tags: Health Plan Costs  •  Health Plan Policy

Closing the Gap on Preventive Care Could Reduce Lost Productivity for Employers
Integrated Benefits Institute Link to more items from this source
Aug. 26, 2020

"Depression represents a disproportionately high productivity cost to employers: averaging $17 per employee per year in disability wage replacement costs compared with $2 for diabetes, the next-highest chronic condition. Screening gaps are less dramatic for cancers but opportunities for improvement in disability leave is still substantial.... Employees who take leave for cancer ... at earlier ages take less time off from work than those who enter the disability system at a later age, suggesting the potential for lower disability leave costs and better health outcomes if cancers are detected earlier on."

Tags: Health Plan Costs  •  Health Plan Design

Text of CMS Technical Fact Sheet: CCIIO Premium Reductions Provisions (PDF)
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS] Link to more items from this source
[Official Guidance]
Aug. 26, 2020

"[On August 25,] CMS issued a sweeping array of new rules and waivers of federal requirements, including provisions addressing the individual and small group health insurance markets.... [F]or the purposes of 2020 benefit year risk adjustment data submissions, issuers of risk adjustment covered plans that provide temporary premium reductions must report the adjusted plan premiums that reflect actual premiums billed to enrollees for any temporary premium credits provided.... HHS's calculation of risk adjustment payment and charges for the 2020 benefit year under the state payment transfer formula will be calculated using the statewide average premium that includes the lower premiums billed by issuer offering these temporary premium reductions.... [F]or the purposes of MLR reporting and rebates, ... issuers that elect to provide temporary premium reductions must report as earned premium the actual, lower premium billed to enrollees for any temporary premium credits provided for the applicable months of 2020 coverage." [Unnumbered and undated; published on CMS website Aug. 25, 2020]

Tags: Health Plan Administration  •  Health Plan Costs

Alphabet's Verily Plans to Use Big Data to Help Employers Predict Health Insurance Costs
Fortune Link to more items from this source
Aug. 26, 2020

"Verily, the Alphabet Inc. life sciences unit that's previously targeted mosquito-borne illness and launched COVID-19 testing programs, is getting into the health insurance business.... Verily hopes that by adding its data-crunching and technological prowess to the equation, it can help employers more accurately assess what sort of risks they face and, eventually, intervene to better predict and control health-care spending on individual employees.... But the move could fan growing concerns about who has access to health-care data, and for what purposes."

Tags: Health Plan Costs  •  Health Plan Design


<< Older News  |  September 25, 2020

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