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All News > Health Plan Design

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CMS Fact Sheet: Proposed Regs for Coverage of Certain Preventive Services Under the ACA
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS] Link to more items from this source
[Guidance Overview]
Jan. 30, 2023

"The proposed rules would leave in place the existing religious exemption for entities and individuals with objections, as well as the optional accommodation for contraception, while also establishing a new pathway -- referred to as an individual contraceptive arrangement -- that individuals enrolled in plans or coverage sponsored, arranged, or provided by objecting entities that are not eligible for or have not opted for the existing accommodation may use to obtain contraceptive services at no cost directly from a willing provider or facility that furnishes contraceptive services."

Tags: Health Plan Design

Administration Proposes New Rules to Expand Access to Birth Control Coverage Under the ACA
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS] Link to more items from this source
[Guidance Overview]
Jan. 30, 2023

"The proposed rules seek to ensure broader access to contraceptive services by creating an independent pathway for individuals enrolled in plans arranged or offered by objecting entities to make their own choice to access contraceptive services directly through a willing contraceptive provider without any cost. This would allow women and covered dependents to navigate their own care and still obtain birth control at no cost in the event their plan or insurer has a religious exemption and, if eligible, has not elected the optional accommodation."

Tags: Health Plan Design

Text of Proposed Regs: Coverage of Certain Preventive Services Under the ACA
U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department Link to more items from this source
[Official Guidance]
Jan. 30, 2023

"Current regulations include exemptions and optional accommodations for entities and individuals with religious or moral objections to coverage of contraceptive services. These rules propose rescinding the moral exemption rule. These proposed rules also would establish a new individual contraceptive arrangement that individuals enrolled in plans or coverage sponsored, arranged, or provided by objecting entities may use to obtain contraceptive services at no cost directly from a provider or facility that furnishes contraceptive services. Contraceptive services would be available through the proposed individual contraceptive arrangement without any involvement on the part of an objecting entity. Under these proposed rules, a provider or facility that furnishes contraceptive services in accordance with the individual contraceptive arrangement for eligible individuals would be able to be reimbursed for its costs by entering into an arrangement with an issuer on a Federally-facilitated Exchange or State Exchange on the Federal platform, which in turn may seek a user fee adjustment."

Tags: Health Plan Design

2023 Employee Benefits and Workplace Predictions: This Year's Must-Have Benefits
BenefitsPro; free registration required Link to more items from this source
Jan. 30, 2023

"2023 is the year that fertility becomes health care ... Comprehensive benefits packages will continue despite the economic downturn ... Personalized benefits navigation ... Fixing the Family Glitch will accelerate a shift away from employer sponsored health care ... Employers will expand leave and benefits policies for caregiving ... Frictionless benefits ... Employers continue to absorb health care premiums and other costs ... Progressive employee benefits."

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

Health Savings Account Balances, Contributions, Distributions, and Other Vital Statistics, 2021
Employee Benefit Research Institute [EBRI] Link to more items from this source
Jan. 27, 2023

"Despite a rebound in out-of-pocket health care spending in 2021, HSA balances increased on average over the course of the year.... Accounts that received an employer contribution saw higher total contributions and were more likely to invest.... Most accountholders took a distribution in 2021.... Age and tenure play a major role in HSA utilization."

Tags: HSAs  •  Health Plan Design

Which Benefits Are Valued Most Depends on Age of Workers (PDF)
Employee Benefit Research Institute [EBRI] Link to more items from this source
Jan. 27, 2023

"[M]iddle-aged employees reported being more likely than younger or older workers to be concerned about various aspects of their well-being. Older workers were, unsurprisingly, focused on retirement benefits. And younger workers highly valued help with day-to-day bills, student loan debt assistance, and career advancement opportunities."

Tags: Health Plan Design  •  Retirement Plan Design

Projected 2024 HSA, HDHP and Excepted-Benefit HRA Figures
Mercer Link to more items from this source
Jan. 26, 2023

"Mercer projects the 2024 inflation-adjusted amounts for health savings accounts (HSAs), high-deductible health plans (HDHPs) and excepted-benefit health reimbursement arrangements (HRAs) will rise significantly from 2023 levels.... [A table] shows the projected HSA, HDHP and excepted-benefit HRA amounts for 2024, along with the 2023 and 2022 values for comparison."

Tags: HRAs  •  HSAs  •  Health Plan Design

Potential Effects of Federal Network Adequacy Standards for Qualified Health Plans (PDF)
Wakely Consulting Group, for America’s Health Insurance Plans [AHIP] Link to more items from this source
Jan. 26, 2023

"Issuers stated that the new regulation, while well-intentioned, has shortcomings that will result in negative downstream impacts to consumers ... [which] may include higher premiums, lower quality of care, and a less consumer-friendly experience.... [C]oncerns focused on ... [1] the negative effects of adding more providers to existing networks, [2] difficulties in negotiations with providers to meet the new requirements, and [3] the CMS oversight process."

Tags: Health Plan Costs  •  Health Plan Design  •  Health Plan Policy

Designing Health Plans with Different Strategies for Certain Classes of Employees
Newfront Link to more items from this source
Jan. 26, 2023

"Employers taking a class-based health plan design approach should ensure the class distinctions are [1] clearly communicated to employees in any plan materials addressing eligibility, [2] approved by the insurance carriers and/or stop-loss providers, and [3] designed to comply with any applicable nondiscrimination rules."

Tags: Health Plan Design

Employer Health Plans Face Competition for High-Quality Doctors
Bloomberg Law Link to more items from this source
Jan. 26, 2023

"Commercial health plans offered by employers will have to do more to hold on to high-quality medical providers who are being attracted to high-paying Medicare Advantage plans ... Employer-sponsored commercial plans, which cover about 157 million people in the US, typically pay higher rates for health-care services than Medicare's fee-for-service system, which pays for each individual service. But Medicare Advantage, a private plan alternative to traditional Medicare, is rapidly gaining popularity, covering more than 28 million people in 2022."

Tags: Health Plan Costs  •  Health Plan Design

High Deductible Health Plan Telehealth Relief, Extended Again
Snell & Wilmer L.L.P. Link to more items from this source
[Guidance Overview]
Jan. 25, 2023

"The 2023 CAA telehealth relief is optional. Employers may, but do not have to, provide telehealth and other remote care services on a pre-deductible basis. However, employers that choose not to provide telehealth on a pre-deductible basis still must comply with FFCRA which ... requires group health plans to cover ... certain COVID-19 diagnostic tests and related services provided during telehealth visits until the end of the Public Health Emergency."

Tags: HSAs  •  Health Plan Design  •  Teleheath

CRS Report: Health Care Provisions of the Budget Reconciliation Measure
Congressional Research Service [CRS] Link to more items from this source
[Guidance Overview]
Jan. 25, 2023

65 pages. "[This report] provides a table with abbreviated summaries of each health provision in P.L. 117-169. Following the table, the report provides a detailed summary of each provision. Appendix A contains commonly used prescription drug and health insurance terms referenced throughout the report. Appendix B includes a table with a list of the abbreviations used in this report." [R47396 Jan. 24, 2023]

Tags: Health Plan Design  •  Health Plan Policy  •  Medicare  •  Prescription Drug Costs

How Not to Do Universal Coverage
Physicians for a National Health Program [PNHP] Link to more items from this source
[Opinion]
Jan. 24, 2023

"An appealing-sounding proposal for universal health insurance envisions a 'social floor' 'basic bundle' of medical care, to be supplemented by those that can afford more. It thus needlessly sacrifices the efficiency, equity, and unity available with single payer."

Tags: Health Plan Design  •  Health Plan Policy

Viable Funding Alternatives for Health Benefits Can Benefit Smaller Firms
Corporate Synergies Link to more items from this source
Jan. 24, 2023

"[S]elf-insured plans work best for small to mid-size businesses when they have very engaged employees, a younger or healthier workforce and good wellness plans.... [T]here are alternative approaches ... One option ... is minimum premium plans, a kind of hybrid between self- and fully insured.... Some employers self-fund a portion of their coverage, such as prescription coverage."

Tags: Health Plan Costs  •  Health Plan Design

Benefits Issues Facing Higher Education Institutions
Bradley Link to more items from this source
Jan. 24, 2023

"[1] Politics and communication ... [2] ACA and school year contracts ... [3] Student employees ... 4. 457(b) plans ... [5] Retiree medical benefits."

Tags: 457 Plans  •  Health Plan Design  •  Retiree Health Plans

UnitedHealthcare Launches Behavioral Health Coaching Program
FierceHealthcare Link to more items from this source
Jan. 20, 2023

"The offering is available as of Jan. 1 for 5 million fully insured members, and self-insured employers can also purchase the program as an employer benefit. Through the program, adults with symptoms of mild depression, stress and anxiety can access support for their mental health needs through virtual modules as well as one-on-one video conferences, phone calls or messaging with coaches."

Tags: Health Plan Design

Public Health Emergency Extended Once Again: Effect on Group Health Plans
Sequoia Link to more items from this source
[Guidance Overview]
Jan. 20, 2023

"[T]he public health emergency ... is now effective through April 11, 2023.... [G]roup health plans must continue to provide coverage related to the testing (including certain over-the-counter tests) and diagnosis of COVID-19 without cost-sharing requirements ... Similarly, coverage for the COVID-19 vaccine must be provided (by non-grandfathered group health plans) without cost sharing for both in- and out-of-network providers."

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

Meet America's Largest Employer of Physicians: UnitedHealth Group
Becker's Healthcare Link to more items from this source
Jan. 19, 2023

"The largest employer of physicians in the United States is not HCA, the VA, or Kaiser Permanente -- it's UnitedHealth Group's Optum. With at least 60,000 employed or aligned physicians across 2,000 locations in 2023, Optum has cemented itself at the forefront of the quickly changing healthcare delivery landscape.... From 2019 to 2022, corporate-owned practices grew 86 percent while corporate employment of physicians grew 43 percent[.]"

Tags: Health Plan Costs  •  Health Plan Design

Congress Extends Pre-Deductible Telehealth Coverage for HDHPs
Bolton Link to more items from this source
[Guidance Overview]
Jan. 18, 2023

"HDHPs may choose to waive the deductible for any telehealth services for plan years beginning in 2023 and 2024 without causing participants to lose HSA eligibility. This provision is optional; HDHPs can continue to choose to apply any telehealth services toward the deductible."

Tags: HSAs  •  Health Plan Design

MHPAEA Exemption Eliminated for Self-Funded Non-Federal Governmental Health Plans
Woodruff Sawyer Link to more items from this source
[Guidance Overview]
Jan. 18, 2023

"The CAA, 2023 ... sunsets provisions of the Public Health Service Act which permitted large, self-funded, non-federal governmental plans ... to opt out of the Mental Health Parity and Addiction Equity Act (MHPAEA).... [A]ny self-funded state and local governmental plans that have not previously elected to opt out of the MHPAEA will no longer be able to submit an election to opt out. Further, any self-funded state and local governmental plans that previously elected to opt out of the MHPAEA will be unable to renew their election once it expires."

Tags: Health Plan Design  •  State and Local Government Plans

Workplace Wellness Trends to Watch in 2023
HR Daily Advisor Link to more items from this source
Jan. 17, 2023

"Hybrid work will be here to stay.... The rise of the four-day work week.... Mental well-being has taken center stage.... The labor movement will grow.... Well-being is a shared responsibility."

Tags: Health Plan Design  •  Misc. Benefits

'My Employees Are Eating Themselves to Death'
InsuranceNewsNet.com Link to more items from this source
Jan. 17, 2023

"The cost of obesity to American businesses is staggering, running into the billions of dollars and impacts all employers through increased rates of health and workers' compensation insurance. So, how much control, if any, can employers exert over what their employees are eating while on the job?"

Tags: Health Plan Costs  •  Health Plan Design

Will Your Smartphone Be the Next Doctor's Office?
Kaiser Health News Link to more items from this source
Jan. 17, 2023

"The same devices used to take selfies and type out tweets are being repurposed and commercialized for quick access to information needed for monitoring a patient's health.... Although doctors and their patients have found some real-world success in deploying the phone as a medical device, the overall potential remains unfulfilled and uncertain."

Tags: Health Plan Design

Changes in Health Insurance Coverage, 2019-2021: Geographic and Demographic Patterns in the Uninsured Rate
Assistant Secretary for Planning and Evaluation [ASPE], U.S. Department of Health and Human Services [HHS] Link to more items from this source
Jan. 16, 2023

"This Issue Brief examines the composition of the population that is uninsured and highlights changes in uninsured rates by geography and demographic factors from 2019 to 2021, during a time of significant federal policy efforts to expand coverage.... [T]he national uninsured rate declined during this period, with larger coverage gains for younger adults; Latino, American Indian, and Alaska Native individuals; non-English speaking adults; and people living in states that recently expanded Medicaid."

Tags: Health Plan Design  •  Health Plan Policy

State Strategies for Controlling Health Costs: Implementation Guides
The Commonwealth Fund Link to more items from this source
Jan. 13, 2023

"Each guide lays out key design decisions that policymakers will need to make, as well as the strategic and operational considerations for success.... [1] Limiting the rate of growth in provider prices.... [2] Capping high provider prices.... [3] Adopting multipayer value-based payment models.... [4] Adopting multipayer hospital global budgets.... [5] Using rate review to make health insurance more affordable."

Tags: Health Plan Costs  •  Health Plan Design  •  Health Plan Policy

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