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All News > Health Plan Design

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HHS Suspends Georgia Health Insurance Market Waiver
InsuranceNewsNet.com Link to more items from this source
Aug. 10, 2022

"Georgians would have enrolled in insurance plans through private insurance brokers rather than the federal healthcare.gov health insurance marketplace. The plan ... initially gained federal approval under then-President Donald Trump in November 2020. [A]fter the Biden administration took office, [HHS] asked Georgia to submit a revised plan for the waiver ... Georgia challenged the HHS findings and did not submit the requested changes to the plan.... Now, HHS has suspended Georgia's waiver plan."

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

District Court: Religious Employer Violated Title VII by Revoking Health Coverage for Employee's Same-Sex Spouse
Thomson Reuters Practical Law Link to more items from this source
Aug. 10, 2022

"[A] dependent audit performed by the plan's administrator flagged the same sex spouse's coverage.... Consistent with the employer's religious belief ... the HR executive informed the employee that ... [t]he spouse's coverage would be terminated at the end of the month ... [T]he employer argued that it was exempt from Title VII based on its status as a religious organization.... Rejecting this interpretation, the district court concluded that ... religious organizations are not exempt from Title VII's prohibition against discrimination based on characteristics other than religion. " [Doe v. Catholic Relief Services, No. 20-1815 (D. Md. Aug. 3, 2022)]

Tags: Health Plan Administration  •  Health Plan Design

Managing State Law Risks of Employer-Sponsored Abortion-Related Travel Benefits After Dobbs
Mintz Link to more items from this source
Aug. 9, 2022

"[W]ith Dobbs, the judicial process has taken on a political gloss. To what extent can any precedent now be relied on? Employers need to take this new 'political' risk into account as the weigh their plan design options. This calculus extends to directors, officers, and LLC managers, who might be targeted personally."

Tags: Health Plan Administration  •  Health Plan Design

Navigating Mental Health Parity Requirements for Travel Benefits
Dickinson Wright Link to more items from this source
[Guidance Overview]
Aug. 8, 2022

"Many employers are considering implementing travel reimbursement options to assist employees who wish to seek abortions that might be restricted by the law in their home states.... In this post, [the authors] take a deeper dive into the MHPAEA requirements, its limited exceptions, how employers might be able to comply with those rules when making a travel benefit available, and provide a brief overview of how employers might prepare for an MHPAEA audit."

Tags: Health Plan Design

HHS Proposes Rule Strengthening Section 1557 Protections Against Nondiscrimination in Health Activities
BakerHostetler Link to more items from this source
[Guidance Overview]
Aug. 8, 2022

"The Proposed Rule aims to realign the scope of Section 1557 -- which has been subject to several regulatory changes, interpretations and litigation throughout several presidential administrations -- with the underlying statutory and regulatory intent, after the 2020 Final Rule regarding Section 1557 was limited in its reach following challenges to the regulation in litigation."

Tags: Health Plan Administration  •  Health Plan Design

HHS Proposes Regs Expanding ACA Non-Discrimination Testing
Willis Towers Watson Link to more items from this source
[Guidance Overview]
Aug. 8, 2022

"The new proposed regulations affirm the Biden administration's executive order protections against discrimination on the basis of sex -- including sexual orientation and gender identity."

Tags: Health Plan Administration  •  Health Plan Design

Expanding Pre-Deductible Coverage for Certain Prescription Drugs Has Limited Impact on Premiums (PDF)
Employee Benefit Research Institute [EBRI] Link to more items from this source
Aug. 5, 2022

"The impact on premiums of expanding pre-deductible coverage to 116 drug classes related to chronic disease management medications in HSA-eligible health plans is relatively small (range 1.3–4.7 percent).... Premiums increased the least ... when employers imposed coinsurance instead of a deductible and when increased use of prescription drugs led to reduced use of other medical services."

Tags: HSAs  •  Health Plan Design  •  Prescription Drug Costs

Health Insurance Providers Expand Networks to Address Growing Mental Health Care Demands
America's Health Insurance Plans [AHIP] Link to more items from this source
Aug. 5, 2022

"All respondents (100%) provide coverage for tele-behavioral health services. The number of in-network behavioral health providers has grown by an average of 48% in 3 years among commercial health plans. The overwhelming majority of health plans (89%) are actively recruiting mental health care providers ... The number of providers eligible to prescribe Medication Assisted Therapy (MAT) for substance use disorder, including opioid dependence, has more than doubled -- growing 114% over 3 years."

Tags: Health Plan Design  •  Teleheath

President Biden Issues Second Executive Order Responding to Dobbs Decision
Thomson Reuters Practical Law Link to more items from this source
Aug. 5, 2022

"The White House ... executive order announces a policy of supporting women's ability to access reproductive health care by traveling to seek abortion care in states where it is legal."

Tags: Health Plan Design  •  Health Plan Policy

What Employers Need to Know in a Post-Dobbs Landscape
Sheppard Mullin Link to more items from this source
Aug. 4, 2022

"This article analyzes several employment law issues employers may face following the Dobbs decision.... Travel benefits for employees seeking reproductive care ... [1] Is the employer's benefit plan subject to ERISA? ... [2] What procedures does the plan cover? ... [3] Specific or 'general' travel stipends? ... [4] What about privacy concerns?"

Tags: Health Plan Design

Room for Improvement in Diabetes and Blood Pressure Care
Willis Towers Watson Link to more items from this source
Aug. 4, 2022

"Although costs of family health insurance plans now exceed $21,000, people in the U.S. continue to receive poor outcomes from healthcare. [Employers] can insist on meaningful quality reporting from health plans and encourage them to implement provider payment and/or performance guarantees to reward higher quality care. Vendor reporting that includes race and other demographic variables can help identify the unmet needs of [plan] participants."

Tags: Health Plan Design

Should Health Plans Pay for Medical Cannabis?
Withum Smith+Brown, PC Link to more items from this source
Aug. 4, 2022

"As we inch closer to the federal legalization of cannabis, everyone is wondering, are my health plans going to start covering the cost of my medical cannabis? ... The first and biggest hurdle for cannabis coverage is that cannabis would need to be FDA approved.... If FDA approval were obtained, health plans would then focus on the cost of insurance benefits and other factors during the implementation of medical cannabis coverage."

Tags: Health Plan Design

Federal Officials Clarify Contraceptive Coverage Requirements
Health Affairs Link to more items from this source
[Guidance Overview]
Aug. 3, 2022

"The latest round of frequently asked questions may be the strongest clarification to date of what is expected of plans and insurers. The agencies emphasize enforcement actions that could be taken for the failure to comply—including penalties that the agencies could impose. And state restrictions on contraception may be preempted by the preventive services provision, known as Section 2713 of the Public Health Service Act."

Tags: Health Plan Design

Employers' Medical Group Plans After Dobbs
Burns Levinson Link to more items from this source
Aug. 3, 2022

"If an employer decides to adopt travel benefits for abortions in its group medical plan, travel costs should also be extended on the same terms for any other medical procedures, mental health or addiction care to avoid inadvertent violation of federal non-discrimination laws. The employer should not have access to any participant's health information for which the participant received benefits under the employer's group medical plan or another arrangement."

Tags: Health Plan Design

Out-of-the-Box Benefits to Boost Recruiting
HR Daily Advisor Link to more items from this source
Aug. 3, 2022

"When it comes to benefits, your business is likely already offering some obvious ones. Healthcare. Dental. Vision. All of these things are important, to be sure, but in today's recruitment market, you may need to go above and beyond to recruit great employees to your company. The sky is the limit in terms of what you can help your employees within order to keep them around."

Tags: Health Plan Design  •  Misc. Benefits

Amazon's Foray Into Primary Care Won't Be Easy
Harvard Business Review Link to more items from this source
[Opinion]
Aug. 3, 2022

"America's health care system seems, paradoxically, both endlessly innovative and profoundly dysfunctional.... Could Amazon's $3.9 billion acquisition be the breakthrough that will change all this?  ... We should never underestimate Amazon. But we also shouldn't underestimate the challenges it faces in working its usual magic in America's huge, troubled, tangled health care sector."

Tags: Health Plan Costs  •  Health Plan Design

Why Virtual Primary Care Is Going Viral
Centivo Link to more items from this source
Aug. 3, 2022

"[T]he movement shifts the concept of off-hours or urgent online visits to that of a virtual yet consistent care team that replaces the traditional in-office primary care relationship....Virtual primary care can treat more than people think.... Virtual primary care reduces unnecessary ER and urgent care visits -- and costs.... Virtual primary care doctors work with in-person providers, too."

Tags: Health Plan Design  •  Teleheath

ACA Shocker: 2023 Affordability Percentage Will Be the Lowest Ever
Accord Link to more items from this source
[Guidance Overview]
Aug. 2, 2022

"The 2023 open enrollment season is quickly approaching and more so than any year to date employers are going to need to use extreme caution to ensure its health plan is affordable.... In 2023 the affordability threshold will be 9.12 percent which is the lowest the number has ever been since the ACA's inception. The number is down significantly from the 2022 amount of 9.61 percent."

Tags: Health Plan Costs  •  Health Plan Design

Administration Delivers New Proposed Rules on ACA's Section 1557 Nondiscrimination Provision
Lockton Link to more items from this source
[Guidance Overview]
Aug. 2, 2022

"The proposed rules apply a broader 'covered entity' definition than the definition included in the currently effective 2020 final rules.... [M]any group health plans will be indirectly affected as the rules include any entity that provides or administers health-related services including health benefits (including telehealth benefits) offered by health insurance carriers in relation to fully insured group health plans as well as the carrier's TPA services provided to self-insured plans."

Tags: Health Plan Design

District Court Vacates Rebuttable Presumption Under No Surprises Act Rules for Air Ambulance Service Providers
Thomson Reuters Practical Law Link to more items from this source
Aug. 2, 2022

"The qualifying payment amount (QPA) presumption at issue in this case is similar to the one regarding emergency services (and certain other services) that the district court vacated last February in litigation brought by general health providers. The same judge who issued the February 2022 ruling also decided the current case involving air ambulance services." [LifeNet v. HHS, No. 22-162 (E.D. Tex. Jul. 26, 2022)]

Tags: Health Plan Costs  •  Health Plan Design

Agencies Caution Group Health Plans to Ensure Contraception Coverage to Extent Legally Required
EPIC Link to more items from this source
[Guidance Overview]
Aug. 1, 2022

"On June 27, 2022, the Departments released a letter encouraging group health plans to fully comply with requirements to cover contraception with no cost-sharing. Under the [ACA], all non-grandfathered individual and group health plans are required to provide preventive services coverage with no cost-sharing. The guidance is clear that medically appropriate or necessary contraception must be fully covered by the group health plan."

Tags: Health Plan Design

The Dobbs Effect: Litigation Over Equal Access to Travel Benefits
Seyfarth Link to more items from this source
Aug. 1, 2022

"Litigants are challenging as discriminatory under Title VII, employer travel benefits that enable employees to travel in order terminate pregnancies in states where it remains legal. Specifically, litigants have begun to assert that providing travel benefits for the purpose of terminating a pregnancy is unlawful if the employer does not also allow travel benefits for pregnant women who intend to carry their pregnancy to term."

Tags: Health Plan Design

Are We There Yet? CAA and Transparency in Coverage
Spencer Fane Link to more items from this source
[Guidance Overview]
July 29, 2022

"[This article provides] a summary of the various requirements and reminders about where group health plans should be in terms of compliance to date.... Requirements effective for plan years beginning on or after January 1, 2022 ... Previous requirements ... Delayed requirements."

Tags: Health Plan Administration  •  Health Plan Design

Text of ACA FAQs Part 54: Preventive Services Requirements for Contraceptive Coverage (PDF)
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]
July 28, 2022

13 pages. 14 Q&As. "Public Health Service (PHS) Act section 2713 and its implementing regulations ... require non-grandfathered group health plans and health insurance issuers offering non-grandfathered group or individual health insurance coverage to cover, without the imposition of any cost-sharing requirements, [specified] items or services ... [P]lans and issuers must currently provide coverage consistent with the 2019 HRSA-Supported Guidelines, and must provide coverage consistent with the 2021 HRSA- Supported Guidelines beginning with plan years (in the individual market, policy years) starting on and after December 30, 2022. The guidance provided in these FAQs regarding the contraceptive coverage requirement under PHS Act 2713 is equally applicable to both the 2019 HRSA-Supported Guidelines and the 2021 HRSA-Supported Guidelines, unless otherwise specified....

  • "Are plans and issuers required to cover items and services that are integral to the furnishing of a recommended preventive service, such as anesthesia necessary for a tubal ligation procedure? ...
  • "Are plans and issuers required to cover, without the imposition of any cost sharing, contraceptive products and services that are not included in a category of contraception described in the HRSA-Supported Guidelines? ...
  • "Are plans and issuers required to cover FDA-approved emergency contraception, including emergency contraception that is available over-the-counter (OTC)? ...
  • "Can a health savings account (HSA), health flexible spending arrangement (health FSA) or health reimbursement arrangement (HRA) reimburse expenses incurred for OTC contraception obtained without a prescription? ...
  • "How can a plan or issuer determine whether a medical management technique is reasonable for purposes of the requirements under PHS Act section 2713? ...
  • "If a plan or issuer utilizes medical management techniques within a category of contraceptives, what constitutes an easily accessible, transparent, and sufficiently expedient exceptions process that is not unduly burdensome on the individual or their provider (or other individual acting as a patient's authorized representative)? ...
  • "May a plan or issuer require a participant, beneficiary, or enrollee to appeal an adverse benefit determination using the plan or issuer's internal claims and appeals process30 as the means for an individual to obtain an exception? ...
  • "Does federal law preempt a state law that prevents the application of PHS Act section 2713? ...
  • "What should an individual do if the individual has difficulty accessing contraceptive coverage under their group health plan or group or individual health insurance coverage?"

Tags: Health Plan Design

Agencies Issue Guidance Regarding Birth Control Coverage
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
[Guidance Overview]
July 28, 2022

"In response to increasing complaints from women and covered dependents about not receiving this coverage, the Departments issued this guidance to remind plans and issuers of the ACA's contraceptive coverage requirements and emphasize the Departments' commitment to enforcement.... 'Today's guidance makes clear that the law requires group health plans and health insurance issuers to provide contraceptive coverage -- including emergency contraception -- at no cost to participants,' said Labor Secretary Marty Walsh."

Tags: Health Plan Design

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