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Health & Welfare Plans Newsletter November 27, 2018 |
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Jobs
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Webcasts, Conferences Self-Insured Health Plan Trends: A Closer Look at the Small-Employer Market
Make Way For The HRA!
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Discussions |
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This Newsletter:
BenefitsLink Retirement Plans Newsletter:
Message Boards Digest:
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Retirement Plan Administrator|
[Official Guidance]
31 pages, Nov. 20, 2018. "Certain small employers whose principal business address is in a county with no qualified health plan through a Small Business Health Plan Options Program (SHOP) Marketplace may be able to claim the credit for small employer health insurance premiums."
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[Advert.]
Nondiscrimination Testing for Health Plans: Code Section 105(h) and Post-ACA Design Alternatives
Dec. 5 webinar. Understand rules and develop cost effective strategies to meet the compliance obligation, avoid lawsuits, and develop health benefit offerings that are both facially and operationally nondiscriminatory. BenefitsLink discount. |
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[Official Guidance]
185 pages. "This proposed rule would amend the Medicare Advantage (MA) program (Part C) regulations and Prescription Drug Benefit program (Part D) regulations to support health and drug plans' negotiation for lower drug prices and reduce out-of-pocket costs for Part C and D enrollees."
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[Guidance Overview]
Text of CMS Fact Sheet: Contract Year 2020 Medicare Advantage and Part D Drug Pricing Proposed Rule "CMS is proposing or outlining for consideration by stakeholders a number of provisions that implement these four strategies. [1] Providing plan flexibility to manage protected classes.... [2] E-prescribing and the Part D prescription drug program ... [3] Medicare advantage and step therapy for Part B drugs ... [4] Part D explanation of benefits ... [5] Prohibition against gag clauses in pharmacy contracts ... [6] Pharmacy price concessions in the negotiated price."
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[Guidance Overview]
Proposed Rule Expands HRA Usage and Forecasts Safe Harbors for ACA Employer Mandate Compliance "By moving to a 'defined contribution' model, employers would be able to cap their annual health care spending and shift the risk to insurance companies. However, unless employers provide substantial HRA contributions, employees would bear the brunt of cost increases imposed by insurers in the individual market. Further, without the combined risk pool that comes with a group health plan, employees may find it difficult to replicate their current coverage without increasing their out-of-pocket expenditures."
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Agencies Issue Final Regs on Contraceptive Coverage Exemptions "The final regulations generally adhere to the [2017] interim final regulations (IFRs) ... [which] significantly broadened the exemptions from the contraceptive coverage mandate ... Exempt employers that wish to provide access to contraceptive services without providing the coverage themselves may use a voluntary accommodation process in which the insurer or third-party administrator (TPA) provides the coverage. The final regulations take effect on January 14, 2019."
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Best Practices When Introducing a Qualified High Deductible Health Plan "[1] [C]onsider offsetting 30‑40% of the deductible so that the contribution is also meaningful. [2] Consider a 3-year commitment to the HSA contribution.... [3] Offering drug benefits tied to coinsurance or copays after the deductible is met will continue to promote the consumerism aspect of these plans.... [4] Employers should research the cost transparency tools their vendor offers.... [5] [A] strong communication strategy is needed.... [6] [F]actor in the company's cost impact to determine how much employees may contribute to the premium (cost of the plan) or how much employers should fund into an HSA."
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CMS Takes Action to Lower Prescription Drug Costs by Modernizing Medicare "The proposal would ensure that Medicare Advantage and Part D plans have more tools to negotiate lower drug prices, and the agency is also considering a policy that would require pharmacy rebates to be passed on to seniors to lower their drug costs at the pharmacy counter.... CMS is also considering for a future plan year, which may be as early as 2020, a policy that would ensure that enrollees pay the lowest cost for the prescription drugs they pick up at a pharmacy, after taking into account back-end payments from pharmacies to plans."
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Medicare Plans Could Gain Drug Pricing Leverage Under CMS Proposal "Health plans would be required to cover at least two drugs per protected class. But they would gain new latitude to exclude additional drugs. One of the proposed exceptions would allow plans to exclude drugs based on price hikes that exceed inflation. The idea is to tamp down costs by giving plans a stronger arm in their negotiations with drug makers."
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Cost-Sharing and Drug-Price Transparency in New York "In New York, prescription drug cost-sharing is rigidly defined by state law for most health-insurance markets, except federally regulated employer-sponsored insurance or Medicare plans.... Although drug-price transparency may be welcomed for its political effects, the disparity between list prices and those actually paid by individuals covered by various insurance plans would tend to mislead rather than inform.... Although most insurers offer price-comparison websites, few enrollees use them. To get more value from price transparency, insurers should be allowed more flexibility in designing cost-sharing so that they may provide more appropriate incentives for consumer engagement."
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NY Approval Clears the Way for $69 Billion CVS Acquisition of Aetna "CVS Health Corp. has agreed to spend $40 million for health insurance education and other conditions to win approval from New York regulators, clearing the way for its acquisition of Aetna Inc., state officials announced [Nov. 26]. CVS announced it expects to close on the $69 billion deal by Wednesday."
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Press Releases |
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Employee Benefit Research Institute Launches New Website and Branding
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Most Popular Items in the Previous Issue |
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An Employer's Guide to Navigating the ACA Reporting Requirements (PDF)
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No Fiduciary Breach Where Employer Failed to Provide Life Insurance Conversion Information
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Connect
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BenefitsLink.com, Inc.
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David Rhett Baker, J.D., Editor and Publisher
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BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2018 BenefitsLink.com, Inc. All materials contained in this newsletter are protected by United States copyright law and may not be reproduced, distributed, transmitted, displayed, published or broadcast without the prior written permission of BenefitsLink.com, Inc., or in the case of third party materials, the owner of those materials. You may not alter or remove any trademark, copyright or other notices from copies of the content.
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