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[Official Guidance]

Text of Agency Proposed Regs: Transparency in Coverage by Health Insurance Issuers and Group Health Plans (PDF)

219 pages. "These proposed rules set forth proposed requirements for group health plans and health insurance issuers in the individual and group markets to disclose cost-sharing information upon request, to a participant, beneficiary, or enrollee (or his or her authorized representative), including an estimate of such individual's cost-sharing liability for covered items or services furnished by a particular provider....[P]lans and issuers would be required to make such information available on an internet website and, if requested, through non-internet means ... These proposed rules also include proposals to require plans and issuers to disclose in-network provider negotiated rates, and historical out-of-network allowed amounts through two machine-readable files posted on an internet website ... [HHS] also proposes amendments to its medical loss ratio program rules to allow issuers offering group or individual health insurance coverage to receive credit in their medical loss ratio calculations for savings they share with enrollees that result from the enrollee's shopping for, and receiving care from, lower-cost, higher-value providers." [Also available: HHS Fact Sheet.]

U.S. Department of Health and Human Services [HHS]; Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]; and Internal Revenue Service [IRS]


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[Official Guidance]

Text of HHS Final Regs: Price Transparency Requirements for Hospitals to Make Standard Charges Public (PDF)

331 pages. "This final rule establishes requirements for hospitals operating in the United States to establish, update, and make public a list of their standard charges for the items and services that they provide.... By disclosing hospital standard charges, we believe the public ... will have the information necessary to make more informed decisions about their care. We believe the impact of these final policies will help to increase market competition, and ultimately drive down the cost of health care services, making them more affordable for all patients." [Also available: HHS Fact Sheet.]

U.S. Department of Health and Human Services [HHS]

[Official Guidance]

IRS Reminder: Health Insurance Providers Fee Will Be Assessed in 2020

"The due date for Form 8963, Report of Health Insurance Provider Information, for Fee Year 2020 is April 15, 2020.... H.R. 195 ... suspended collection of the fee for the 2019 calendar year.... [T]his does not affect the filing requirement and payment of the fee for 2020.... The applicable amount for fee year 2020 is [approximately $15.5 billion].... The IRS will send each covered entity its final fee calculation [being a portion of the applicable amount] by August 31st using Letter 5067C."

Internal Revenue Service [IRS]

[Official Guidance]

Text of 2019 IRS Form 8941: Credit for Small Employer Health Insurance Premiums (PDF)

Eligible small employers use Form 8941 to figure the credit for health insurance premiums paid by the employer for employees enrolled in a qualified health plan offered through a Small Business Health Options Program (SHOP) Marketplace.

Internal Revenue Service [IRS]

[Guidance Overview]

CMS Announces Historic Price Transparency Requirements to Increase Competition and Lower Healthcare Costs for All Americans

"If finalized, the proposed Transparency in Coverage rule would require health plans to:

  • "Give consumers real-time, personalized access to cost-sharing information, including an estimate of their cost-sharing liability for all covered healthcare items and services, through an online tool that most group health plans and health insurance issuers would be required to make available to all of their members, and in paper form, at the consumer's request....
  • "Disclose on a public website their negotiated rates for in-network providers and allowed amounts paid for out-of-network providers."

Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

[Guidance Overview]

2019 IRS Draft Instructions for Forms 1094-C and 1095-C Include Very Few Changes

"While many ... expected some changes as a result of the Individual Mandate being reduced to $0 beginning in 2019 the draft instructions were virtually identical compared to the 2018 iteration of the instructions.... [This] article touches on the few changes, almost entirely numerical, that were made to the 2019 instructions."


[Guidance Overview]

Editor's Pick Michigan's Automobile Insurance Reforms May Mean Additional Costs for Group Health Plans

"Employers with employees residing in Michigan may want to revisit their health plans' coordination-of-benefits (COB) provisions for motor vehicle accident-related medical expenses. Beginning July 1, 2020, legislation revises the state's no-fault automobile insurance law in a way that could increase health plans' exposure to costs resulting from motor vehicle accidents."


[Guidance Overview]

Massachusetts Employers' Health Coverage Reports Due by December 15

"Beginning Nov. 15, employers with six or more Massachusetts employees can access the state's Health Insurance Responsibility Disclosure (HIRD) form to complete and submit by Dec. 15. Penalties for failure to comply could total $1,000-$5,000 per violation.... This is the second year of HIRD reporting."


CMS Releases Proposed and Final Rules to Make Hospitals and Insurers Post Prices, Cost-Sharing Information

"Under the rule, hospitals will have to post in a searchable and convenient format the payer-negotiated rates for 300 shoppable services. The hospitals also have to post a single data file with negotiated rates for all services that can be used by consumers, researchers and app providers. The proposed version generated major opposition from both the hospital and insurer industries, which charged it was unworkable as contracts are not automated in some facilities and that the cost would be prohibitive."



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To Lower Costs, Administration to Force Hospitals to Reveal Price of Care

"Both the hospitals and health insurers say they should not be required to make public what they consider proprietary information, and they are expected to mount legal challenges to any mandated disclosure. In Ohio, a state law requiring price transparency that was passed two years ago is still stuck in the courts."

The New York Times; subscription may be required

Editor's Pick Benefits Renewal 2020: Questions to Ask

"[1] Will the return of the [ACA] premium tax affect your plan renewal? ... [2] Does your renewal timeline include all vendor decision deadlines? ... [3] Is your group life plan in compliance with the Section 79 nondiscrimination rules? ... [4] Is your group life maximum benefit higher than the guaranteed issue amount? ... [5] Is there any chance you've unintentionally disqualified participant HSAs? ... [6] Have you reviewed your existing Wrap Document and Wrap Summary Plan Description and made any necessary amendments? "


Healthy Culture Can Lead to Healthy Workforce

"In the U.S. nearly half of all employers -- and nearly all employers with at least 500 workers -- offer health and wellbeing programs ... These ... efforts will not produce the desired results if participation is low.... Align the health of the workforce with the core values of the team.... Make the business case to obtain leadership buy-in ... Cultivate models of healthy behavior ... Make the right choice the easy choice."

Integrated Benefits Institute

Health Care Spending: Diabetes Leads Areas of Concentration (PDF)

"Just one percent of enrollees accounted for 28 percent of total spending on health care services in 2017.... One finding that stands out is the large percentage of claimants each year with diabetes. The results suggest a strong correlation between diabetes and other health conditions. Among individuals in the top 10 percent of claimants for five years (2013 - 2017), half of those with diabetes also had hypertension[.]"

Employee Benefit Research Institute [EBRI]

JAMA Study Highlights Healthcare Spending Waste

"The study points to six main areas ... [1] Failure of care delivery ­­­ -- $68.8 billion; [2] Failure of care coordination -- $33.9 billion; [3] Overtreatment or low-value care -- $20.7 billion; [4] Pricing failure -- $86.3 billion; [5] Fraud and abuse -- $26.8 billion; [6] Administrative complexity -- $265.6 billion."

Frenkel Benefits

Benefits in General

Deskless Yet Informed: Successful Plan Communications for Hard-to-Reach Employees (PDF)

"Whether working on the shop floor, behind the wheel of a truck, in a warehouse, in a checkout lane, or in any number of other job venues and capacities, deskless employees can be a problematic audience for effective benefits communication.... [O]rganizations will benefit from addressing four primary obstacles to effective communication with deskless employees: communication barriers, managers/supervisors as the conduit, subject matter 'inexperts' and an information void for spouses."

Benefits Quarterly, published by the International Society of Certified Employee Benefit Specialists [ISCEBS]

Press Releases

Call for Presentations: 2020 Annual ISCEBS Employee Benefits Symposium
ISCEBS {International Society of Certified Employee Benefit Specialists]

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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 2019, 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, 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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