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[Official Guidance]

Text of Draft 2019 IRS Form 8963: Report of Health Insurance Provider Information (PDF)

Dec. 5, 2019. "On the first line, list information for the single-person covered entity or designated entity, whichever applies. Next, for a controlled group, separately list information for every person who is a controlled group member at the end of the day on December 31, 2019, and who would qualify as a covered entity in 2020 if it were a single-person covered entity (see instructions)."

Internal Revenue Service [IRS]

[Official Guidance]

Text of Draft 2019 IRS Form 1095-B: Health Coverage (PDF)

Dec. 5, 2019. "This Form 1095-B provides information needed to report on your income tax return that the individuals in your tax family (yourself, spouse, and dependents) had qualifying health coverage (referred to as 'minimum essential coverage') for some or all months during the year. Individuals who don't have minimum essential coverage and don't qualify for an exemption from this requirement may be liable for the individual shared responsibility payment."

Internal Revenue Service [IRS]

[Guidance Overview]

IRS Extends Deadline for 2019 Employer ACA Disclosures

"While the date for filing with the IRS was not extended, filers can obtain an automatic 30-day extension by submitting Form 8809 by the due date for the ACA information returns. Form 8809 may be submitted on paper or electronically, and no explanation for the extension is required....[T]he IRS deadlines (and extensions) for filing and furnishing ACA forms may not apply to the state reporting requirements."


[Guidance Overview]

IRS Continues ACA Reporting Relief But with a Twist

"Notice 2019-63 generally does not extend this relief to large self-funded employers, except for Forms 1095-C that are prepared on behalf of individuals who are not full-time employees for the entire 2019 calendar year.... Examples of where this relief may extend to Forms 1095-C are: [1] former employees who terminated employment before 2019 but were enrolled in the self-funded plan under COBRA or retiree coverage; and [2] employees who were part-time during all of 2019, but were enrolled in the self-funded plan because the plan sponsor extended eligibility for the self-funded plan to part-time employees."

Miller Johnson

The Role of HR Technology in Controlling the Cost of Health Plans

"Tools that used to be optional in the open enrollment process are quickly becoming mandatory. These include simple Web integrations like plan documents, [ACA] disclosures, and provider directories, as well as more detailed analyses like plan comparison and cost projection tools. A simple 'pop-up' glossary of terms is almost essential now if an employer is including innovative new plan options in its healthcare choices. Here are comparative examples."

HR Daily Advisor

CMS Publishes 2018 National Healthcare Expenditures

"Total national healthcare spending in 2018 grew 4.6 percent ... [T]he share of the economy devoted to health spending decreased from 17.9 percent in 2017 to 17.7 percent in 2018.... ... Private health insurance spending (34 percent of total health care spending) increased 5.8 percent to $1.2 trillion in 2018, which was faster than the 4.9 percent growth in 2017.... Out-of-pocket spending grew 2.8 percent to $375.6 billion in 2018, which was faster than the 2.2 percent growth in 2017."

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

Prescription Drug Prices Down Slightly Last Year

"Prices for prescription drugs edged down by 1% last year, a rare result driven by declines for generics and slow, low growth in the cost of brand-name medications ... The price drop was for retail pharmacy prescriptions, not medications administered in hospitals or doctor's offices.... [T]he last time retail prescription drug prices declined was in 1973, when they went down by 0.2%."

Associated Press

Health Savings Account Balances, Contributions, Distributions, and Other Vital Statistics, 2018

"Enrollment in high-deductible, HSA-eligible health plans was estimated to be between 23 and 36.8 million policyholders and their dependents and covered nearly 3 in 10 employees in 2018.... Two-thirds of accountholders ended 2018 with positive net contributions, meaning annual contributions were higher than annual distributions.... Only 14 percent of accountholders contributed the fully allowable annual amount."

Employee Benefit Research Institute [EBRI]

Provider Charges Relative to Medicare Rates, 2012-2017

"[S]pecialties possessing the ability to surprise bill out-of-network patients -- emergency and ancillary physicians -- have charged notably higher amounts relative to Medicare rates than other specialties ... [A]verage charges have been growing especially fast relative to Medicare payment rates in the two specialties most commonly associated with surprise billing -- emergency medicine and anesthesiology -- at 6.7 and 4.4 percent annually on average from 2012-2017[.]"

The Brookings Institution

Employers, Insurers, Unions Urge Full Repeal of Cadillac Tax

"More than 1,000 employers, insurers, unions, and other organizations ... urged Senate leaders to scrap a controversial tax on expensive employer-sponsored health plans that's set to go into effect in 2022.... [T]he organizations warned that the failure to repeal the so-called 'Cadillac tax' on certain employer plans would lead workers to pay more for medical treatment and face narrower provider networks."

Modern Healthcare Online; free registration may be required

Text of White Paper from HHS: Risk Adjustment Data Validation (HHS-RADV)

120 pages. "HHS is considering potential modifications to four specific aspects of the HHS-RADV program: [1] enrollee sampling; [2] outlier detection; [3] the error rate calculation and [4] the application of HHS-RADV results ... The options in this white paper were developed based on HHS's ongoing internal analysis of potential refinements to the HHS-RADV program for future benefit years, as well as comments received on HHS-RADV through notice-and-comment rulemaking and through listening sessions with stakeholders. [HHS is] seeking comments on the options outlined in this white paper to help inform potential future rulemaking in these areas."

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


There's Nothing Wrong With Health Care That Less Money Couldn't Fix

"[1] Expect deflation for health care prices and spending.... [2] Expect drug prices to deflate. ... [3] Reassess and minimize the cost of middlemen. ... [4] Accept that utilization review and other cost-management tools are good and necessary.... [5] Move further away from fee-for-service. ... [6] Prioritize primary care. ... [7] Make cost reductions an integral part of consolidation. ... [8] Implement a Cadillac (excise) tax on lavish benefits. "

Bruce Pyenson and Marjorie Schulman, in Health Affairs


Managing Specialty Medication Costs

"Setting administration and quantity limits are two effective cost-containment measures, but more effective strategies are needed.... [E]stablishing government-led price controls might be a good compromise; however, care should be taken so that these controls don't mitigate too greatly the profit potential that fosters innovation."

Frenkel Benefits

Most Popular Items in the Previous Issue, Inc.
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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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