Health & Welfare Plans Newsletter

June 8, 2020

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View COVID-19 News and Resources

[Official Guidance]

Text of CMS Compliance Letter: COVID-19 Guidance for Non-Federal Governmental Health Plans (PDF)

"This letter highlights COVID-19 guidance relevant to non-Federal governmental plan sponsors.... [1] Requirement to cover COVID-19 diagnostic testing and certain related Items and services without cost-sharing or medical management.... [2] Temporary period of relaxed enforcement of certain timeframes related to group market requirements under the Public Health Service Act.... [3] Expanding and promoting access to telehealth options and prescription drugs during the COVID-19 outbreak."

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

[Guidance Overview]

Full Coverage for HIV Drugs to Be Required July 1

"Employer health plans will be required to cover 100% of the costs of specialty drugs prescribed to prevent high-risk individuals from contracting HIV, effective with July 1, 2020 renewals and after. Several variables may influence the financial impact."

HUB International

[Guidance Overview]

New Requirements and Options for Health and Cafeteria Plans

"Participants have extended time to make coverage elections, make COBRA payments and file benefit claims. Sponsors of cafeteria plans also have new options to provide additional relief to participants, including the ability to make additional mid-year elections to change coverage. These requirements and options require coordination with insurers and administrators and should be clearly communicated to employees."

Cohen & Buckmann P.C., via PLANSPONSOR; free registration may be required

[Guidance Overview]

Flexibility for Flexible Spending Accounts in Light of COVID-19

"Employers should carefully consider available design decisions before implementing the changes permitted under the Notices, as employers that wish to take advantage of this flexibility also have the ability to make key plan design decisions -- for example, employers may determine which changes will be permitted and may utilize a shorter time frame during which election changes can be made than would otherwise be permitted under the guidance.... [E]mployers may want to consider limiting elections to 'prevent adverse selection' and limiting changes to no less than the amounts already reimbursed."

Mayer Brown

Positioning Virtual Care to Transform Health Benefits

"[C]onsiderations as you start to plan for your health program's virtual care transformation.... [1] The new front door to care.... [2] Virtual care as the new foundation to rebuild primary care.... [3] Right-sized reimbursement will dictate the virtual care economy.... [4] Design for new options with the triple aim in mind.... [5] Keep an eye on public policy.... [6] Are there savings to be had?"

Mercer

Where Do Drug Benefits Go From Here?

"As employers responded quickly to support employees during this health crisis, many have worked with their pharmacy providers to ease restrictions and promote safer distribution avenues for obtaining drug therapies. Now, as they look ahead to the challenges of providing a sustainable benefit program in a time of economic uncertainty, it will be critical to consider if the prescription drug plan should change to meet the organization's objectives."

Mercer

New Data on the Cost of COVID-19 Treatment for U.S. Private Insurers

"The overall assumed rates of hospitalization for infected individuals has been reduced to align with recent studies. The rate has also been adjusted for age and morbidity differences by line of business. The estimated unit cost of a COVID-related hospital admission has been increased based on survey data provided by AHIP members. Estimated impacts of deferred care on overall healthcare spend was included and combined with the COVID treatment costs to arrive at a combined impact on cost of care by line of business."

America's Health Insurance Plans [AHIP]

Innovations in Healthcare Technologies: Opportunities for Health Insurers

"An integrated system for insurance operations delivers a single solution across all business units, thereby enabling smooth and synchronised process flow across the entire business.... Health insurers worldwide have started to leverage available data innovatively for a wider range of purposes, including sales, underwriting, claims and fraud detection.... Innovation in the global healthcare market is not just restricted to the technology itself, but expands into developing new health insurance products and new ways of distributing insurance products by leveraging technology, mainly mobile phones."

Milliman

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BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2020 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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