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July 7, 2020 logo logo
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Changes to the ACA's Nondiscrimination Requirements

"[T]his new final rule: [1] Streamlines the definition of 'covered entity' to group health plans and employers that accept federal funding from the HHS ... [2] Removes the notice and tagline requirements that have proven to be both time-consuming and costly for plan sponsors. [3] Maintains protections for disabled individuals and those who are not proficient in English. [4] Eliminates the requirement for a compliance coordinator and grievance program for covered entities that have more than 15 employees."


Medical Loss Ratio Rebates Rise -- Who Receives the Rebate?

"[P]rivate insurers are set to pay out $2.7 billion in Medical Loss Ratio (MLR) rebate dollars this year. This amount marks a substantial increase from the $1.3 billion paid out in 2019 and continues to set new records ... [T]he majority of rebates are coming in the individual market, not in the group benefit segment where employer clients are grouped for the purposes of rebate calculation.... [T]he rebate amount is a function of the insurance carrier, the market segment, and the type of plan or product purchased."


Sharp Increase Predicted for Healthcare Costs

"A recent PwC report expects costs to rise by 4% to 10% in 2021, a sharp increase from recent years. The survey points to mental health utilization and specialty drugs as two big drivers. It also alludes to provider utilization as pent-up demand, in part fueled by cash-strapped providers who suffered financially from deferment of non-COVID-19 care during the height of the crisis. PwC indicates the permanency of telemedicine and the willingness of employers to move to narrowing network choices as an offsetting cost mitigation. And it is time for the insurance plans to pay the piper for COVID-19 treatment."


District Court Upholds CMS Regs Requiring Rate Disclosures by Hospitals in 2021

"Judge Nichol decided that CMS' Final Rule would allow patients to make educated pricing comparisons and decide which hospital is best for their care. His decision focused on empowering consumers and requiring hospitals to participate in a more competitive market.... [T]he AHA announced that it would appeal the ruling ... Senate Republicans introduced legislation on July 1, 2020 that would codify a price transparency rule into statute." [American Hospital Ass'n v. Azar, No. 19-3619 (D.D.C. Jun. 23, 2020)]

Sheppard Mullin

National Association of Insurance Commissioners Releases Draft PBM Model Legislation

"Although still a work in progress, the draft language would require PBMs to obtain a license from the state's insurance commissioner, permit the commissioner to adopt PBM regulations, and prohibit certain PBM abuses (such as retroactive payment reductions, spread pricing, and self-dealing)."

National Center for Policy Analysis [NCPA]

Opportunities for Health Care Payers in the 'New Normal' (PDF)

"Providers are experiencing cash flow challenges due to the loss of revenue-generating procedures and office visits. Payers, on the other hand, are experiencing short-term cash windfalls as a result of record-low claims expenses. But, they are preparing for the coming economic recession that will no doubt negatively impact health plan revenue by way of a shifting mix of membership. Health plans must use this crisis to think strategically, not only about their current products and sources of revenue, but about new insurance products and market niches."

Alvarez & Marsal

Especially Now, Workers Need Mental Health Benefits

"[1] Leverage your existing benefits.... [2] Open a line of communication.... [3] Leverage technology, like telemedicine."

Corporate Synergies

Press Releases

Most Popular Items in the Previous Issue, 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 2020, 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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