[Guidance Overview]

New Guidance on COVID-19 Vaccine-Related Premium Surcharges and Discounts

"In the new guidance, the Tri-Agencies take the position (without explanation) that vaccine premium incentive programs are 'activity-only' health-contingent programs.... Similar to other non-tobacco premium incentives, vaccine incentives increase the cost of coverage for employer mandate purposes. This means that if the incentive is a premium discount, the discount is treated as not earned, and thus, affordability is based on the assumed increased premium cost for the participant."  MORE >>

Groom Law Group

[Guidance Overview]

COVID-19 Vaccination Incentives and Surcharges OK'd in Group Health Plan Guidance

"Most employers are considering multiple entry points each plan year for participants who become vaccinated or even 'rolling' qualification for the incentive/removal of the surcharge. Some employers are also considering aligning new qualifying periods as the [CDC] releases additional guidance, for example, in the case of booster shots.... Employers should be cautious about offering incentives to/imposing surcharges on only select groups of employees."  MORE >>

McGuireWoods

[Guidance Overview]

Vaccine Surcharges: Yes, You Can!

"[The FAQ] does not require an accommodation for religious or other non-medical reasons. There is also no prohibition against allowing employees to meet the vaccination criteria at any time during the year.... [Q]uestions remain, such as how the vaccine surcharge program should work during mid-year periods and whether it uniformly applies to other dependents."  MORE >>

Jackson Lewis P.C.

[Guidance Overview]

Feds Confirm Vaccine Wellness Programs Are OK, Employers May Ask About Vaccination Status

"The FAQs indicate that a reasonable alternative could include requiring the employee to attest to complying with masking recommendations.... The FAQs suggest ... that assisting employees with either receiving the vaccine ... or satisfying the alternative standard will help ensure the wellness program is not overly burdensome."  MORE >>

Lockton

ERISA Exhaustion Requirement Not Satisfied by Verbal Appeal When Plan Required Written Appeal

"the court stated that none of the documents Plaintiffs produced in discovery constituted appeals; they were mostly claims submissions made before the initial denials, as well as miscellaneous faxes, post-it notes and other documents that included no requests for appeal. Regarding the purported phone calls, the court held that the parties were bound by the unambiguous language in the subject plans requiring written appeals." [Ligotti v. United Healthcare Services, No. 16-60558 (S.D. Fla., Jun. 8, 2021)]  MORE >>

Hinshaw & Culbertson LLP

Projected Medical Plan Cost Increases for 2022 Are Similar to Pre-Pandemic Increases (PDF)

34 pages. "Survey respondents project per-person cost trends for open-access PPO/POS plans to be 7.3 percent. The projected annual cost trend for outpatient prescription drugs is 8.4 percent. Double-digit specialty Rx cost trend ... continues to be a major driver of Rx cost trends and a challenge for plan sponsors. Provider price increases are still the primary driver for both hospital and Rx trends. Utilization is the primary driver of trend for physician services.... For the first time in the 25 years that Segal has conducted this survey, actual 2020 trends were negative for medical and dental due to deferred and eliminated care."  MORE >>

Segal

With Healthcare Cost Increases Returning to Pre-Pandemic Levels, Employers Focus on Affordability and Wellbeing

"Employers expect their costs for medical and pharmacy benefit expenses to increase 5.2% in 2022, even after taking cost management initiatives into account. The increase is slightly lower than the 5.5% increase employers projected for 2021 but sharply higher than the actual 2.1% increase in 2020."  MORE >>

Willis Towers Watson

Major Insurers Running Billions of Dollars Behind on Payments to Hospitals and Doctors

"Anthem Blue Cross, the country's second-biggest health insurance company, is behind on billions of dollars in payments owed to hospitals and doctors because of onerous new reimbursement rules, computer problems and mishandled claims ... Hospitals are also dealing with a spike in retroactive claims denials by UnitedHealthcare, the biggest health insurer, for emergency department care[.]"  MORE >>

Kaiser Health News

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Anyone Actually Spotted a 'Simple Cafeteria Plan' in the Wild?

"Curious as to thoughts on this. I don't think I've actually seen anyone utilizing a 'Simple Cafeteria Plan' (pursuant to a provision in the Affordable Care Act). Any thoughts on why? Is it that the 2% employer contribution is a major sticking point, or are there other reasons? Seems like it would work well for many really small employers, if it isn't the required employer contribution that's the problem."

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