"On August 19, 2022, [HHS, DOL and the Treasury Department] released final rules titled 'Requirements Related to Surprise Billing: Final Rules.' ... The rules finalize certain requirements under the July 2021 interim final rules relating to information that group health plans and health insurance issuers offering group or individual health insurance coverage must share about the qualifying payment amount (QPA).... Information about the QPA that plans and issuers must share.... Payment determinations under the federal IDR process."  MORE >>

"The final rule's most significant change is elimination of the 'rebuttable presumption' in favor of the QPA, a part of the interim final rule that has been the subject of eight lawsuits from providers and two court decisions thus far.... The final rule ... does not dictate which offer the IDR entity should select. It instead focuses on the process that IDR entities should use when choosing between two competing offers."  MORE >>

"[S]ome employers may find that the contributions that low-wage employees must pay for coverage under their health plans in 2023 will cause that coverage to be deemed unaffordable. If that occurs, the employer will need to pay an assessment for each full-time employee who forgoes employer coverage and instead obtains subsidized coverage through an ACA health insurance exchange. That assessment is calculated for each month in which coverage remains unaffordable. For 2022, the amount was $343.33 per month ($4,120 for an entire year)."  MORE >>

Aug. 19, 2022. "Between April 15th and August 11th, disputing parties initiated over 46,000 disputes through the federal IDR portal, which is substantially more than the Departments initially estimated would be submitted for a full year. Of the disputes initiated between April 15th and August 11th, certified IDR entities rendered a payment determination in over 1,200 disputes. Between April 15th and August 11th, non-initiating parties challenged over 21,000 disputes' eligibility for the federal IDR process, which constitutes nearly half of all disputes initiated."  MORE >>

"The average stop-loss coverage premium increase is 9.8 percent for the nearly 250 health plans in Segal's national medical stop-loss database's 2022 dataset.... The most common specific deductible, which 10 percent of plans have, is $250,000. That's up from $200,000 in the 2021 dataset."  MORE >>

"Faced with the constant upward pressure from health care trends each year, employers are exploring new solutions to trim costs. One approach is to address the high costs associated with patients with chronic and complex health conditions."  MORE >>

33 pages. "The four industries with the lowest [employer-sponsored insurance (ESI)] offer rates in 2019 ... account for nearly half of the decrease in employment between March 2019 and March 2021.... Across the different demographic groups, ESI coverage rates generally rose or remained stable among workers and declined or remained stable among the broader working-age adult population." [R47219 Aug. 19, 2022]  MORE >>