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Understanding the Fiduciary Responsibility Employers Face for Their Benefit Plans

Viewpoints by Craig Hasday One of the most critical components of the Employee Retirement Income Security Act of 1974 (ERISA) is the fiduciary responsibility imposed on employers and administrators managing these types of plans. Employers should be concerned. ERISA requires employers to maintain oversight of vendors and monitor pharmacy and medical costs, and the penalties for non-compliance can be severe. In fact, there have been two significant lawsuits that underscore the exposure. In both Lewandowski v. Johnson and Johnson and Navarro v. Wells Fargo & Co, a class of employers alleges damages due to a breach by their employer of …

https://www.epicbrokers.com/insights/employer-fiduciary-risk-assessment-checklist/

Fiduciary Rule Changes Require Better Plan Management

Viewpoints from Craig Hasday Employees pay greater than 20% of the cost of their employer-sponsored healthcare premiums. In addition to those premiums, the average American family spends more than $4,000 per year on their out-of-pocket medical costs. Healthcare costs, after a COVID-driven pause, are continuing to escalate and consumers are feeling the pain. Employee Retirement Income Security Act (ERISA) rules afford some protection to employers regarding traditional plan management if they document a continual process to work in the best interest of the participant. Today there is much more for a business to worry about …

https://www.epicbrokers.com/insights/fiduciary-rules-pharmacy-costs/

Health Claim Data Is Power

Viewpoints from Craig Hasday There are different types of gamblers in Las Vegas. The first type sits at the slot machines and watches their money vanish with each handle pull. Sure, some win, but it’s rare and they usually give it back to the house with continued play. Then there are those that understand the game and know the odds. Since the odds are in favor of the house, these gamblers lose, but not as much and not as often. And then there are the card counters – the ones that have the data to beat the odds and mitigate …

https://www.epicbrokers.com/insights/health-claim-data-is-power/

Stay Close to Your Self-Insurance Advisor

Viewpoints from Craig Hasday In 2019, about 61% of workers with employer-sponsored insurance were enrolled in a self-insured or partially self-insured plan.* As healthcare costs rise, employers – guided by advisors like EPIC – seek cost savings by negotiating the components of health insurance premiums rather than leaving this to the opaque, and highly profitable, health insurance carriers. Plan elements, such as pharmacy costs, are routinely “carved out” and put under a microscope by sophisticated employers and their advisors. Self-insurance, however, entails assuming more risk of adverse claims. And the terms of this type of coverage are about …

https://www.epicbrokers.com/insights/stay-close-to-your-self-insurance-advisor/

Transparency and the Value of a Great Insurance Broker

… even for astute consultants, as the sleight of hand of providers increases in stealth factor. All of the constituents are seeking to maximize their share of the profits. So, new federal transparency regulations have come into play, which seek to make it clearer for payers to understand and negotiate costs. Viewpoints from Craig Hasday Transparency surrounding hospital costs went into effect on January 1, 2021, and Centers for Medicare & Medicaid Services (CMS), the federal agency that regulates these laws, has already started sending out warning letters of non-compliance. These show just how important the providers believe it is to …

https://www.epicbrokers.com/insights/transparency-and-the-value-of-a-great-insurance-broker/

Are You Ready for Healthcare Disruption? It’s Coming

… 19 expenses are in greater demand. This sentiment was also shared by UnitedHealthcare in their earning report. There is no doubt that the negative medical cost inflation seen in COVID-stricken 2020 was an aberration. Medical cost trend is reemerging and the nation’s largest retailers clearly see the potential. Viewpoints from Craig Hasday Amazon, the most valuable company in terms of market capitalization, made its fortunes by disrupting markets and they are at it again with Amazon Care. When Amazon purchased PillPack with its 50-state pharmacy license, it was clear that would be a cornerstone of Amazon’s …

https://www.epicbrokers.com/insights/are-you-ready-for-healthcare-disruption-its-coming/

Are Healthcare Costs Stabilizing?

… 15.6% in 2018 and those gross drug costs escalated at a faster pace than overall healthcare spending. Factoring in rebates, the report indicates, would reduce the four-year average trend to 3.8% – and I would think this would drive costs for even 2018 below the general inflation rate. Viewpoints from Craig Hasday It wasn’t long ago that double-digit trends were the norm for healthcare, and there seemed to be no end in sight. Employers are getting used to lower increases and with the political pressure being exerted on price increases – particularly with respect to prescription drugs …

https://www.epicbrokers.com/insights/are-healthcare-costs-stabilizing/

Managing Pharmacy Costs Is Key for Employers

… 7% of spending. To give you some reference, diabetes and oncology drugs each contributed less than 20% of spend. ESI also noted that the impact of specialty drugs is continuing to grow. It’s a concern when 2% of prescriptions account for nearly half of spending in any given year. Craig Hasday wrote about the importance of actively managing pharmacy costs earlier this year. With the ludicrous price tag on specialty pharmaceuticals, it’s imperative that employers know which drugs are driving costs and how to best mitigate them. Medical carriers struggle to provide their clients with the best possible …

https://www.epicbrokers.com/insights/managing-pharmacy-costs-is-key-for-employers/