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Navigating HIPAA Compliance

While Plan Administrators handle various daily operations within their health and welfare benefit plans, certain essential operational features are outsourced to external service providers. These operational tasks often involve handling protected health information (PHI). Since 1996, the Health Insurance Portability and Accountability Act (HIPAA) has governed the standards for safeguarding and transmitting PHI between covered entities and business associates. When a Plan Administrator enlists a service provider to execute tasks for their benefit plan, that service provider assumes the role of a business associate. Under the same regulations as covered entities, business associates are required to protect PHI. The exchange …

https://www.epicbrokers.com/insights/navigating-hipaa-compliance/

What Does Blue Shield of California’s New Unbundled Pharmacy Model Mean to Employers?

… quo. So, what does this news mean to employers? Employers seeking lower costs should proceed cautiously. This new model is a great opportunity to request stronger guaranteed discounts, rebates, and even trend guarantees. These types of guarantees are not generally available in traditional carve-in models, where medical and pharmacy benefits are bundled together. Pharmacy carve-out is likely necessary, and a market check is essential even if there is no intention to change PBMs. By negotiating for these guarantees, employers can ensure they are receiving the best possible pricing for their employees’ prescription medications. Additionally, employers should request the …

https://www.epicbrokers.com/insights/blue-shield-unbundled-pharmacy-model-and-employers/

Compliance Matters Newsletter | September 2023

Let our team help you navigate the ever-changing benefits compliance landscape each month. Check out this month’s latest alerts, additional updates, and resources – hot off the press: Employee Benefits Compliance Alerts The Facts About Potential California Long-Term Care Legislation State-managed Long-Term Care (LTC) programs are a focus of many state legislatures, including California. California released the results of a Long-Term Care Task Force feasibility study in December 2022 and intends to release an actuarial study in January 2024. While no legislation has been introduced in California yet, employers and employees should be aware of …

https://www.epicbrokers.com/insights/compliance-matters-newsletter-september-2023/

Legislation to Reform the ACA’s Employer Reporting Requirements

Employers have long sought relief from the burden of the reporting requirements under Sections 6055 and 6056 of the Affordable Care Act (ACA) for enforcement of the individual and employer mandates. Currently, employers and health insurance providers that provide minimum essential coverage must report information for each covered individual to the Internal Revenue Service (IRS), including the covered individual’s social security number. Employers and providers must also send a copy of this information to the covered individual (through tax forms 1095-B and 1095-C) by January 31 of each year. The error rate of 82% is indicative of …

https://www.epicbrokers.com/insights/legislation-reform-acas-employer-reporting-requirements/

PBM Drug Pricing Practices Under Increased Scrutiny from Senate HELP Committee

Bipartisan Support for PBM and Prescription Drug Reform On Thursday, May 11, 2023, the Senate Health, Education Labor and Pensions (HELP) Committee approved four new bills and eight bipartisan amendments by a vote of 18-3. One of the bills introduced, the Pharmacy Benefit Manager Reform Act (S. 1339), establishes new requirements for pharmacy benefit managers (PBMs) as well as associated civil penalties. The committee aims to increase transparency, improve employer decision-making and reduce prescription drug costs. PBMs are important intermediaries between drug manufacturers, pharmacies, insurers and plan sponsors. PBMs negotiate drug rebates and fees with drug manufacturers, reimburse …

https://www.epicbrokers.com/insights/pbm-drug-pricing-practices-under-increased-scrutiny/

Compliance Matters Newsletter | August 2023

Let our team help you navigate the ever-changing benefits compliance landscape each month. Check out this month’s latest alerts, additional updates, and resources – hot off the press: Employee Benefits Compliance Alerts Washington State Long-Term Care Is Now in Effect Originally established in 2021, the Washington Cares Fund provides long-term care for Washington workers. Payroll deductions of .58% of wages began July 1, 2023. Most employees can no longer apply for a private-plan exemption, although some exceptions are available. Workers who contribute the required length of time may apply for benefits starting in July 2026. Learn …

https://www.epicbrokers.com/insights/compliance-matters-newsletter-august-2023/

EPIC Welcomes Benet Heames

… Ontario/Southwest Employee Benefits Team EPIC is excited to announce that Benet Heames has joined the firm as a Principal for the Ontario/Southwest territory’s Employee Benefits Practice. Heames will work closely with his clients to develop strategies to improve the employee healthcare journey and drive business results through employee retention and recruitment. Heames joins EPIC with more than 15 years of experience serving as a Client Sales Executive, Regional Sales Director and Employee Benefits Specialist. “We are excited to welcome Benet Heames to our rapidly expanding Southern California Benefits Team,” said Matt Clemo, EPIC’s Southern California Employee …

https://www.epicbrokers.com/insights/epic-welcomes-benet-heames/

Long-Term Care Needs Affect All of Us

Viewpoints from Craig Hasday More than half of Americans turning 65 will need some form of long-term care (LTC) assistance as they age, according to the U.S. Department of Health and Human Services (HHS). Long-term care insurance helps cover the costs associated with aging, such as nursing home care, assisted living and in-home care. The need to prepare for this life stage affects all of us, either directly as care seekers or indirectly as possible caregivers or planners. LTC services can be expensive – without insurance, the costs can quickly deplete retirement savings for the average American …

https://www.epicbrokers.com/insights/long-term-care-affects-all/