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… is too small to be credible,” or they provide incurred data with completion factors that aren’t specified. They’ll also stall so the most recent data isn’t available until months later. The federal government is onto this, first taking action by requiring hospital pricing transparency and now pharmacy benefits manager (PBM) transparency. Transparency reduces the margins and profits of these types of intermediaries and allows plan sponsors to make decisions using relevant and timely data points. EPIC partners with Innovu, a data aggregator, to get timely data feeds from third-party administrators (TPAs) and PBMs – with line-item …

… first is individual coverage, or specific stop loss, which restricts the plan’s monetary risk of any individual claimant to a pre-established limit. The second is aggregate stop loss, which limits risk exposure for all claimants to a pre-set maximum. After the elimination of annual and lifetime maximum benefits for covered individuals, introduced by the Affordable Care Act in 2010, things got riskier. Today’s stop-loss environment has become very complicated, and an employer should choose their broker/consultant carefully. Up until a few years ago, it was rare for individual claims to exceed $1 million, but …

Viewpoints from Craig Hasday On December 23, 2022, President Biden signed the Secure Act 2.0 into law as a part of a $1.7 trillion omnibus spending package. I have been anxiously awaiting this legislation. In a 2018 private letter ruling, Abbot Labs was allowed to make matching employer contributions to 401(k) plans for student loan repayments made by their employees. Private letter rulings (PLRs) are not law but apply to a specific situation for which the PLR is written. I have been advising employers to jump on this change whenever this law (which I thought was inevitable …