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Another Court Rules Against Cross-Plan Offsetting

… an acceptable method for recouping provider overpayments. Generally, the Third-Party Administrator (TPA) or insurer of a medical plan may withhold payments to a provider on a new claim to recoup overpayments made to that same provider for other claims. This practice typically occurs in situations such as coordination of benefits, subrogation, or payment mistakes. In addition, cross-plan offsetting occurs when a TPA or insurer, with multiple employer clients, offsets payments to a particular provider for one client’s plan to recoup the overpayments made to that provider from another client’s plan or policy. The Employee Retirement Income …

https://www.epicbrokers.com/insights/another-court-rules-against-cross-plan-offsetting/

Maryland Public Health Emergency Paid Sick Leave

Maryland is the latest state to implement a paid sick leave law, H.B. 581, the Maryland Essential Workers’ Protection Act (the Act). Maryland’s law provides paid leave to employees working in Maryland who are unable to work due to a public health emergency related to a communicable disease. The new law became effective on June 1, 2021, but the paid leave provisions are on hold until the state government provides funding. On May 28, 2021, Maryland Governor Larry Hogan announced his intention to allow the Act, to become law without his signature. The Act requires essential employers to …

https://www.epicbrokers.com/insights/maryland-public-health-emergency-paid-sick-leave/

Departments Provide Long-Awaited Guidance on the No Surprises Act

… ensuring compliance with these new rules; however, self-funded plan sponsors are legally responsible for ensuring compliance. The guidance does not address all the provisions of the No Surprises Act including but not limited to guidance on the independent dispute resolution process, the good faith estimates and advanced explanation of benefits, provider directories or continuity of care. Background On July 1, 2021, The Office of Personnel Management (OPM), along with the departments of Health and Human Services (HHS), Labor (DOL), and Treasury released “Part 1” of regulations implementing the No Surprises Act. The interim final rule with comment period (IFC …

https://www.epicbrokers.com/insights/departments-provide-long-awaited-guidance-on-the-no-surprises-act/

Supporting Self-Care for Employee Caregivers with Aging Parents

… leave a similar legacy for my kids and grandkids and the thought broke my heart. While it is not easy for me to put myself first, I joined a fitness center and carved out time twice a week to work with a trainer, committed to walking a few times a week and met with a dietician. I now attend a chair yoga class once a week, because sometimes all you need is someone to remind you how to breathe. Supporting such a large population of your caregiving workforce in keeping healthy is a must for benefits programs. Consider adding some

https://www.epicbrokers.com/insights/supporting-self-care-for-employee-caregivers-with-aging-parents/

President Biden Signs an Executive Order on Competitive Drug Pricing

On July 9, 2021, President Biden signed an expansive Executive Order on Promoting Competition in the American Economy (Order). The Order addresses several issues and areas of the economy in which the Biden Administration (Administration) plans to spur competition to promote small business, worker, and consumer interests. Among the many issues that Order addresses is the cost that healthcare consumers pay for prescription drugs and healthcare services. The Order sets out several administrative policies meant to decrease prescription drug prices. According to the Biden Administration, President Biden’s Order identifies several factors that have weakened competition in the marketplace. The …

https://www.epicbrokers.com/insights/president-biden-signs-an-executive-order-on-competitive-drug-pricing/

Transparency and the Value of a Great Insurance Broker

… of consultants on all sides. There is no doubt that pharmacy cost transparency rules are needed and they are coming. Federal laws restrict “profits” to 15-20% of insurance premiums, but here is a relatively new game that’s being played: All of the four national health insurers own pharmacy benefits managers (PBMs) and other providers of healthcare. Owning providers allows the health insurers to expand profits in areas other than “premiums.” The federal law restricts profits on premiums but does not restrict profits on services rendered by providers owned by these insurance carriers. Axios announced days ago that the …

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

HHS Announces the Protections Against Surprise Medical Bills Notice and First Interim Rule

The No Surprises Act is the balance billing or surprise billing relief portion of the Consolidated Appropriations Act, 2021 (CAA). All of the No Surprises Act provisions take effect on January 1, 2022. Congress tasked certain federal agencies with engaging in extensive rulemaking proceedings during 2021. On July 1, 2021, The Departments of Health and Human Services (HHS), Labor (DOL), Treasury, and the Office of Personnel Management (collectively known as “the Departments”) issued Requirements Related to Surprise Billing; Part I. The HHS COVID-19 RESOURCES Coronavirus Resource Center Return-to-Office Protocols & Considerations Client Panel What Employers Need to Know …

https://www.epicbrokers.com/insights/hhs-announces-the-protections-against-surprise-medical-bills-notice-and-first-interim-rule/

EPIC Commits to Staying Connected!

EPIC Launches 2nd Annual Virtual Benefits Event Virtual Employee Benefits University is July 19 – 23 On Monday, July 19, we launched our second Virtual Employee Benefits University (VEBU). Our focus on this week-long learning event reflects our commitment to our employees, EPIC’s most valuable asset, and our virtual VEBU platform provides an interactive, high-touch environment to gather and learn from each other and our vendor partners. Our VEBU theme this year is the Five Pillars of Success: Innovation, Organic Growth, Collaboration, People First and M&A. Each day, we are presenting a key learning topic based on …

https://www.epicbrokers.com/insights/epic-announces-2nd-annual-virtual-benefits-event/