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Medical Loss Ratio Rebates: What They Are & How They Should Be Handled

ā€¦ any portion of a planā€™s premium, the employer must calculate how much of any MLR rebate should be considered plan assets, meaning that the rebate should be used strictly for the benefit of plan participants. Decisions about how to allocate the participantsā€™ portion of the rebate are subject to Employee Retirement Income Security Act (ERISA)ā€™s general standards of fiduciary conduct. Background Included in the Affordable Care Act (ACA) were new rules that required health insurance companies to disclose certain financial data. This includes the portion of medical plan premiums spent on paying claims and quality improvement initiatives and ā€¦

https://www.epicbrokers.com/insights/medical-loss-ratio-rebates-what-they-are-how-handled/

Outbreak Period: Guidance on Extended Timeframes for COBRA Elections & Payments

Quick Facts After a National Emergency was declared, the regulatory agencies jointly issued a final rule extending several deadlines applicable under the Health Insurance Portability and Accountability Act (HIPAA), Consolidated Omnibus Budget Reconciliation Act (COBRA) and Employee Retirement Income Security Act (ERISA). For the period beginning March 1, 2020, until 60 days after the end of the National Emergency, all group health plans, disability plans, other employee welfare benefit plans and employee pension plans must disregard the time period known as the ā€œOutbreak Periodā€ when administering plans with respect to the deadlines covered by the rule. IRS guidance in Notice ā€¦

https://www.epicbrokers.com/insights/outbreak-period-guidance-extended-timeframes-cobra-elections-payments/

HHS Issues FAQs on HIPAA Privacy & COVID-19 or Flu Vaccine Status

Quick Facts In September, the Department of Health and Human Services (HHS) released a set of frequently asked questions (FAQs) addressing Health Insurance Portability and Accountability Act (HIPAA) privacy requirements and employee vaccines. The FAQs address to whom the privacy rule applies, what constitutes protected health information (PHI) and permitted uses and disclosures of PHI. The FAQs provide examples of situations where a request for an individualā€™s vaccination status does not implicate the HIPAA Privacy Rule. The FAQs state that once a covered entity has information regarding an individualā€™s vaccination status, that information is considered PHI and the ā€¦

https://www.epicbrokers.com/insights/hhs-faqs-hipaa-privacy-covid-19-flu-vaccine-status/

Self-Funded Employers May Need to Pay Washington Stateā€™s WAPAL Fee

Quick Facts Washington State recently passed legislation requiring health insurance carriers and health plans to pay a quarterly assessment to assist medical providers with managing patientsā€™ mental health needs. Health insurance carriers will pay on behalf of fully insured plans, but self-funded plans may need to pay the fee themselves. Fees will be reported and paid online quarterly. The fees are not preempted by Employee Retirement Income Security Act (ERISA). Background The state of Washington has passed legislation requiring health insurance carriers and employers that sponsor self-funded health plans to pay a quarterly assessment to support a state ā€¦

https://www.epicbrokers.com/insights/self-funded-employers-washington-wapal-fee/

No Surprises Act Part II Interim Final Rule: The Independent Dispute Resolution Process

ā€¦ estimates of expected charges, the independent dispute resolution (IDR) process, the patient-provider dispute resolution process for uninsured and self-pay patients, and the new external review requirements. The comment period for the new final interim rule closes on December 6, 2021. The Centers for Medicare & Medicaid Services (CMS) and Employee Benefits Security Administration (EBSA) created Surprise Billing webpages that provide information on the NSA. HHS created the IDR Entity Certification Application Web Form Quick Reference Guide that explains the process for an arbitration organization to become a certified IDR entity. To be certified, an IDR entity must possess (directly ā€¦

https://www.epicbrokers.com/insights/no-surprises-act-part-ii-independent-dispute-resolution/

Latest Wave of Healthcare Systems Seeks Direct Sales to Northeast Employers

The New York metro area is seeing another resurgence in healthcare delivery systems attempting to sell their services directly to employers offering benefits programs. These systems are looking to work with their existing medical insurers or even bypass them entirely ā€“ getting into direct competition for insured members and patients. Viewpoints from Adam Okun Kaiser Permanente pioneered a new model for healthcare financing and delivery 60+ years ago in California. They created a healthcare system for their workers, later opening their insurance product to other employers using the Kaiser network and securing a captive member base for its doctors and hospitals ā€¦

https://www.epicbrokers.com/insights/healthcare-systems-seek-direct-sales-northeast-employers/

Washington State Creates the WA Cares Fund

ā€¦ care (LTC) benefits. An employee payroll tax will provide funding for the WA Cares Fund. Washington employees may opt out of the payroll tax if they meet certain criteria by the exemption deadlines. However, exemption from the WA Cares payroll tax disqualifies a worker from ever receiving future WA Cares benefits. The newly created WA Cares Fund provides eligible Washington workers with state payroll tax-funded LTC insurance benefits beginning January 1, 2025. Employee premiums completely fund the WA Cares benefits. Employers are not required to contribute to any portion of the WA Cares premium ā€“ a 0.58% ($0.58 ā€¦

https://www.epicbrokers.com/insights/washington-state-creates-wa-cares-fund/

Missouri Passes the Victimsā€™ Economic Safety and Security Act

ā€¦ of employees. Covered employees receive: One week of unpaid leave, if the employer has 20-49 employees; and Two weeks of unpaid leave if the employer has 50 or greater employees. Employees may take this unpaid leave intermittently or on a reduced work schedule. VESSA also entitles covered employees to benefits and employment protection. Employees cannot lose any accrued benefits while on leave, and their employer must maintain their healthcare coverage. Additionally, employers must return employees to their same or an equivalent position upon their return from leave. Finally, VESSA requires employers to make reasonable safety accommodations for employees who ā€¦

https://www.epicbrokers.com/insights/missouri-passes-victims-economic-safety-security-act/