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Transparency Requirements & Surprise Billing – Agency FAQs Offer Several Delays

… are delayed, with some requirements delayed indefinitely until further guidance is provided. However, there are a few requirements that will go into effect in 2022 as originally indicated. Group Health Plan Application & Responsibility The transparency in coverage rules apply to most group health plans, but not grandfathered health plans, excepted benefits (including limited scope dental or vision benefits), or health reimbursement arrangements (HRAs). The CAA requirements apply similarly, but there is no exception for grandfathered health plans. For fully insured plans, the requirements will be handled by the carrier. For self-funded plans, the requirements will generally be handled by …

https://www.epicbrokers.com/insights/transparency-surprise-billing-agency-faqs-delays/

Amazon and the Continuing Disruption of Primary Care

Primary care physician relationships were once deemed the most sacred in the healthcare system. Long considered the gatekeeper of medical services, plan members built loyal, trusting relationships with these providers, who in turn acted as “quarterbacks” for their patients’ healthcare needs. Like a general contractor overseeing a large construction project, primary care physicians (PCPs) directed members to the appropriate specialists, prescription drugs and hospital systems – and followed up with their patients to ensure medical needs were being met. In fact, the entire health maintenance organization (HMO) model was predicated upon the referral discretion of the PCP; as have more recent …

https://www.epicbrokers.com/insights/amazon-and-the-continuing-disruption-of-primary-care/

San Francisco Makes Updates to the 2022 HCSO Requirements

The San Francisco Health Care Security Ordinance (SF HCSO) requires employers with San Francisco employees to meet specific healthcare expenditure-related obligations. The San Francisco Office of Labor Standards Enforcement (OLSE) updated the SF HCSO website to reflect changes made during the July 19, 2021, San Francisco Board of Directors (the Board) meeting. During the meeting, the City amended the SF HCSO related to telework. On August 6, 2021, the City also announced the updated Health Care Expenditure (HCE) rates for businesses. In addition, the annual employer reporting must be submitted as typically required before the 2022 annual filing deadline …

https://www.epicbrokers.com/insights/san-francisco-makes-updates-to-the-2022-hcso-requirements/

Another Court Rules Against Cross-Plan Offsetting

… As a refresher from a previous article, 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/

Federal Agencies Release New and Additional Guidance Related to COVID-19

Several Federal Agencies have issued COVID-19 (coronavirus) related guidance. On July 26, 2021, the Department of Health and Human Services (HHS) issued guidance addressing how nondiscrimination rules apply to the condition dubbed “long COVID.” On that same day, the Internal Revenue Service (IRS) released Notice 2021-46 to explain further the Consolidated Omnibus Budget Reconciliation Act (COBRA) premium assistance available under the American Rescue Plan Act of 2021 (ARPA). On July 29, 2021, the IRS updated its Frequently Asked Questions (FAQs) on the paid sick and family leave tax credits available under ARPA to clarify the types of employee …

https://www.epicbrokers.com/insights/federal-agencies-release-new-and-additional-guidance-related-to-covid-19/

Market Pulse Survey: COVID-19 Vaccine & Return to Office Plans

What is Your Company’s Approach to the COVID-19 Vaccine & Return to Office Plans? Earlier this year, we released a survey to determine employers’ initial thoughts on how the availability of the vaccine would be addressed in their workforce. At that time, very few companies were requiring inoculation. In light of the recent surge in the Delta Variant, more companies are now rethinking their approach. Forbes reported that several large tech companies are now going to be requiring vaccinations. Walmart also announced that their corporate staff would be required to be vaccinated and store/warehouse staffers would be incented …

https://www.epicbrokers.com/insights/market-pulse-survey-covid-19-vaccine-return-to-office-plans/

Getting Back to Business Travel While Facing the Delta Variant

Employers encounter an array of issues as employees return to offices and the world looks towards the future with an eye on COVID-19 and its ever-changing variants. Global benefits strategy and preparedness issues for American companies with locations outside the U.S. most likely keep their benefits managers and human resources teams up at night. On top of return-to-office challenges around the world, global travel is starting to increase – but with that comes many concerns. Viewpoints from Matt Marmorek Several of our clients have resumed business travel outside the U.S., and our number-one piece …

https://www.epicbrokers.com/insights/getting-back-to-business-travel-while-facing-the-delta-variant/

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/