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Attacking Out-of-Network Again

One of the hallmarks of in-network-only plans is that the provider prices have been pre-negotiated as a precondition for the doctor or hospital to join the network – and the insurer and employer to benefit from the lower costs – in exchange for the volume the provider receives through the insurance network. Preferred Provider Organization (PPO)-style plans, similar to the earlier indemnity-style plans, provide coverage (albeit at greater cost to the member) for non-negotiated, out-of-network providers. Employees get more choice at greater cost, and doctors receive some reimbursement from the plan and the remainder …

https://www.epicbrokers.com/insights/attacking-out-of-network-again/

Covering Coronavirus: Risk Considerations Volume 1, Issue 22

EPIC Risk Advisory Bulletin Volume 1, Issue 22 In this issue, we take a focused look at: Supply Chain and Business Risks Entertainment Industry Update Looming Transportation Deadlines Truckers Keep America Rolling Insurance Products and Coverage Information News of Note Human Resources and Employee Benefits Coronavirus Resources for the Fall CA Workers’ Compensation Law Advanced Workers’ Compensation Webinar October 1 Preparing Office Ventilation Systems for Workers The information presented here is intended to provide a high level overview of critical areas of concern for businesses around coronavirus. Consult your EPIC insurance broker for more in-depth guidance. Supply Chain & Business …

https://www.epicbrokers.com/insights/covering-coronavirus-risk-considerations-volume-1-issue-22/

COVID-19 Makes 2021 Medical Cost Predictions Far More Challenging

Self-insured employers typically establish “premium equivalent rates” in the third quarter of the prior year. These are an estimation of claims based upon the most recent claim data available. While these rates are used to set healthcare cost budgets, the costs that hit an organization’s income statement are based upon actual claim costs paid during the year. Several of the large public brokers predicted significant COVID-19-related costs. The EPIC financial team did not. We believed that the deferral of care would offset any pandemic claim spikes and we were right. As 2020 winds down, it is …

https://www.epicbrokers.com/insights/covid-19-makes-2021-medical-cost-predictions-far-more-challenging/

Pharmacy Update Aug 2020

FDA Rejections The Food and Drug Administration (FDA) recently rejected Gilead’s filing for approval of filgotinib for rheumatoid arthritis. With the FDA asking to see data from an ongoing clinical trial, Gilead is unlikely to be able to refile until mid-2021, pushing it further behind its competitors for the Janus Kinase (JAK) inhibitor market. These drugs suppress the immune system to prevent damage to the joints. The FDA rejected BioMarin’s Roctavian for hemophilia A. This expensive gene therapy was expected to revolutionize the treatment of this disease. However, the manufacturer will be required to complete an ongoing …

https://www.epicbrokers.com/insights/pharmacy-update-aug-2020/

There’s a Lot of Money Going to Healthcare Innovation – Will It Work?

Viewpoints from Craig Hasday Lucrative profit potential, along with political and economic pressure to reduce healthcare costs, has spawned consolidation and vertical integration of traditional insurers and pharmacy benefit managers. But costs continue to escalate, and these traditional markets will no doubt be challenged for solutions. Mergers, consolidation and innovation have combined with political agendas with multiple opinions even within the Democratic and Republican parties. Healthcare is a fragmented and inefficient industry in the United States and nearly 20% of U.S. Gross Domestic Product represents a significant opportunity for the nation’s largest companies to do it better. Walmart …

https://www.epicbrokers.com/insights/theres-a-lot-of-money-going-to-healthcare-innovation-will-it-work/

Medicare Part D Notice Requirements

Quick Facts Employers that sponsor group health plans that provide prescription drug coverage to Medicare-eligible individuals must disclose the creditable or non-creditable status of the drug coverage for the upcoming calendar year. The notices must be provided each year before October 15, which is the start date of the annual Medicare open enrollment period. Model creditable or non-creditable coverage notices are available from the Centers for Medicare & Medicaid Services (CMS). Overview The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) requires employers that offer prescription drug coverage to notify Medicare-eligible individuals as to whether …

https://www.epicbrokers.com/insights/medicare-part-d-notice-requirements/

Properly Handling Medical Loss Ratio (MLR) Rebates

Quick Facts The Affordable Care Act (ACA) requires health insurers to spend a minimum percentage of premiums on medical care, called the medical loss ratio (MLR). The minimum federal MLR standards are 80% for small group policies or 85% in the large group market. Insurers, including HMOs, must rebate (refund) any excess premiums to the policyholder by September 30 of the following year. Employers that receive MLR rebates must handle the funds in accordance with applicable plan terms and federal guidance. Background The Affordable Care Act (ACA) requires health insurers and HMOs to spend at least a certain percentage of …

https://www.epicbrokers.com/insights/properly-handling-medical-loss-ratio-mlr-rebates/

Communication Basics in a Not-So-Basic World

… excellent tools to help support your message as long as they are relevant and provide an important visual reference for your audience. Callout boxes are another effective way to visually draw attention to key points or information. Remember – plan ahead and start with the end in mind; identify what your audience needs to know, key points they need to remember, and why they should care. These things will help you prepare, design and deliver your message concisely and effectively. The EPIC Communications & Engagement team works closely with our clients to help make meaningful, engaging employee communications. Check out our recent

https://www.epicbrokers.com/insights/communication-basics-in-a-not-so-basic-world/