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Final 2021 Notice of Benefit and Payment Parameters

Quick Facts Recently, the Department of Health and Human Services (HHS) issued its Final Notice of Benefit and Payment Parameters for 2021 (Final Rule). Under the Final Rule, the Affordable Care Act’s (ACA’s) out-of-pocket maximum limit will increase to $8,550 (self-only coverage) and $17,100 (family coverage) in 2021. The required contribution percentage for the individual mandate’s affordability exemption will increase for 2021. The Final Rule clarifies that issuers, including employer-sponsored health plans, are permitted but not required to count the value of a manufacturer coupon discount toward the ACA’s annual …

https://www.epicbrokers.com/insights/final-2021-notice-of-benefit-and-payment-parameters/

The Truth About Weight: Why Weight-Based Health Programs Can Cause More Harm Than Good

Viewpoints from Craig Schmidt Wellness programs, challenges and social media influencers focus on weight as if it’s a true indicator of health. Hate to break it to you (and them) – it’s not. Health is more than a number on a scale, it’s a way of life that should be as diverse in its evaluation and outlook as people are. Let’s quickly define health; according to the World Health Organization (WHO) health is the state of complete physical, mental and social wellbeing – not merely the absence of disease. I don’t see weight in there, do you …

https://www.epicbrokers.com/insights/the-truth-about-weight-why-weight-based-health-programs-can-cause-more-harm-than-good/

Healthcare Is at the Crossroads Again

Viewpoints from Craig Hasday In a largely symbolic effort, House Democrats introduced a bill to modify healthcare laws. It’s too bad this one has no chance – some of the changes look pretty good and what we might get after the election power shift could end up much worse. The bill expands and protects Medicaid and reduces or eliminates premiums for the lowest earners and most vulnerable populations. It also clears up a technical error in the Affordable Care Act (ACA) that eliminated subsidies for spouses and children in the event the employee is eligible for employer-sponsored coverage (despite …

https://www.epicbrokers.com/insights/healthcare-is-at-the-crossroads-again/

DOL Clarifies FFCRA and CARES Act COVID-19 Testing Coverage Requirements

… today issued another set of FAQs that address employers’ ongoing obligations to cover certain testing expenses under their group health plans; however, return-to-work COVID-19 testing is not required to be covered by a group health plan. COVID-19 Testing FFCRA generally requires group health plans to provide benefits for certain items and services related to diagnostic testing to detect SARS-CoV-2 or diagnose COVID-19. Plans must cover these costs with no cost sharing (including deductibles, copayments and coinsurance), prior authorization or any other medical management requirement, when furnished on or after March 18, 2020 (FFCRA …

https://www.epicbrokers.com/insights/covid-19-testing-coverage-requirements/

Traditional Insurance Carriers Are Reimagining Healthcare – They Have To

For more of our coronavirus coverage, visit epicbrokers.com/coronavirus  Viewpoints from Craig Hasday Blue Shield of California has introduced a new program, called “Health Reimagined.” Their press release indicates that “they couldn’t just incrementally improve on a system that’s fundamentally dysfunctional.” Trying to address the needs of increasingly stressed providers, and patients who continually complain about healthcare costs and frustrations with the system, Blue Shield of California is experimenting with a clinic model. It’s no surprise that this initiative is based in California, the operational base of Kaiser Permanente, one of the most successful HMOs ever …

https://www.epicbrokers.com/insights/traditional-insurance-carriers-are-reimagining-healthcare-they-have-to/

Covering Coronavirus: Risk Considerations Volume 1, Issue 16

EPIC Risk Advisory Bulletin Volume 1, Issue 16 The global COVID-19 (coronavirus) pandemic remains both dynamic and fluid. We continue to see unprecedented disruptions at home and abroad. In this issue, we take a focused look at: General Information on Coronavirus Supply Chain and Business Risks Emergency Exemption Extension for Commercial Drivers Insurance Products and Coverage Information Commercial Property Coverage for Riots Hurricane Preparation Checklist News of Note Human Resources and Employee Benefits WC Presumptive Compensability Legislation Update Monitoring Remote Workers Insights from Across the Firm General Information on Coronavirus It has been nearly three months since the coronavirus …

https://www.epicbrokers.com/insights/covering-coronavirus-risk-considerations-volume-1-issue-16/

Cost Modeling Projections

Introduction The cost impact to the U.S. healthcare system by the COVID-19 pandemic has been estimated by reputable studies in a range of 6%-15% of U.S. healthcare spend in 2020. These studies are of special interest to self-insured employers, health plans, and reinsurers for pricing and planning purposes. An important feature of these models is that they do not attempt to quantify the behavioral changes of beneficiaries who are unable or unwilling to seek care during times of social distancing and hospital resource scarcity. EPIC calculates that in 2020, COVID costs for the U.S …

https://www.epicbrokers.com/insights/cost-modeling-projections/

Reactive vs. Proactive Benefits - Don’t Get Caught in the Trap

… some things have not changed. Like the need to be strategic in planning for your employee benefits program. I was reminded of this in a recent 2021 strategic planning meeting with a new client who mentioned they’d never had a discussion like this before. That comment explained why their benefits plans were so dysfunctional; too expensive, poorly communicated, ineffective, and out of compliance. Does this sound like your program? It’s a simple concept – most employee benefit plans react, rather than plan. Medical rate increase? Reduce benefits or find a new carrier. Salesperson calls with a new product offering …

https://www.epicbrokers.com/insights/reactive-vs-proactive-benefits-dont-get-caught-in-the-trap/