Colorado’s reinsurance program received federal approval this summer. We first reported on the program in April while the proposal was being debated in the Colorado legislature.

The Medicare Part D Notice is just one of the many compliance responsibilities to which most employer health plans are subject. Since this notice is due in just a couple of weeks, here’s what you need to know: 

Having a baby can be extremely exciting, and there are so many things to prepare for and think about! In addition to the many other things going through your mind, here a few reminders regarding insuring your new bundle of joy: 

Many employers have benefitted greatly from having some type of self-funded arrangement where they participate in the actual claims experience of their employees with protection from catastrophic claims. At Fall River, self-funded plans are one of our major areas of expertise, and we view self-funding as a five-step spectrum, rather than just a yes/no question. Register for our Advanced Self Funding Webinar here. 

Many employers are offering High Deductible Health Plans (HDHPs) to their workforce these days, and they sometimes express concern that members with chronic conditions may delay much-needed routine care because of the financial burden they experience while meeting their deductible.

Good news is on the horizon! On July 17, 2019, the IRS expanded the list of services considered preventive and therefore able to be covered by insurance before or at a reduced deductible.

In June, the Trump Administration issued new rules expanding the function of Health Reimbursement Arrangements (HRA) in an attempt to provide employers additional options for providing health coverage.  These rules, which will go into effect in January 2020, create two new ways to offer pre-tax dollars for purchasing health coverage: the Individual Coverage HRA (ICHRA) and the Excepted Benefit HRA (EBHRA).

Employers are often considering ways to enhance their benefits packages and attract great employees. Some employers might increase their contributions towards the health plans or 401(k) matching contributions, but another option is to offer an opt-out payment for those employees waiving the company-sponsored health coverage. At Fall River we are asked about this option frequently, and we continue to evaluate the pros and cons as well as the rules of doing so.

Direct Primary Care (DPC), aka “concierge medicine,” is an alternative provider payment model gaining traction with employers who are tired of high health insurance rates and their employees not receiving the care they need. Instead of billing the insurance carrier for routine care, DPC providers usually charge a monthly flat fee which allows the member access to unlimited routine services such as laboratory services, same-day or next-day appointments, and sometimes even house calls. The savings generated by this model can certainly benefit companies, especially those that are self-funding their plans.

The Patient Centered Outcomes Research Institute (PCORI) fee is due July 31, 2019 for employers with any type of self-funded plan and/or a Health Reimbursement Arrangement. The fee helps fund unbiased research that evaluates the clinical effectiveness of medical treatments regardless of the profit potential. This fee is also known as the Comparative Effectiveness Research Fee, or CERF.

The IRS recently announced the changes to the contribution limits for High Deductible Health Plans (HDHPs) and Health Savings Accounts (HSAs) in 2020. Also in this article, we’ve answered some of the most common questions we receive on HSAs. See if you know the answers before you read ours!