We are very excited to announce our incredible growth in the past few years, and the addition of two new professionals to our amazing team!

A Health Reimbursement Arrangement (HRA) is an employer-established account that allows them to reimburse a portion of the member’s out-of-pocket costs, usually while meeting the deductible on their health plan. Under the current regulations established by the Affordable Care Act (ACA) in 2010, HRAs are only allowed in conjunction with an employer group health plan. On October 29^th, 2018, proposed regulations were announced by the Treasury Department, Health and Human Services, and the Department of Labor, that could change this limitation. 

The Trump Administration recently proposed a plan that could potentially cut pricing for pharmaceuticals through Medicare Part B. Attempts to lower these costs is nothing new, and the Obama administration had proposed something similar before he left office, with little success.  

With unemployment at historic lows and student debt at historic highs, it’s no wonder that employers are considering fresh types of benefits plans to attract talent. Some companies are offering student loan repayment benefits linked to their 401(k) plans, a practice which recently received a green light from the IRS in a private letter ruling. Though the ruling is not comprehensive and applies only to one company’s practice (pharmaceutical firm Abbott Laboratories), the decision provides guidance on how the IRS might rule in other cases. 

When the Obama administration issued guidance defining discrimination under the ACA to include denying certain benefits to transgender individuals, many employers began including new protocols for approving and covering certain benefits.

Those requirements appear to be shifting in the face of recent court cases as well as an expected new rule from Health and Human Services (HHS). While nothing is final yet, we’ve received a few questions from clients and wanted to address the status of this evolving issue. 

Fall River clients have complimentary access to HR360, a comprehensive online Human Resources portal designed to help you comply with employment and benefit laws in all 50 states. With HR360, you’ll find easy, step-by-step guidance on a broad range of laws and policies. Even non-clients can check it out at no cost! Learn how HR360 can make your life easier!

The partisan battle over the Affordable Care Act (ACA) heated up once again during the first week of September, when Judge Reed O’Connor in Fort Worth, Texas heard arguments from Republican attorneys general stating that the ACA is unconstitutional.  Although it may take a few weeks or even months for the judge to render his decision, the healthcare industry continues to speculate about the potential implications for the market, individuals, and employer group plans.  The crux of the issue is around the individual mandate and the preexisting condition protections that the ACA introduced.

We wrote a blog article in April about Consumerism and how to empower your employees to be smart consumers of health care. We know how difficult and confusing benefits can be, so check out these five additional tips to continue this education for your employees to enable them to advocate around their own health care and out-of-pocket expenses! 

At Fall River we are committed to helping our members understand their health benefits and provider bills. We know that navigating the benefits world can be confusing, and unfortunately, we are seeing more and more claims situations that prove it’s getting ever more complicated. 

Here are recent examples of some complex and downright outrageous claims issues we want you and your members to be aware of.

This past May, the Trump administration released its plans to reduce pharmaceutical prices on four fronts. The policy was laid out in a blueprint which describes the various fronts the Center for Medicare and Medicaid Services (CMS) and the department of Health and Human Services (HHS) propose to take to alleviate the problem. The four areas the administration proposes to target for action are increasing competition, better negotiation, creating lower list prices, and reducing patient Out-of-Pocket spending. Since all employer plans are impacted by the rising costs of prescriptions, we are encouraged to see active steps proposed to address the problem.