The Medical Loss Ratio obligations under the ACA cap the percentage of premium dollars health insurers may use for administration, marketing, and profits. If a health insurer collects more than the allowed amount for these spending categories, they must provide a rebate to affected groups. A few of the medical carriers have recently sent out Medical Loss Ratio (MLR) rebates, so it’s important to know what can be done with that money. If employees paid any portion of the monthly premiums, employers will likely need to share the rebate with them.

The Kaiser Family Foundation has released their 2020 Annual National Employer Benefits Survey. The survey has been tracking benefit statistics from private and public employers (other than the Federal Government) in the United States for the last 22 years. The 2020 survey included interviews with 1,765 employers.

Fall River has written in past articles about how Health Reimbursement Arrangements (HRAs) can be a valuable cost-containment strategy while effectively rendering employees’ benefits unchanged. We recently completed an internal analysis of one client who was able to slash their effective renewal increase down from 15% to 5% by adjusting and expanding their HRA.

It’s clear that virtual open enrollment meetings are part of our new normal. Whether you’ve been doing them for years or for the first time this year, there’s a lot to consider if you want to make them as successful as possible. Fall River has been assisting our clients with ideas and best practices to make the process as seamless and engaging as possible for HR professionals and employees. Our national partner, Alera, hosted a great webinar in early September entitled Taking Virtual Open Enrollment to the Next Level. 

The COVID-19 outbreak in 2020 has created new challenges for families and employers, and has sparked much discussion about a more formal Family and Medical Leave policy. On the upcoming Colorado November ballot is Proposition 118, which introduces a Paid Family and Medical Leave Insurance Program for eligible employees with benefits that would begin in 2024. 

2021 is right around the corner, and employers with calendar year plans are deciding on their benefit changes for 2021. Health Reimbursement Arrangements (HRAs) can be a great option for reducing healthcare costs while keeping employees’ benefit level the same or better. They can also help you to create greater consumerism within your plan as well as offer a way to take a small step towards self-funding your plan. A fantastic recent article (weekly wrap-up) from our national partner Alera will help you get familiar with HRAs, point out some compliance aspects to be aware of, and highlight some important factors to consider when deciding if it’s the right move for your company.

The ever-growing prescription drug industry has long been ripe for innovation and disruption. At the same time, members struggle to manage the many prescriptions they may need to take at the same time.  As the cost of many prescription medications continues to be very high, Americans are increasingly looking outside traditional pharmacies for purchasing alternatives. One of these newer alternatives is PillPack, which was purchased in May 2018 by Amazon, and may actually help members improve their medication compliance, a key metric in improving health.

The COVID-19 pandemic has created uncertainty for many employers who worry that expensive Coronavirus testing and treatment could lead to a spike in premiums in 2021. But is it a foregone conclusion that we’ll see large renewals, or a myth?

Clients for whom Fall River is the health insurance broker were recently given free access to our new HR support tool, AleraHR. For those of you who have used ThinkHR before, AleraHR is our white-labeled version of that system.  AleraHR is a very robust HR and compliance system that offers many valuable and time-saving modules related to just about any HR topic you can think of! Best of all, you can submit questions by email or phone and get answers fast from certified HR professionals you can rely on.

All health plans are required under HIPAA to distribute certain notices, such as the Notice of Special Enrollment Rights when employees become eligible, and the CHIP notice which must be sent to employees annually. But there are quite a few other requirements that sometimes catch employers off guard.