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! 

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, continue reading for what you need to do.

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.

On July 25, 2018, the House of Representatives passed two health care bills, H.R. 6199 and H.R. 6311, that would make significant changes to Health Savings Accounts (HSAs), Flexible Spending Accounts (FSAs) and Health Reimbursement Arrangements (HRAs). Republicans are pushing to expand HSA usage with a number of Democrats leaning toward supporting these bills as well. Both bills would still need at least 60 votes from the Senate to go into place, which may not be possible before the end of this Congressional session in December.

Employers with 15 or more employees whose wellness program include biometric testing or health risk assessments (HRAs) may need to reconsider their wellness incentives, as changes to the rules governing either of these wellness plan features go into effect January 1, 2019. 

The expansion of Association Health Plans (AHPs) has arrived. The U.S. Department of Labor announced regulations that will allow these plans to become effective as early as September 2018. AHPs allow small business to band together to purchase health insurance. Continue reading to understand whether these Association Health Plans might be a fit for your organization. 

If you have a self-funded or partially self-funded plan (including all “Level Funding” plans), you need to know about New York State’s Health Care Reform Act (HCRA) of 1996, even if you don’t have employees in New York. The HCRA, which still applies today, was created to generate funding for a wide variety of health care initiatives in the state, and requires providers of health care services and Third Party Administrators (TPAs) to participate in that funding. In 1997, the State created the New York Public Goods Pool to collect funds for those initiatives and for indigent care in the state.