The Patient Centered Outcomes Research Institute (PCORI) fee is due July 31, 2018 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.

When consumers need to access emergency health care services, they usually do not have the time nor presence of mind to determine whether a provider treating them is in-network or not. When those emergencies expose them to out-of-network providers, the provider or facility may “balance bill” the consumer for amounts beyond what the insurer paid. This out-of-network balance billing can create financial burdens and undermine the consumer’s confidence that health insurance will protect them from financial hardship.

Reference Based Pricing (RBP) is a cost containment strategy that some larger employers have implemented to help place a cap on the cost of larger medical services.  It’s a savvy strategy that, in the past, has worked best with self-funded large employers but is gaining steam across employers of all sizes.

The final Affordable Care Act provisions for 2019 have been released and they are in line with the regulations proposed on October 27, 2017. The provisions primarily concern the out-of-pocket maximums, Essential Health Benefits (EHBs), and the Marketplace.

The IRS has published inflation-adjusted Health Saving Account (HSA) contribution limits for 2019, along with minimum deductible and maximum-out-of-pocket expenses for the high deductible health plans (HDHP) associated with HSAs.

Current benefit plans have given more purchasing and decision-making power to the members with higher out-of-pocket responsibilities. Members do not always understand what their benefit plans cover, and the costs associated to that coverage, which can cause a lot of confusion and frustration. 

We at Fall River Employee Benefits understand that benefit plans can be an intimidating and confusing subject. We want to empower and educate our client’s employees to be their own best health advocates and make informed decisions regarding their health care. 

We love helping our clients create year-round campaigns to teach their employees to be better consumers of health care. There are many topics to cover, so we’ll likely do several articles in this area.