May 12, 2022
If you are a Plan Sponsor of self-funded or level-funded health plans you have new administrative requirements starting on July 1, 2022.
In an effort to improve the transparency in healthcare costs, hospitals were required in 2021 to provide clear and accessible pricing information online for the items and services they provide. The next phase of this rule comes into effect July 1, 2022 and will require insurers to provide access to customized out-of-pocket cost information for consumers related to a list of 500 shoppable services. This information must be provided via a publicly accessible website, must include 3 distinct machine-readable files, and must be updated monthly.
This CMS Link provides some additional information directly from the Centers for Medicare and Medicaid Services.
This is a significant burden for individual health plan sponsors and as a result your carrier or plan administrator can provide you a link to post on your publicly accessible website. This link will take those interested in the information to a site, hosted by your carrier or administrator, that contains all of the required information in the appropriate formats which will be updated timely.
You should have heard directly from your carrier or will be hearing from them shortly with information related to this link and the rule itself. If you have not yet heard from them or have additional questions, please contact us today to discuss.
January 9, 2024
Sponsors of self-funded ERISA plans have fiduciary obligations to plan participants, which includes the obligation to provide a full and fair review of claims and effectively and meaningfully communicate or engage with plan participants regarding claims denials. One district court recently clarified that this obligation may include the need for the plan administrator, which is […]
December 4, 2023
On July 25, 2023, the agencies released an extensive proposed rule related to the Mental Health Parity and Addiction Equity Act (the “Proposed Rule”) as well as a Technical Release requesting comments on certain proposed data requirements for nonquantitative treatment limitations (“NQTLs”) and the potential for an enforcement safe harbor if certain data requirements are […]