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.
September 8, 2023
Tenth Circuit Court of Appeals Hands Down a Big Win for ERISA Preemption After several failed attempts by pharmacy benefit managers (“PBM”) to challenge state laws regulating PBMs, the 10th Circuit Court of Appeals (in Pharmaceutical Care Management Association v. Mulready) handed down a big win for PBMs and, by extension, self-funded ERISA plans, when […]
August 28, 2023
IRS Issues Affordability Percentage Adjustment for 2024 The Internal Revenue Service (IRS) has released Rev. Proc. 2023-29, which contains the inflation adjusted amounts for 2024 used to determine whether employer-sponsored coverage is “affordable” for purposes of the Affordable Care Act’s (ACA) employer shared responsibility provisions and premium tax credit program. As shown in the table […]