Innovative Benefit Planning Blog

Health Plan Disclosure Requirements for Prescription Drugs

Posted On: September 29, 2022 | Categorized as: Events

health plan disclosure requirements

Under the Affordable Care Act (ACA) transparency-in-coverage (TiC) rules and provisions of the Consolidated Appropriations Act, 2021 (CAA), group health plan sponsors must both disclose and report detailed information regarding a plan’s prescription drug coverage and costs. There is significant overlap under the two sets of disclosure rules, which has led to confusion regarding compliance. The confusion is even greater since the rules impose two required components for prescription drug cost disclosure – an annual report (Report) to the Centers for Medicare & Medicaid Services (CMS) and a mandatory machine-readable file (MRF). The Report deadline was originally set for last year, but the Departments that enforce the rules delayed the deadline until December 27, 2022. Also, because there is significant overlap in the rules regarding prescription drug costs, the Departments delayed the prescription drug MRF requirement indefinitely pending further regulation and guidance. Recent CMS guidance provided some technical clarifications to…


Departments Issue No Surprises Act FAQ and Clarify Independent Dispute Resolution Process

Posted On: September 29, 2022 | Categorized as: Events

no surprises act FAQ

The U.S. Departments of Health and Human Services, Labor, and the Treasury (the “Departments”) recently released final rules regarding the No Surprises Act. The rules specifically address required independent dispute resolution (IDR) of certain claims and expenses and finalize prior interim final rules relating to information that group health plans must disclose.Federal IDR ProcessThe No Surprises Act required regulators to develop an IDR process to resolve conflicts between payers and providers regarding out-of-network expense amounts. Any disputes unresolved after 30 days of negotiating can be referred by either side to binding arbitration from a certified IDR entity. The IDR entity will consider the qualified payment amount (QPA) – the insurance plan's median contracted rate for the same or similar service in an area – and other relevant submitted information, and then select one side’s suggested payment amount.Under interim final rules issued in October 2021, certified IDR entities were to select…


Substantial Medical Loss Ratio Rebates Expected in 2022

Posted On: September 29, 2022 | Categorized as: Compliance

Per the Kaiser Family Foundation, an estimated 8.2 million Americans will be due rebates for 2022. Further the analysis states that health insurers are expected to pay a total of $1 billion to policyholders.  In light of this, plan sponsors should be prepared to handle any Medical Loss Ratio (MLR) rebates they receive from their insurance issuer in a manner that aligns with applicable rules. The Affordable Care Act (ACA) outlines the requirements private health insurance issuers must follow, including obligations related to premium spending. The ACA requires health insurers to spend at least 80% to 85%, depending on the size of the market, of premium dollars on medical care. The remaining 20% to 15% is reserved for administration, marketing expenses and profit. If these requirements are not met, plans are required to provide annual rebates to the policyholders, the Medical Loss Ratio (MLR) Rebates. These refunds or rebates are…


New Jersey Division on Civil Rights Enacts New Workplace Poster Requirements

Posted On: September 14, 2022 | Categorized as: Events

On August 1, 2022, the New Jersey Division on Civil Rights (DCR) adopted new and amended regulations around the “Display of Official Posters of the Division on Civil Rights.” New Jersey employers, housing providers and places of public accommodation are required to display posters to inform individuals and covered entities of their rights and obligations under the New Jersey Law Against Discrimination (LAD) and New Jersey Family Leave Act (NJFLA). The DCR has now released the revised posters that will need to be utilized to satisfy the requirements under the LAD. Additionally, employers with 30 or more employees who are covered by the NJFLA, will also need to replace their current NJFLA poster with the revised version. The revised posters must be prominently displayed in places easily visible to those who would be impacted by violations under the laws. Covered employers will also need to distribute the posters annually to…


Innovative Benefit Planning Receives Women’s Business Enterprise Owned Certification

Posted On: September 13, 2022 | Categorized as: Company News

Innovative Benefit Planning is proud to announce that The Women’s Business Enterprise National Council, has awarded Innovative Benefit Planning the national ‘Women’s Business Enterprise’ certification. “Empowering women in the workplace and acknowledging their contributions to everyday operations is not only important but extremely necessary,” said Terriann Procida, CEO. “Having a diverse team made up of not only women, but individuals from diverse backgrounds and cultures, has allowed us to bring an array of different perspectives to the table which adds to our growth, productivity, and so much more.” As the Chief Executive Officer and founding partner of Innovative Benefit Planning, Procida has worked endlessly to ensure the company embraces a commitment to diversity in the workplace. Fostering an inclusive environment is vital to the way the organization operates, which allows employees the opportunity to grow, feel accepted, and be challenged. Innovative employees see a representation of a variety of genders,…


Biden Administration’s Fiscal Year 2023 Budget Calls for Increased Enforcement for MHPAEA

Posted On: August 29, 2022 | Categorized as: Compliance

fiscal year 2023 budget

The Biden Administration’s FY 2023 proposed budget requests increased funds to enforce the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). Specifically, the budget would allot $125 million to the states for MHPAEA enforcement. Additionally, President Biden requested an additional $275 million for the Department of Labor (DOL) to perform MHPAEA audits of group health plans over the course of the next 10 years. The proposed budget would also grant authority to the DOL to turn enforcement efforts toward the vendors who design and apply quantitative and non-quantitative treatment limitations (QTL and NQTL) for self-funded group health plans. Currently, the DOL’s authority is limited to the group plan sponsors under ERISA. This shift would allow the DOL to zero in on the parties responsible for the creation and administration of the play provisions, which are typically the plan’s carriers, instead of limiting the audit to the plan sponsor,…


President Biden Signs Inflation Reduction Act Into Law

Posted On: August 29, 2022 | Categorized as: Compliance

inflation reduction act

On August 16, 2022, President Biden signed the long-awaited Inflation Reduction Act which aims to reduce rising health care costs and greenhouse gas emissions, as well as raise taxes on corporations. The President’s signature comes after the House and Senate passed the bill last week along party lines following much debate and a deal negotiated between Senators Charles Schumer and Joe Manchin. Within the $430 billion dollar legislation there are several health care related provisions which target the prescription drug costs under Medicare, plan subsidies through the Marketplace, and as a result, a likely expansion for individual coverage health reimbursement arrangements (ICHRAs). A breakdown of the health care provisions is below. For a summary of provisions see here. Medicare Part D Prescription Drug coverage: Cost-sharing for insulin will be capped at $35 per month for Medicare Part D participants, and manufacturers will be required to pay Medicare a rebate if…


FDA Issues Final Rule Enabling Access to Over-the-Counter Hearing Aids

Posted On: August 22, 2022 | Categorized as: Compliance

hearing aids

Around 30 million adults in the U.S. deal with some form of hearing loss, but only an estimated 1 in 5 have addressed the issue with the use of a hearing assistance device. On August 16, 2022, the U.S. Food and Drug Administration (FDA) issued a final rule that would allow Americans to access hearing aids over-the-counter (OTC). The final rule creates a new category for OTC hearing aids, which will allow individuals with perceived mild to moderate hearing loss to purchase hearing aids directly in-store or online without prescription, medical exam or fitting by an audiologist. Prior to this, insurance coverage for hearing aids has been limited, with Medicare offering no coverage for individuals. This final rule is a result of legislation passed in 2017 by Congress (FDA Reauthorization Act of 2017) which required the FDA to create a category of OTC hearing aids and an Executive Order signed…


IRS Announces ACA Affordability Contribution Percentage for 2023

Posted On: August 5, 2022 | Categorized as: Compliance

ACA written on paper

The IRS announced a decrease in the ACA Affordability Contribution Rate from 9.61 in 2022 to 9.12 percent for the 2023 plan year, the most significant decrease since the ACA’s commencement. Under the ACA, Applicable Large Employers (ALEs), employers with 50 or more full time and/or full-time equivalent employees, are required to offer affordable minimum value coverage to all full-time employees and their dependents. The contribution percentage is used to determine whether the employer-sponsored health coverage is “affordable” under the ACA’s employer shared responsibility provisions. A plan will be considered affordable under the ACA if the employee’s contribution level for self-only coverage does not exceed the specified percentage of the employee’s household income. Failure to offer affordable coverage may result in employer shared responsibility penalties, which can be substantial. The IRS recognizes that it is difficult for an employer to determine an employee’s household income, so employers are able to…


June/July 2022 Compliance Recap

Posted On: August 3, 2022 | Categorized as: Compliance

compliance recap

The summer has seen a flurry of compliance-related activity, most notably the landmark decision issued by the U.S. Supreme Court to overturn Roe v. Wade. As we move into the second half of the 2022 employee benefits compliance calendar, there are a number of important issues to note.SCOTUS OVERTURNS ROE V. WADE; EMPLOYERS WEIGH BENEFITS RESPONSESAs forecast in a leaked draft opinion in May, the U. S. Supreme Court officially overturned Roe v. Wade on June 24. The official opinion specifically held that the U.S. Constitution does not confer a right to abortion; Roe and Casey (the two landmark abortion rights cases) are overruled; and the authority to regulate abortion is returned to the people and their elected representatives. Thus, each state will now have autonomy to decide how it will handle abortion rights within – and potentially beyond – its borders.Employers have been weighing what, if anything, they will do regarding abortion and abortion-related services and expenses under…


HHS Issues Proposed Rules under ACA Section 1557 to Clarify Scope of Discrimination Protections

Posted On: July 29, 2022 | Categorized as: Compliance

The U.S. Department of Health and Human Services (HHS) has announced a proposed rule (Proposed Rule) implementing Section 1557 of the Affordable Care Act (ACA) that prohibits discrimination on the basis of race, color, national origin, sex, age, and disability in certain health programs and activities. The Proposed Rule is the latest turn in a series of events that has expanded and contracted – and led to great confusion regarding – the application and enforcement scope of Section 1557. According to HHS, the Proposed Rule intends to restore protections for patients and consumers in certain federally funded health programs and HHS programs. The Proposed Rule affirms protections against discrimination on the basis of sex, including sexual orientation and gender identity consistent with the U.S. Supreme Court’s holding in Bostock v. Clayton County, and reiterates protections from discrimination for seeking reproductive health care services. HHS has issued the rule to further…


Retirement Plan Solutions to Address the Tight Labor Market

Posted On: July 18, 2022 | Categorized as: Retirement Plans

woman with calculator and pen

Employers who face staffing challenges in the current worker-driven labor market are implementing innovative retirement plan solutions to help them recruit new candidates and retain experienced personnel.Over the past two years, organizations have lost millions of valued team members as the Great Resignation and the Great Retirement boosted turnover. Filling those positions means competing in a tight labor market where high-demand candidates have the upper hand.One way companies can better compete in this challenging environment is by leveraging options within and outside of their retirement plans to support recruiting and retention. Here are several strategies that can strengthen your initiatives to recruit strong candidates and keep them in place for years to come.Paying Signing Bonuses Via Their Retirement Plan Using signing bonuses to attract new employees is a proven strategy. However, some employers also encourage retention by earmarking some portion of those bonuses as contributions to their retirement plans These…


Transparency in Coverage: Machine Readable Files

Posted On: July 15, 2022 | Categorized as: Compliance

online files

July 1, 2022, marks the effective date for plans and issuers to begin posting two Machine-Readable Files (MRF) links to a public website so individuals can readily learn their in-network group health plan costs, as well as historical paid amounts for out-of-network services. Ahead of this deadline, plans and issuers should have communicated with plan sponsors the location of the link and how they can access the information associated with the link. Each MRF must use a non-proprietary, open format to be identified in technical implementation guidance, i.e., JSON, XML, etc. Carriers providing files in PDF format are not in compliance with the required standards.Below are some highlights and next steps for plan sponsors that may be helpful as they continue to navigate this new requirement and make efforts to ensure compliance.Purpose and IntentThe machine-readable files requirement is part of a broader effort to achieve overall pricing transparency in healthcare.…


Innovative Benefit Planning Named “Top Employee Benefits Consultant” Award

Posted On: July 11, 2022 | Categorized as: Company News

business men shaking hands

Innovative Benefit Planning is honored to be recognized by Mployer Advisor as a winner of their “Top Employee Benefits Consultants” Awards for 2022. The program evaluates brokers based on breadth and depth of experience across employer industries, sizes, insurance products, and employer reviews. Innovative was recognized as a broker that demonstrate market-leading competencies and a proven track record of success among employers, insurance providers, and peers. Winners were chosen based on exceptional online reviews, a high M Score rating, historical data, and demonstrated business experience.  "The team at Mployer Advisor is proud to honor this group of top insurance consultants as part of the 2022 class for our second annual Top Employee Benefits Consultant Awards. Employer-sponsored healthcare and benefits cover over 150M+ Americans. Who an employer selects as their benefit advisor has more impact on cost and quality than who they choose as the insurance carrier" said Brian Freeman, the…


With Inflation on the Rise, How Can You Ensure Your Employer Health Benefit Costs Are Under Control?

Posted On: June 29, 2022 | Categorized as: Events

Innovative is thrilled to announce the first August event of the month: With Inflation on the Rise, How Can You Ensure Your Employer Health Benefit Costs are Under Control? Health insurance is a billion-dollar business with many inefficiencies and hidden revenue streams within it. In many ways, your employer sponsored health plan is funding it, which is impacting your costs. What we find is most employers have no idea how much waste and hidden revenue there is, causing you high costs and a broken plan.During this seminar, you will learn the components causing the waste and how to uncover it within your plan. We will review several strategies and solutions available to middle market employers that you can begin to deploy to disrupt the system and begin to put money back in your pocket and your employees’ pockets.Learning objectives include:Understand what is happening in the health insurance system and whyUncover…


An Employer’s Guide to Workplace Protections for Abortion-Related Decisions

Posted On: June 28, 2022 | Categorized as: Compliance

Employers likely have questions about abortion-related employment protections and healthcare benefits after Friday’s SCOTUS controversial decision that overturned Roe v. Wade. Given the ruling, people in states with strict abortion limitations may end up traveling to other states to receive abortion-related care. Can employees take job-protected leave to obtain such services? What other rights might employees have under federal employment laws? Here are a few points you should keep in mind in light of the June 24 Dobbs v. Jackson Women’s Health Organization decision. Anti-Discrimination Laws Protect Abortion-Related Decisions Employers should understand the workplace protections employees have under existing federal anti-discrimination laws and how they apply to an employee’s decision whether to have an abortion. The Interplay of Employment Discrimination Statutes Title VII of the Civil Rights Act of 1964 bans employment discrimination based on color, national origin, race, religion, and sex. Additionally, in 1978, Congress enacted the Pregnancy Discrimination…


Supreme Court Issues Ruling in Dialysis Case

Posted On: June 28, 2022 | Categorized as: Compliance

In a 7-2 decision, the U.S. Supreme Court has issued its opinion in Marietta Memorial Hospital Employee Health Benefit Plan v. DaVita Inc., ruling in favor of Marietta Memorial Hospital's health plan. In the Court's opinion, drafted by Justice Brett Kavanaugh, the Court held the plan did not violate a federal statute which obligates private insurers to cover the first 30 months of dialysis following a patient's end-stage renal disease diagnosis. In the opinion, which reversed the judgment of the U.S. Court of Appeals for the Sixth Circuit, Justice Kavanaugh opined, "The question in this case is whether a group health plan that provides limited benefits for outpatient dialysis - but does so uniformly for all plan participants - violates the Medicare Secondary Payer statute. We agree with petitioner Marietta and the United States as amicus curiae that the answer is no."In 2018, DaVita, Inc. sued Marietta Memorial Hospital’s health…


Innovative Launches Employee Lifecycle Tool Kit

Posted On: June 23, 2022 | Categorized as: Company News

Innovative is excited to launch our Employee Life Cycle Tool Kit! Today’s tight labor market and the broad range of flexible work/life options make it more important than ever to properly manage each step in the employee lifecycle. Addressing their emerging needs means employers must engage their teams at each step of the lifecycle. We are offering 11 resources that will help employers deliver an exceptional employee experience that today’s workers seek. Our tool kit covers each step within the employer-employee relationship, from the time perspective team members become interested in your organization, through recruitment and onboarding, talent development, and departure.You’ll learn: Interview best practices 5 ways to leverage benefits to combat recruiting challenges and boost retention Talent acquisition/employer branding Strategies for employee development The top 6 benefit trends employees want in 2022 6 steps employers can take to embrace and focus on the employee experience Effective performance management 8…


7 Low-Cost Initiatives Employers Can Incorporate in Their D&I Programs Now

Posted On: June 23, 2022 | Categorized as: Employee Benefits, HR Consulting

Countless studies show that employers who focus on diversity and inclusion policies and practices help increase employee engagement and boost overall happiness in the workplace, thus improving retention. Research shows that companies with diverse, inclusive teams generate 19% more revenue and perform 35% better than their industry average.While integrating diversity, equity, and inclusion (DEI) programs in the workplace might seem expensive, there are actually several ways to efficiently make the workplace more inclusive.Here are 7 techniques companies can consider integrating DEI initiatives without added cost:Tweaking your paid-time-off policies offers multiple opportunities to align DEI initiatives with existing benefits. Consider:Does your parental leave policy include adoptions and new foster children?Is family leave specific only to mothers, or can it include new fathers and/or same-sex new mothers? Is parental leave longer for birth mothers than for others?Is your sick leave policy broad enough to cover a variety of contingencies, such as transition…


May 2022 Compliance Recap

Posted On: June 16, 2022 | Categorized as: Compliance

The month of May again brought relatively little major employee benefit compliance guidance from federal agencies. However, there was plenty of activity in the courts to provide useful insight into steps employer plan sponsors can take to safeguard against benefits litigation. DEPARTMENT OF LABOR PROVIDES MENTAL HEALTH CONDITION GUIDANCE UNDER FMLA The U.S. Department of Labor (DOL) released Fact Sheet #280 as well as Frequently Asked Questions (FAQs) about how the Family and Medical Leave Act of 1993 (FMLA) accommodates mental health-related leaves. The DOL’s Wage and Hour Division issued the guidance as part of Mental Health Awareness Month to provide employers additional information on how to handle leave requests for mental health concerns. Among the notable provisions in the guidance – especially given the ongoing COVID-19 pandemic, incidents of gun violence, and news regarding the economy – is a reminder that an FMLA-eligible individual working for an employer subject to FMLA may take…


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