What is Bundled Pricing?

Category: Employee Benefits

What is Bundled Pricing?

Posted On: February 15, 2021 | Categorized as: Employee Benefits

What is Bundled Pricing? Many employers are frustrated with a lack of financial and quality transparency in the healthcare marketplace. As such, many employers have considered offering a bundled pricing solution to their employees. Bundled pricing is a unique solution that provides employees the opportunity to shop for a procedure with an all-in price upfront. How Does Bundled Pricing Work? A bundled pricing vendor will negotiate directly with providers for non-emergent healthcare services. In other words, an employee can go on and choose when and where they'd like to have the procedure at an all-in cost. These prices are often a fraction of the typical cost of those services and there's no surprise when an invoice comes in the mail. Bundled pricing provides employers and employees alike the opportunity to have a transparent healthcare environment. Some pitfalls to consider are the fact that bundled pricing is relatively new to the…


Understanding Captives and Consortiums

Posted On: February 3, 2021 | Categorized as: Employee Benefits

Understanding Captives and Consortiums As health insurance costs continue to rise, many small and mid-size employers have looked for ways to alternatively fund their plans and potentially save costs. Self-funding can be daunting and unmanageable for many small to mid-size employers, but there are many self-funding options to consider. Captives and consortiums provide the ability to self-fund your plan while offsetting risk and having some cash flow efficiencies. They allow employers to band together with other employers, to get enhanced pricing, bundled services, and to offset risk in bad years. Captives A captive provides more direct risk sharing as the group is in a pool of other employers where they'll have their own stop-loss, but also a captive layer that will kick in for high cost claimants. Consortiums A consortium provides the ability to band together with other groups for purchasing power, to purchase things such as stop-loss and administrative…


Mandatory Coverage of COVID-19 Vaccines under Group Health Plans

Posted On: December 23, 2020 | Categorized as: Compliance, Employee Benefits

Mandatory Coverage of COVID-19 Vaccines Under Group Health Plans On December 11, 2020, the Food and Drug Administration (FDA) issued an Emergency Use Authorization for the Pfizer-BioNTech COVID-19 vaccine (Pfizer vaccine). The following day, December 12, 2020, the Centers for Disease Control Advisory Committee on Immunization Practices (ACIP) issued an interim recommendation for use of the Pfizer vaccine in persons age 16 years or older for the prevention of COVID-19. Alternative COVID-19 vaccines are likely to be approved by the FDA under emergency authority in the coming weeks. Group health plans are encouraged to prepare to cover the cost of the Pfizer and other approved COVID-19 vaccines. Under the Coronavirus Aid, Relief, and Economic Security Act (CARES Act), non-grandfathered individual and employer-sponsored group health plans are required to cover the entire cost of preventative services by not imposing cost-sharing in the form of deductibles, copays, coinsurance or other amounts on…


Partially Self-Funded Plans with an HRA

Posted On: December 3, 2020 | Categorized as: Employee Benefits

Partially Self-Funded Plans with an HRA As health insurance costs continue to rise, more and more small and mid-size employers are looking for ways to take control of their healthcare costs. A health reimbursement account, or an HRA, is a way in which employers can step into self-funding and start to take some control. A health reimbursement account is an opportunity for the employer to self-fund a portion of the health insurance plan. Typically, employers will choose a plan with a higher deductible, higher co-pays, and potentially higher co-insurance, and will decide to self-fund that portion of the plan to take on some risk. Companies that have considered self-funding, but are wary of some of the risks, might want to take a step towards self-funding with a health reimbursement account. By utilizing increased deductibles, co-pays and co-insurance and putting an HRA into place, an employer is taking the risk that…


Understanding Key Health Insurance Terms

Posted On: November 23, 2020 | Categorized as: Employee Benefits

Understanding Key Health Insurance Terms The language of health insurance can be confusing but understanding some key terms will help your employees comprehend the basics of your organization’s plan, allowing them to make smart decisions that will benefit their family. Rather than feeling confused, encourage them to review the following key terms and ask questions when necessary. Premium - sometimes referred to as contributions, payroll deductions, or per pay costs, are the amount employees pay each month for covered health insurance. Copay - the fixed amount the employee pays for health care services, such as $25 for a doctor's visit. After your copay, the insurance pays the balance of the bill. Deductible - a fixed dollar amount the employees pay each plan year for health care services before their health insurance begins to pay. Coinsurance - the percentage of costs the employee will pay. If your organization’s plan has a…


Final Rules on Coverage Transparency

Posted On: November 16, 2020 | Categorized as: Compliance, Employee Benefits

Final Rules on Coverage Transparency On October 29, 2020, the Internal Revenue Service (IRS), Department of Labor (DOL), and the Department of Health and Human Services (HHS) (collectively, Departments), released final rules on coverage transparency, in order to provide health coverage recipients with an estimate of their potential cost-sharing liability for health related services prior to the receipt of care. The final rules require group health plans and insurance issuers in the individual and group markets to disclose cost-sharing information and negotiated rates in electronic or paper form. The final rules also allow issuers to reward plan enrollees with “shared savings payments,” without running afoul of medical loss ratio (MLR) requirements. Issuers are permitted to provide employees who use lower-priced providers with a percentage of the savings relative to a benchmark. Effective Dates Public Disclosure of Negotiated Rates and Historical Allowed Amounts: January 1, 2022 Disclosure of Cost Information: January…


6 Self-Funding Strategies to Suit Your Needs

Posted On: November 12, 2020 | Categorized as: Employee Benefits

Self Funded Plan printed on keyboarded key

6 Self-Funding Strategies Self-funding is nothing new as it has been a common form of health plan financing since 1974. Self-funding provides great flexibility with plan designs and provides freedom from most state laws. In fact, over 60% of US employees are covered under a self-insured medical plan. Under self-funded arrangements, the employer assumes all the risk of claims with backup protection from stop-loss coverage and retains the savings over fully insured. Employers partner with TPA and other vendors to provide claims administration, case management and network access. Employers with as many as 50 employees can consider self-funding, however we see employers with 100 or more participating in this funding arrangement. Advantages and Benefits The employer, which is also known as the plan sponsor in a self-funded arrangement, can determine the plan design that best suits the needs of their employees. Regulatory is defined at federal only, not state. The…


3 ACA Reporting Errors and The Pandemic’s Impact

Posted On: October 22, 2020 | Categorized as: Compliance, Employee Benefits

3 ACA Reporting Errors and The Pandemic’s Impact As we approach the end of 2020, we must consider how the various enrollment fluctuations due to the COVID-19 Pandemic will impact the ACA Employer Mandate and the already tedious 1095/1094 ACA Reporting. The IRS recently granted a March 2nd deadline extension for the 1095 reporting and this extra time will likely be needed for employers to accurately audit their data as we are expecting to see additional errors due to furloughs, layoffs and coverage extensions. Prior to filing, employers should audit their reporting for the following common errors to avoid an unnecessary penalty letter. Enrollment Changes and Code Errors For each month an employee is offered coverage and one of codes 1B through 1E is entered in line 14, an employee should have a dollar amount indicated in line 15. If there are blank entries this could trigger a penalty for…


Have You Received an MLR Rebate Check? What To Do Next?

Posted On: October 9, 2020 | Categorized as: Compliance, Employee Benefits

Have You Received an MLR Rebate Check? What To Do Next? The Affordable Care Act requires health insurance carriers to spend at least 80-85 percent of premium dollars on medical care and healthcare quality improvement. If the carrier does not meet this medical loss ratio (MLR) obligation, it must give affected customers a rebate.  Rebates must be distributed by the carriers each year by September 30. Any employer that receives a refund then needs process and distribute within 90 days to avoid triggering ERISA trust requirements. For your convenience we have included more information regarding this topic in our compliance bulletin, including: How should the rebate be divided? Are former plan participants entitled to a share in the rebate? How may the employer use the rebate? How should the rebate be provided? Additional Q&As on how the rebate should be used If you have any questions about distribution or how…


Judge Rules for HHS in Price Transparency Case

Posted On: June 25, 2020 | Categorized as: Employee Benefits

Judge Rules for HHS in Price Transparency Case

Judge Rules for HHS in Price Transparency Case A federal judge ruled against the American Hospital Association (AHA) on Tuesday in its lawsuit attempting to block an HHS rule pushing for price transparency. The judge ruled in favor of the department, which requires hospitals to reveal private, negotiated rates with insurers beginning Jan. 1.  The AHA stated they are requesting an expedited review as they are concerned with the significant burden this will place on hospitals when resources are already stretched thin as a result of the pandemic and increased patient care needed.  Click here to read the full brief.  



IRS Releases Two New COVID-19 Notices

Posted On: May 13, 2020 | Categorized as: Employee Benefits, HR Consulting

IRS Releases Two New COVID-19 Notices To provide additional relief to Americans during these challenging times, the IRS released Notice 2020-29 and 2020-33. These notices provided new relaxed rules for 2020 for making elections under Cafeteria plans, using amounts during a grace period or carryover period changes to the method determining the carryover amounts under Health Flexible Spending Accounts (FSAs)  and clarifying which premiums can be reimbursed under Individual Coverage Health Reimbursement Arrangements (ICHRAs). Notice 2020-29 In Notice 2020-29, the IRS provides for increased flexibility with respect to mid-year elections under a cafeteria plan during calendar year 2020 related to employer sponsored health coverage, Health FSAs and Dependent Care Assistance Plans (DCAPs). This notice also provides increased flexibility with respect to grace periods and carryover periods to apply unused amounts in health FSAs to medical care expenses incurred through December 31, 2020, and unused amounts in dependent care assistance programs…


Open Enrollment and Outcomes Based Health Screenings Options During COVID-19

Posted On: May 5, 2020 | Categorized as: Employee Benefits

open enrollment options

Open Enrollment and Outcomes Based Health Screenings Options During COVID-19 Due to the COVID-19 outbreak, employers who were planning on offering on-site health screenings tied to payroll deductions are unfortunately being forced to consider other options.  Thankfully, the screening vendors have been flexible with delaying screening dates. As an employer, if you were offering premium discounts based on screening results, you must decide what to do with your payroll deductions and incentives now that screenings will not be occurring before the start of your new plan year. What options do employers with outcomes based wellness plans have? Many employers have expressed interest in keeping the current payroll deduction rates in place for a few more months. Unfortunately, under HIPAA’s rules regarding health contingent wellness programs, this option is not allowed.  Members must be given the opportunity to screen and earn incentives at least once every 12 months. To comply with…


Final Rule on the Extension of Certain Timeframes for Employee Benefit Plans Due to COVID-19

Posted On: May 4, 2020 | Categorized as: Compliance, Employee Benefits

On March 13, 2020, President Trump issued the Proclamation on Declaring a National Emergency Concerning the Novel Coronavirus Disease (COVID-19) Outbreak and by separate letter made a determination, under Section 501(b) of the Robert T. Stafford Disaster Relief and Emergency Assistance Act, that a national emergency exists nationwide beginning March 1, 2020, as the result of the COVID-19 outbreak. The Department of Labor (DOL) and the Department of the Treasury (Treasury) issued a final rule that extends certain timeframes under the Employee Retirement Income Security Act (ERISA) and Internal Revenue Code (IRC) for group health plans, disability, and other welfare plans, pension plans, and participants and beneficiaries of these plans during the COVID-19 national emergency. The timing extensions are issued to help alleviate problems faced by health plans to comply with strict ERISA and IRC timeframes and problems faced by participants and beneficiaries in exercising their rights under health plans…


Paycheck Protection Program and Health Care Enhancement Act

Posted On: April 29, 2020 | Categorized as: Compliance, Employee Benefits

PPP blocks

Paycheck Protection Program and Health Care Enhancement ActIn response to the spread of the 2019 novel coronavirus (COVID-19), President Trump signed the Paycheck Protection Program and Health Care Enhancement Act (PPPHCEA) into law on April 24, 2020. The PPPHCEA is phase 3.5 in Congress' response to the COVID-19 pandemic following the Coronavirus Aid, Relief, and Economic Security Act (CARES Act), the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020, and the Families First Coronavirus Response Act (FFCRA). The PPPHCEA is a $484 billion package that increases amounts authorized and appropriated for the Paycheck Protection Program (PPP) discussed in our April 2, 2020, and April 13, 2020, Advisors for emergency economic injury disaster loans (EIDL) and for emergency grants under the CARES Act. The PPPHCEA also provides additional funding for health care providers.PPP FundingThe PPP was established under the CARES Act to provide small employers with an incentive to keep workers on their…


Relaxed Life, Disability and Long-Term Care Insurance Underwriting

Posted On: April 28, 2020 | Categorized as: Employee Benefits

As a result of the COVID-19 National Emergency, insurance companies have adapted to help individuals easily secure protection and obtain insurance without a medical exam that requires a nurse to visit your home or office. This is a TEMPORARY change that will likely end when social distancing can stop. How This Can help You:  You may get approved for the insurance products listed below without having to complete a medical exam or provide fluids during the underwriting process: Term and & Permanent Insurance Age 18-65: Up to $5,000,000 of death benefit Age 66-70: Up to $3,000,000 of death benefit Long-Term Care Insurance No limit on monthly LTC benefit Disability Insurance Age 18-45: No limit on monthly benefit Simplified Application Process Go to the insurance carrier’s online submission tool with Innovative to complete the electronic application. Electronically sign any necessary forms for your application. The insurance carrier will schedule and conduct…


Gov. Murphy Signs Executive Order Granting Grace Periods for Insurance Premium Payments

Posted On: April 14, 2020 | Categorized as: Compliance, Employee Benefits

Gov. Murphy Signs Executive Order Granting Grace Periods for Insurance Premium Payments On April 9, 2020, New Jersey Governor Phil Murphy signed Executive Order No. 123, extending grace periods during which certain insurance companies, including health and dental insurers, life insurers, and property and casualty insurers, will not be able to cancel policies for nonpayment of premiums. Grace Periods for Small Group Employer (0-50 EE’s) Grace period may be initially applied to April or May premium as the policyholder determines and will continue for 60 days from that date. Coverage MUST remain in force and claims must be paid not pended. If a carrier has already provided a grace period for April premium, the time period for which a grace period has already been granted shall be applied toward the emergency grace period. Grace period only applies to policyholders that were in good standing with their insurance carrier on March 1,…


CARES Act: Impact on Employee Benefits

Posted On: April 7, 2020 | Categorized as: Compliance, Employee Benefits

CARES Act: Impact on Employee Benefits On March 27, 2020, Congress passed, and the President signed, an unprecedented 2 trillion-dollar stimulus and relief package into law, named the Coronavirus Aid, Relief, and Economic Security Act or the CARES Act. This act provides direct stimulus relief to corporations and individuals. While there are many facets to this act, this brief serves to highlight the changes to employee benefits due to the CARES Act. Expanded COVID-19 Testing The Families First Coronavirus Response Act (FFCRA) required group health plans and insurers to provide coverage of certain diagnostic COVID-19 testing and related services without cost-sharing and without preauthorization. The CARES Act expands on these provisions: All testing for COVID-19 must be covered without cost-sharing for fully insured and self-funded plans. In addition to tests approved by the FDA, this includes tests for which: the developer has requested, or intends to request, an emergency use…


COVID-19 Employer Considerations Regarding Employment Decisions and Plan Coverage Changes

Posted On: April 7, 2020 | Categorized as: Employee Benefits, HR Consulting

Due to the recent national health crisis in our country, many employers are considering the best way to handle a temporary economic turndown to best position themselves for recovery once the pandemic ceases and businesses can begin to return to some sense of normalcy. In addition, many employers are also navigating the benefit coverage changes being made by their insurance carrier(s) or by state and/or federal mandates which may include cost considerations, plan document revisions and employee notifications. Below are some explanations regarding various workplace employment options and health plan considerations. Employer/Employee Relationship One of the decisions employers are faced with is how to handle their workforce. Employers and insurance companies are using many terms to describe employer/employee relationships such as reduction in hours. furlough, temporary layoff, and permanent layoff. Many employers desire to keep employee benefits intact during this period. It is important to understand the differences and how…


Telemedicine Wait Times

Posted On: April 2, 2020 | Categorized as: Employee Benefits

In light of the recent COVID-19 (coronavirus) outbreak. The CDC recommends leveraging telemedicine for your unique medical needs to help limit the spread of the virus by eliminating the risk of exposure to the ER, urgent care, and primary care offices. They are recommending members schedule their virtual visits rather than remain in the virtual waiting room for an unknown period of time. For more information, download PDF here.  Please contact the Innovative Benefit Planning team if you have any further questions.


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