Healthcare Services

How can your company reduce pharmacy costs while providing the best care and service to employees?  Our PBM model consistently delivers high value and significant savings to clients. While each element of our program produces savings for clients, the savings are maximized when all programs are implemented. As each pathway targets different savings opportunities. In nine months, our client achieved $54K in savings through clinical management of the various pathways. The analysis was conducted for our  client that has 86 lives and a total of 105 members.

Employee Benefit Advisors has the expertise to evaluate and work with PBMs. – EBA provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

Do you know how specialty medications are impacting your company’s health insurance costs? While specialty medications offer promising treatment options for complex conditions, their high cost can pose challenges for affordability and access, impacting both patients and healthcare systems.  Specialties not only cause significant increases to the overall plan, but can impose financial hardships on employees.

Employee Benefit Advisors has the expertise to evaluate and work with PBMs. – EBA provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

When medication costs go up, insurance costs follow suit because insurance companies have to cover those expenses. So, rising pharmaceutical medication prices can lead to higher health insurance premiums for consumers. If you are self-funded and using a Pharmacy Benefit Manager you need to understand how your PBM is managing the cost of pharmaceuticals.

Employee Benefit Advisors has the expertise to evaluate and work with PBMs. – EBA provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

People are being charged for preventive health care, health care that should be at no cost to them. That’s the headline from an article in the US News & World Report by Robert Preidt, HealthDay Reporter.

The article stated, “Out-of-pocket charges for preventive care that should be free under the Affordable Care Act can discourage patients from receiving recommended care…”. While a majority of patients are receiving preventive care for free, those who were charged only paid about $20 or less.

Unexpected charges were also common for routine screenings for cancer, diabetes, cholesterol, depression, obesity, and sexually transmitted infections, as well as pregnancy-related services.

The primary conclusion of the study was these charges were discouraging future health care screenings.

Employee Benefit Advisors provides, employee benefits, Healthcare Consumption Audits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services. We can customize a wellness plan for your budget and culture.

The No Surprises Act, a ban on surprise medical bills, will take effect beginning in 2022.

Surprise Medical Bills

Surprise medical bills occur when patients unexpectedly receive care from out-of-network health care providers. – A patient goes to an in-network hospital for surgery or emergency care, and an out-of-network doctor is involved in the patient’s care. Patients are not able to determine the network status of providers, such as emergency room doctors or anesthesiologists. The patient is simply not involved in the choice of provider.

No Surprises Act

The Act applies to surprise bills from doctors, hospitals, and air ambulances. It prohibits these providers from billing patients who have health coverage for unpaid balances. Providers will have to work with the health insurance issuer carrier to determine the appropriate amount to be paid by the plan.

(The No Surprise Act was included in the stimulus bill signed by President Trump on Dec 27, 2020.)

EBA will continue to keep you updated as information becomes available on the details of the law.

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services. We can customize a wellness plan for your budget and culture.

Employee Benefit Advisors recommends communicating the following to you employees. Odds are your company has either employees on Medicare, family members on Medicare, or both.

Copays for the Coronavirus test have been waived, but not the cost of the doctor visit needed to get the test or the treatment.

Telehealth – CMS announced that it will expand telehealth services for Medicare beneficiaries and cut back on HIPAA enforcement. Email and texts to docs will be possible! Read the CMS details here

Cost of testing – Medicare Part B (Medical Insurance) covers a test to see if you have coronavirus (officially called 2019-novel coronavirus or COVID-19). https://www.medicare.gov/coverage/coronavirus-test

3 Day Hospitalization Waived for Skilled Nursing Facilities – The waiver of the requirement for a 3-day prior hospitalization for coverage of a SNF stay provides temporary emergency coverage of SNF services without a qualifying hospital stay, for those people who are evacuated, transferred, or otherwise dislocated as a result of the effect of disaster or emergency. In addition, for certain beneficiaries who recently exhausted their SNF benefits, it authorizes renewed SNF coverage without first having to start a new benefit period (Blanket waiver for all impacted facilities). Click here to download the full CMS memo.

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

Symptoms people may experience:
1. runny nose (Not to be confused with allergies)
2. sore throat
3. cough (develop the habit of coughing into your sleeve or handkerchief – never your hand!)
4. fever
5. tightening of chest / difficulty breathing (severe cases)

What can you do?
• Emergency Room – very expensive
• Urgent Care – less expensive than ER but more cost-effective options exist
• Primary Care Physician – generally a low flat copy; at most the contracted rate between the physician and insurance company
Because COVID-19 is highly contagious to prevent contaminating health care service workers, it is not recommended you go directly to the              ER, UC or PCP.
• Telemedicine – no cost! – If you need emergency care or any additional care the doctor will advise you.
(According to the Centers for Medicare & Medicaid Services (CMS), Essential Health Benefits (EHB) coverage generally includes coverage for the diagnosis and treatment of COVID-19.)

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.