Healthcare

“One Big Beautiful Bill”

The President has signed the “One Big Beautiful Bill”. The health-related provisions are as follows:

The bill:

Did not take away the employer tax exclusion, a big win in maintaining the ability of employers to offer employee benefits.

Did not renew the enhanced premium tax credits, which means they will revert to the original Affordable Care Act (ACA) formula on January 1, 2026. This may result in some people who currently receive premium tax credits in the Individual market becoming ineligible during the upcoming open enrollment season.

Additionally, the bill requires verification of the following items prior to a beneficiary receiving a premium tax credit:

  • Household income and family size
  • Whether the individual is an eligible alien
  • Any health coverage status or eligibility for coverage
  • Place of residence

The bill did not increase the contribution limits for HSAs, but:

  • Permanently permits pre-deductible coverage of telehealth services for HSA-linked plans, a very big win for your clients; and
  • Permits use of HSA funds to reimburse up to $150 per month for Direct Primary Care arrangements ($300 per month for families). These arrangements would not be classified as health plans, preserving HSA eligibility for individuals who participate in them. This is also a very big opportunity for your clients that can save money while enhancing benefits for employees, a very big win for us.

 

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

Pharmacy Benefit Management – Part 3 – Case Study

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.

Pharmacy Benefit Management – Part 2

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.

Pharmacy Benefit Management – Part 1

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.

Florida PBM Reform is Here

Effective July 1, 2023 the Florida legislation reshapes the PBM landscape, requiring that PBMs pass through 100% of all manufacturer rebates to plan sponsors, while prohibiting spread pricing, clawbacks, mail order mandates, affiliate-only networks, and other practices that have long been status quo for many in the pharmacy industry.

Florida SB 1550 requires that entities in Florida with a PBM service contract executed on or after July 1, 2023, including a renewal, are required to be pass-through as of January 1, 2024. That may be a challenge for PBMs not accustomed to crediting plan sponsors.

Employee Benefit Advisors is uniquely qualified to help transition companies to meet the new regulatory requirements. We have extensive experience in working with total pass through PBMs and reduced the pharmacy spend for our clients. Contact us for all your compliance questions.

 

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

Fat People Are Costing Your Company

Several years ago, I blogged, Fat People Have Issues, with the disclaimer of posting the politically incorrect title in hopes of getting more people to read. Not being one to suddenly bow to the woke politically crowd I have posted another potentially insensitive title, again, in hopes of getting more people to read. As I said then, I like fat people, many of my friends are fat. So please take it in good humor. I don’t need hate mail. I also recognize some people have genetic challenges. – Bottom line, I’m hoping the information will motivate you to implement a targeted wellness campaign.

Employers bear a large share of excess costs attributed to obesity. Normal-weight employees cost an average of $3,830 per year in covered medical, sick day, short-term disability, and workers’ compensation claims, while morbidly obese employees cost more than twice that amount, or $,8067.

Key Findings from the National Center for Biotechnology Information

  1. Weight loss offers significantly significant savings for obese employees with weight-related conditions, such as diabetes, hypertension, mental health disorders, arthritis and back pain.
  2. The greatest savings potential is for those with the highest baseline body mass index. “This suggests that investments in weight management programs that produce even relatively small amounts of weight loss, when directed at the most obese populations, could provide meaningful savings for employers.”
  3. The greatest savings potential is among non-Hispanic white employees.

Exerts taken from Benefits Pro.

You can read the November 19th, 2014, blog Fat People Have Issues by going to my website www.ebafl.com/blog and searching the title.

 

 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.

Overpaying for Prescriptions? – Try this

If you are fortunate enough to have health insurance with a low deductible or low-cost prescription co-pays, the high cost of drugs is driving up the premiums that you or your employer pay, making getting health insurance expensive and challenging.

Every American should have access to safe, affordable medicines. If you don’t have insurance or have a high deductible plan, even the most basic medications can be costly.

The Mark Cuban Cost Plus Drug Company, https://costplusdrugs.com,  takes these problems head on. The goal is to dramatically reduce the cost of drugs, but it is just as important to introduce transparency to the pricing of drugs, so patients know they are getting a fair price.

Cost Plus Drugs marks up the price they are able to purchase the prescription by 15%, so they can continue to run the company and invest in disrupting the pricing of as many drugs as possibly. Then they add on the actual cost, $3.00, that their pharmacy partners charge to prepare and provide your prescription to you.

Every product we sell is priced exactly the same way – the cost plus 15%, plus the pharmacy fee, if any. When you get your medicine from Cost Plus Drug Co., you’ll always know exactly how they arrived at the price.

 

 

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.

Many Patients Billed for Preventive Care That Should Be Free

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.

No More Surprises

Shock by your hospital bill?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.

Health Care Transparency

New transparency requirements on group health plans and health insurers in the individual and group markets were issued by the Departments of Labor (DOL), Health and Human Services (HHS) and the Treasury (Departments).

The final rule requires plans and issuers to disclose:

  • Price and cost-sharing information for a list of 500 services must be available via the internet for plan years beginning Jan. 1, 2023. All items and services are required to be available for plan years beginning Jan. 1, 2024.
  • In-network provider-negotiated rates and historical out-of-network allowed amounts on their website for plan years beginning Jan. 1, 2022.

The final rule also allows insurers that share savings with consumers—resulting from consumers shopping for lower-cost, higher-value services—to take credit for those “shared savings” payments in their medical loss ratio calculations.

 

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.

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