Human Resources

Pharmacy Benefit Management – Part 3 – Case Study

By April 11th, 2024   Healthcare, Healthcare Services, Human Resources

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

By March 28th, 2024   Healthcare, Healthcare Services, Human Resources

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

By March 13th, 2024   Healthcare, Healthcare Services, Human Resources

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.

IRS Guidelines – Indexed for 2024

By December 1st, 2023   Compliance - ACA & Other, Human Resources

FICA
Social Security Tax is 6.2% on income up to $168,600
Medicare Tax unlimited 1.45% to Unlimited

ACA Affordability — The ACA benchmark for determining the affordability of employer-sponsored health coverage will drop significantly to 8.39% of an employee’s household income for the 2024 plan year.

High Deductible Health Plans
Minimum Annual Deductible (Individual/Family) $1,600 / $3,200
Maximum Out-of-Pocket Limit (Individual/Family) $8,050 / $16,100

Health Savings Accounts
Individual / Family $4,150 / $8,300
Catch-up Contribution $1,000

Excepted Benefit HRA $2,100

Excepted-benefits health plans are non-traditional, fully insured and tax-advantaged health plans that are exempt from Affordable Care Act (ACA) requirements, which means they can be offered to select (versus all) employees at the employer’s discretion, including practice owners/partners.

ACA Plan Limits
Out-of-Pocket Limits Individual / Family $9,450 / $18,900

Flexible Spending Accounts
Health Care Flexible Spending Account Maximums $3,200 Maximum carryover $640
Dependent Care Spending Account Maximum $5,000

Dependent Care Spending Account Maximum for highly compensated ($150,000 in 2023) employees $3,000
The dependent care FSA maximum is set by statute and is not subject to inflation-related adjustments.

Standard Mileage Rates
65.5 cents per mile for business miles driven
22 cents per mile for medical or moving purposes
14 cents per mile driven in service of charitable organizations

Parking (monthly) $315
Mass Transit Passes (monthly) $315

Compensation
Compensation Limit $345,000
Highly Compensated Employee Salary Amount $155,000
Annual Compensation for Key Employee $220,000
Defined Benefit Plan Limit $275,000
Defined Contribution Plan Limit $69,000

Retirement Plans
401(k) $23,000
401(k) Catch-up $7,500

IRA Limit $7,000/$8,000 for age 50+
Simple IRA Limit $16,000/$3,500 Catch-Up

Employee Benefit Advisors 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

By August 22nd, 2023   Compliance - ACA & Other, Healthcare, Human Resources

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.

CAA 2023 Allows for Telehealth Relief

By January 5th, 2023   Compliance - ACA & Other, Human Resources

The Consolidated Appropriations Act, 2023 (CAA23) was signed into law on December 23, 2022. One of the health provisions contained in the law was the relief on telehealth coverage offered through HSA Qualified High Deductible Health Plans (HDHPs).

Typically, HSA-qualified HDHPs cannot pay for covered services, except for specified preventive care, until the individual satisfies the plan’s deductible. The CARES Act that passed into law in 2020 permitted people who have coverage through a HDHP to receive telehealth care at no cost, regardless of the plan’s annual deductible, without impacting their eligibility to contribute to an HSA. This provision was set to expire on December 31, 2022. Now, the CAA23 creates a safe harbor for first-dollar telehealth coverage offered through an HDHP for plan years beginning after December 31, 2022 through December 31, 2024.

Plan sponsors can only begin taking advantage of this new relief once their plan renews after December 31, 2022. This means that groups with plans renewing on January 1, 2023, can offer the relief immediately, whereas groups with plans that renew in a different month of the year will need to wait until the start of their 2023 plan year to begin offering it.

The way the legislation is written, there is a small gap for non-calendar year plans. The new extension applies for plan years beginning after December 31, 2022. For example, an HDHP with a plan year beginning June 1 could not offer telehealth before the deductible for the period from January 1, 2023 through the end of May 2023. Any HDHP that does not have a calendar plan year would have a similar gap between January 1, 2023 and its plan year start.

The telehealth relief is optional for plan sponsors. Group plan sponsors are not required to offer their participants access to telehealth coverage at all, nor do they have to offer it on a first-dollar basis for any type of plan offering, including HDHPs. If a group decides to adopt this relief, they also need to make sure their plan documents are amended accordingly.

 

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

IRS Guidelines – Indexed for 2023

By January 3rd, 2023   Compliance - ACA & Other, Human Resources

FICA
Social Security Tax is 6.2% on income up to $160,200
Medicare Tax unlimited 1.45% to Unlimited

Individual Mandate’s Affordability Exemption — required contribution percentage is 8.17%.

High Deductible Health Plans
Minimum Annual Deductible (Individual/Family) $1,500 / $3,000
Maximum Out-of-Pocket Limit (Individual/Family) $7,500 / $15,000

Health Savings Accounts
Individual / Family $3,850 / $7,750
Catch-up Contribution $1,000

ACA Plan Limits
Out-of-Pocket Limits Individual / Family $9,100 / $18,200

Flexible Spending Accounts
Health Care Flexible Spending Account Maximums $3,050 Maximum carryover $610
Dependent Care Spending Account Maximum $5,000
The dependent care FSA maximum is set by statute and is not subject to inflation-related adjustments.

Mileage & Transportation

The IRS has not announced the official 2023 mileage rates. Considering that fuel prices are not at a peak high anymore as back in June and July of 2022, there is a chance the IRS mileage rate 2023 remains at the same levels, currently being:

Standard Mileage Rates
62.5 cents per mile for business miles driven
22 cents per mile for medical or moving purposes
14 cents per mile driven in service of charitable organizations

Parking (monthly) $300
Mass Transit Passes (monthly) $300

Compensation
Compensation Limit $330,000
Highly Compensated Employee Salary Amount $150,000
Annual Compensation for Key Employee $215,000
Defined Benefit Plan Limit $265,000
Defined Contribution Plan Limit $66,000

Retirement Plans
401(k) $22,500
401(k) Catch-up $7,500

IRA Limit $6,500/$7,500 for age 50+
Simple IRA Limit $15,500/$3,500 Catch-Up

 

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

Significant Change in ACA Affordability

By August 16th, 2022   Compliance - ACA & Other, Human Resources

The Affordable Care Act (ACA) benchmark for determining the affordability of employer-sponsored health coverage will significantly decrease to 9.12% of an employee’s household income for the 2023 plan year. This is a significant decrease from the 2022 level of 9.61%. This affordability percentage affects an individual’s eligibility for federally subsidized coverage from a marketplace exchange. It also can potentially affect the employer’s liability for shared-responsibility assessments.

 

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.

Fat People Are Costing Your Company

By May 10th, 2022   Healthcare, Human Resources

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

By April 6th, 2022   Healthcare, Human Resources

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.

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