Human Resources

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.

CAA 2023 Allows for Telehealth Relief

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

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

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

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.

Benefits Matter

Workers are rethinking what work means to them, driving an increase in both resignations and demand for talent. For many employers, the best talent is the talent already on their team. Retention is crucial—and benefits matter.

In today’s extremely tight labor market, generous benefits can help tip the scales in attracting and retaining employees. One of the best retention tools is Employer-Sponsored Health Insurance.

Healthcare as a Retention Strategy

Employers need a strategy. The 2023 out-of-pocket maximum (OOPM) for health plans is $9,100 for single coverage and $18,200 for family coverage. While it’s no secret the cost of health care is rising, to few employers are using it to their advantage. Concerns about health care affordability for lower-wage workers, along with the need to retain and attract employees in a competitive labor market, are resulting in a whole new cost sharing strategy. When health benefit cost growth accelerates, employers typically ratchet up cost management efforts to keep increases at sustainable levels. Employers of choice however hold off on raising deductibles and other cost-shifting measures, some even made changes to reduce employees’ out-of-pocket contributions for health services.

Ancillary Benefits

Is your benefits package meeting the expectations of today’s workforce? It’s time to stop thinking of ancillary benefits as ‘extras.’

With changing employee expectations, it’s clear that there’s a higher demand than ever for non-medical benefits. In today’s highly competitive job market where employees are resigning in record numbers—confident they can do better elsewhere, give yourself a competitive edge by offering the non-medical benefits employees and job seekers expect and no longer think of as ‘extras’—dental, vision, life/ad&d, std / ltd.

Employee Assistance and Mental Health Plans

Benefit priorities have shifted in response to the pandemic’s impact on the workforce. Employers view supporting the mental, emotional, and behavioral health of employees as business critical. Adding or expanding programs to increase access to behavioral health care has become a top priority for employers.

 

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.

At-Home COVID-19 Testing Information

Employee Benefit Advisors would like to share the below information regarding at-home COVID-19testing from some of the carriers.

As always, if you have any questions or would like additional information, please reach out.

 

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.

Medicare Secondary Payer Penalty

The U.S. Department of Health and Human Services (HHS) has increased the following penalty affecting group health plans:

Medicare Secondary Payer (MSP): Violating the prohibition of offering Medicare beneficiaries financial or other benefits as incentives not to enroll in or to terminate enrollment in a group health plan that would otherwise be primary to Medicare will now trigger penalties of up to $9,753.

 

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.

IRS Guidelines – Indexed for 2022

FICA
Social Security Tax is 6.2% on income up to $147,000
Medicare Tax unlimited 1.45% to Unlimited

High Deductible Health Plans
Minimum Annual Deductible (Individual/Family) $1,400 / $2,800
Maximum Out-of-Pocket Limit (Individual/Family) $7,050 / $14,100

Health Savings Accounts
Individual / Family $3,650 / $7,300
Catch-up Contribution $1,000

ACA Plan Limits
Out-of-Pocket Limits Individual / Family $8,700 / $17,400

Flexible Spending Accounts
Health Care Flexible Spending Account Maximums $2,850 Maximum carryover $570
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
Standard Mileage Rates
58.5 cents per mile for business miles driven
18 cents per mile for medical or moving purposes
14 cents per mile driven in service of charitable organizations

Parking (monthly) $280 2022
Mass Transit Passes (monthly) $280

Compensation
Compensation Limit $305,000
Highly Compensated Employee Salary Amount $135,000
Annual Compensation for Key Employee $200,000
Defined Benefit Plan Limit $245,000
Defined Contribution Plan Limit $61,000

Retirement Plans
401(k) $20,500
401(k) Catch-up $6,500
403(b) $20,500
457(b)(2) and 124(c)(1) $20,500
457(b) Catch-up $6,500

IRA Limit $6,000/$7,000 for age 50+
Simple IRA Limit $14,000/$3,000 Catch-Up

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