Coverage for Virtual Substance Abuse Treatment Grows

Thousands of American families have been affected by the tragedy of someone with a substance abuse problem.

For many, especially during the COVID-19 pandemic, finding available and affordable treatment has been difficult or impossible. Recently, however, virtual treatment options have become available, and some insurance companies are beginning to pay for them.

This is an important development for both the group health insurance arena as well as the individual health insurance market. For employers, this is another lifeline that they can highlight for their staff as so many people have been affected by the stresses of the pandemic. For individual policyholders, they could have access to convenient and timely treatment.

Start-up companies across the country are offering virtual substance abuse treatment, including:

  • Boulder Care, which provides digital opioid-addiction treatment.
  • Pear Therapeutics, which provides software-based disease treatments; its lead product is a treatment for substance abuse disorders approved by the U.S. Food and Drug Administration.
  • Ria Health, which employs 45 clinicians who can prescribe treatments online for alcohol-addicted patients.

These start-ups have attracted the attention of group health insurance companies, some of which are starting to cover their treatments for people insured under their health plans. For example:

  • Ria Health has contracts with at least four insurers covering millions of people.
  • Boulder Care has a partnership with Anthem.
  • Pear Therapeutics has contracts with regional health plans in three states.
  • An opioid-addiction treatment provider in Massachusetts has partnerships with UnitedHealth Group and Kaiser Permanente.

Virtual treatments for addiction are becoming popular for several reasons. Patients may feel a social stigma from receiving in-patient treatment at rehabilitation centers.

Instead, virtual treatment in their homes permits them to keep their conditions private. It also provides flexibility. Ria Health offers its services on demand while enabling patients to customize their goals.

Receiving treatment faster

Demand for substance abuse treatment has grown during the pandemic.

Studies show that a quarter of American adults reported drinking more alcohol during the health emergency, including more than half of parents of elementary school children. As a result, space has been at a premium at in-patient rehabilitation facilities. Some have had lengthy waiting lists.

Virtual treatment gives new options to patients who cannot get admitted to rehab centers.

Because of the pandemic:

  • Some states made new rules for prescribing medicine via telehealth visits less restrictive.
  • The federal government started requiring payment parity for physician visits done via video.

Both of these factors have encouraged the growth of these start-ups.

These solutions are attractive to insurers because they reduce costs. Substance abuse patients who cannot get into rehab centers may overdose and end up in emergency rooms.

ERs are often the most expensive places to obtain care. Planned treatments over periods of time reduce the need for ER visits.

Multiply the savings over hundreds of thousands of patients, and it should be no surprise that insurers are signing seven-figure contracts with these providers.

Employers see these new plan features as an additional way to retain valuable employees. In any large group of employees, there will be some who are suffering from addiction or have family members who are, and they will value this benefit.

If you are an employer who offers these plans, you may want to check with your health insurers to see if they’ve changed coverage terms for this type of treatment. If so, you may want to consider spreading the word among your staff.

For some of your employees or their family members, life-saving help may be just a video chat away.

Employers Mull Higher Health Plan Cost-Sharing for Unvaccinated Staff

Some employers are considering a new incentive for their workers to get vaccinated against COVID-19: Charging them higher health insurance premiums if they don’t.

A recent brief from consulting firm Mercer reported that employers are looking at surcharging the health insurance premiums for employees who refuse vaccination for reasons other than disability or sincere religious belief. Many employers apply similar surcharges for employees who use tobacco.

The news comes as the Delta variant of the coronavirus that causes COVID-19 has sent infection rates soaring, with reports indicating that most new cases are occurring in people who have not been inoculated.

Employers may choose this option for a simple reason: The large costs of hospital stays and treatments for COVID-19 patients. When health plans incur large claim costs, they must either accept lower profits or make up the difference by spreading the costs among plan participants. Charging higher premiums penalizes vaccinated and unvaccinated employees alike.

The U.S. Equal Employment Opportunity Commission has said that it is permissible for employers to require workers to be vaccinated. However, many employers have been hesitant to take that step, fearing negative employee reactions, waves of resignations and bad publicity.

Freedom of choice

Surcharging insurance premiums for unvaccinated workers may be an appealing alternative for some employers. Rather than ordering employees to get vaccinated, they would leave them free to choose.

Those who would rather bear higher costs as a consequence of refusing a vaccine would be free to make that choice. In turn, vaccinated employees would not have to subsidize the health care costs of colleagues who make riskier decisions.

A Mercer spokesperson has estimated that any surcharges would be in the range of $500 to $1,300 per year.

Extra costs like that might induce reluctant workers to get the shots. If unvaccinated employees decide to get vaccinated in order to avoid a surcharge, the workplace should be safer and more productive. Absenteeism due to illness can negatively impact productivity.

The takeaway

Employers need to consider the following before implementing surcharges:

  • The EEOC has provided guidelines for employers wishing to offer vaccine incentives. Employers should stay within those guidelines.
  • Are the incentives necessary? They might not be in areas or workplaces where vaccination rates are already high.
  • The line between “encouraging” and “coercing” employees to get vaccinated is not well-defined. Employers should avoid imposing surcharges that could be viewed as coercive.
  • Some employees have pre-existing health conditions that make the vaccinations unsafe. Others seriously practice religions that forbid their use. Federal law requires employers to accommodate these workers.

Group Health Insurers Not Factoring In COVID-19 Effects in 2022 Pricing: Study

In a glimpse of what we may expect in terms of premiums, a new study by the Kaiser Family Foundation has found that most insurers are not factoring in added costs or savings related to COVID-19 for their 2022 health coverage rates for personal health plans in 13 states and the District of Columbia.

The insurers expect health care utilization to return to pre-pandemic levels by 2022, according to the analysis by KFF.

While the analysis focused on the individual market, KFF found that insurers were making similar assumptions about how COVID-19 would affect their group market costs and pricing.

Despite them not expecting significant effects from COVID-19, there are other issues that are on health insurers’ radars that are likely to increase rates, including the costs of treatment that was delayed in 2020, the continued use of telehealth services and new federal regulations in response to the pandemic. A recent survey by PricewaterhouseCoopers found that employers are expecting an average rate increase of 6.5% for group health coverage.

It’s clear that most insurers are viewing the COVID-19 pandemic as a one-time event, with limited, if any, impact on their 2022 claims costs. KFF referred to the pandemic’s effect on rates as “negligible.”

The foundation looked at rate filings of 75 insurers and only 13 of them stated that the pandemic would increase their costs in 2022, but even then, most of them predicted an effect of 1%. The reasons those 13 insurers cited for the expected higher costs include:

  • Costs related to ongoing COVID-19 testing, treatment and vaccinations.
  • Anticipated vaccination boosters.

Delayed treatment, policy changes

While most insurers don’t expect to be paying out excessive amounts for treatments and medications related to COVID-19 infections, they are concerned about the increased flow of patients seeking treatment for procedures they postponed last year.

Those postponements have led to pent-up demand, driving higher utilization in 2021, which some health plans expect will spill over into 2022.

As a result, some insurance companies have filed rates that include a “COVID-19 rebound adjustment” to account for the services that were deferred in 2020.

Other carriers have filed for rate increases based on predictions that those delayed services will lead to an exacerbation of chronic conditions. Some are also predicting that COVID-19 “long-haulers” could push claims costs higher.

On top of all that, insurers this year have had to make decisions about benefits, network design and premium pricing in the face of the pandemic and federal policy changes that could dramatically expand coverage under the Affordable Care Act.

Other concerns

Some insurers are concerned about the costs associated with the explosive growth of telehealth services during the pandemic. These tele-visits boomed as people were avoiding doctors’ offices due to stay-at-home and social distancing orders and to reduce the chances of COVID-19 transmission.

Kaiser Permanente in one of its filings wrote: “We anticipate the high utilization of telehealth services to persist beyond the lifespan of the outbreak into the foreseeable future.”

Another insurer, MVP in Vermont, said that while it has seen costs associated with in-person ambulatory services increase this year and a return to in-person visits, it has not seen a reduction in use of telehealth services.

Finally, Blue Cross Blue Shield of Vermont in its filing predicted that the increased expenditures for mental health services (demand for which spiked in 2020 as people wrestled with isolation and depression aggravated by the pandemic) would continue in 2022 and beyond.

The insurer predicted that claims for mental health and substance abuse treatment would climb 20% from 2020 to 2022.

Pandemic Brings Voluntary Benefits to Fore

One major repercussion of the COVID-19 pandemic is that employees are embracing the voluntary benefits their employers are offering them, but they’d like to see more choices and issues such as mental health and voluntary benefits have risen to the fore.

The Hartford’s “2021 Future of Benefits Study” found that before the pandemic, benefits were mainly viewed as a means of attracting and retaining talent. But the pandemic changed all that due to the stress of having our work and personal lives upended, as well as the widespread suffering and grief that the coronavirus has caused. 

The most significant shift that The Hartford noted has been in what employees value most and they would like to see employee benefits cover better:

  • Voluntary benefits,
  • Mental health and well-being,
  • Engagement and technology, and
  • Paid leave.

Solid voluntary benefits

Most everyone has felt the personal effects of the pandemic, either contracting COVID-19 and being hospitalized or seeing family or friends get sick and check in for treatment. Many have had loved ones die from the disease. 

As a result, voluntary benefits have become a larger priority for many workers.

In addition, employees are expressing more interest in supplemental benefits such as critical illness insurance, hospital indemnity insurance and accident insurance. Employers listened and during the last year:

  • 36% of companies surveyed added accident insurance, half of them due to the pandemic.
  • 32% added hospital indemnity insurance, nearly two-thirds of them adding the coverage in response to the pandemic.
  • 29% added critical illness insurance, 84% of which did so due to the pandemic.
  • 27% added life insurance, three-fourths of which did so due to the pandemic.
  • 21 added long-term disability, nearly two-thirds of them doing so due to the pandemic.

A new focus on mental health

Besides the physical toll that the COVID-19 pandemic took on people who contracted the disease, many have been dealing with mental health and work-balance issues, particularly if they were suddenly thrust into working from home.

That coupled with the overall stress that the pandemic has had on people, has prompted a greater demand for employers to prioritize mental health for their staff. The study found that:

  • 59% of workers said their company’s culture has been more accepting of mental health challenges this past year.
  • 27% of employees said they struggle with depression or anxiety most days or a few times a week (up from 20% in March 2020).
  • 70% of employers now recognize that employee mental health is a significant workplace issue, up from 59% in June 2020.

While the pandemic has brought greater attention to the mental health challenges many workers face, it has also shed light on the opportunities for employers to support their team.

This can be done by ensuring that your health plans include a mental health component, offering your workers an employee assistance program and providing staff with resources, help and education that address wellness and mental health.

Engagement and tech

There was a quantum shift in 2020 to virtual benefits enrollment due to the logistics and danger of turning open enrollment meetings into super-spreader events.

Employers were left having to figure out how to conduct open enrollment and provide benefits education most effectively if a significant portion of their staff was now working remotely. Most employers opted for remote educational and open enrollment events that include teleconferencing and online portals for choosing or renewing health plans. 

The survey predicts that the reliance on technology will only increase, with 75% of employers saying their company’s open enrollment strategy will depend more strongly on online resources this year.

The Hartford said that personalization would be key to the success of any employee benefits program:

  • 58% of workers surveyed said they would like a personalized recommendation for what insurance benefits they should be buying.
  • 76% of employers said that they are offering personalized benefit recommendations during open enrollment, up from 71% in June 2020.
  • Story-driven enrollment tools can offer an employee context. Presenting the material in a relatable way and tailoring the message based on an understanding of an individual’s benefits needs, influences and life stage, can help someone better evaluate whether a certain benefit is right for them.

Paid time off

Paid time off has become a much hotter topic since the pandemic started. COVID-19 prompted a number of states as well as the federal government to support paid time away from work through new laws and regulations.

Employers also took note, and 75% of them ended up increasing the types of paid time away from work they provided, beyond state and federal requirements.

Here’s what happened:

  • 46% of employers expanded their paid medical leave.
  • 46% expanded their paid sick time.
  • 39% expanded paid family leave.
  • 30% expanded paid parental leave.
  • 30% expanded paid time off or vacation time.

How to Create a Flextime Policy

With so many people having been relegated to remote work during the COVID-19 pandemic, many employers are now wrestling with how to proceed as it starts to wane. Many companies are considering implementing hybrid, flextime work schedules after seeing success with remote work.

Flextime is the use of flexible schedules in which employees spend a portion of their workday on the worksite, and the rest from home or another location. For example, a flextime schedule might require an employee to work on-site from 8 am to 2 pm, and complete the rest of the workday from another location.

Unfortunately, there is little legal guidance on the use of flextime schedules. Even the federal Fair Labor Standards Act, which governs minimum wage and overtime pay for most employees, does not address flexible work schedules.

Alternative work arrangements are a matter of agreement between the employer and the employee.

Flextime considerations

If you decide that you want to extend flextime to one or more of your employees, you should start by drafting an official company policy on exactly how it works. It’s always good to get it down on paper.

Take your time to make sure you have all angles covered, including ensuring that you don’t run afoul of wage and hour laws in the process. 

Among other considerations, you should address the following three issues when crafting your flextime policy:

  • Which employees are eligible for flextime (management, sales or others);
  • What hours employees are required to work on-site; and
  • Whether prior approval is required from management or human resources.

Once you’ve written out your policy, it may be a good idea to pass it by your legal counsel to ensure you comply with all relevant wage and hour laws. When approved, include the new flextime policy in your company’s employee handbook, so that it is received by all employees who are or may become eligible for the alternative work schedule.

Benefits of flexible hours

Through the availability of smartphones and wireless internet, the amount of work employees can complete off-site has grown significantly. Utilizing available technology for this purpose can increase productivity, and even expand the geographic area in which a business operates. 

Employees working remotely can also better attend to family and personal matters, improving their work-life balance and in some cases reducing the need for a leave of absence. They also don’t have to waste time commuting, which for some can be more than two hours or more on the road every day. 

Creating a virtual workplace that allows a company to offer a flextime schedule can result in a number of significant benefits, including:

  • Saving money on work space;
  • Retaining valuable employees;
  • Bringing on outside project teams;
  • Expanding visibility; and
  • Increasing efficiency and productivity.

Vision Coverage Can Reduce Overall Health Care Costs

Research has found that employers who offered their workers stand-alone vision benefits experienced $5.8 billion in cost savings in the aggregate over four years due to reduced health care costs, avoided productivity losses, and lower turnover rates.

That’s because individuals who receive an annual comprehensive eye exam are more likely to enter the health care system earlier for treatment of serious health conditions, thereby significantly reducing their long-term cost of care.

Additionally, people are more likely to get an annual comprehensive eye test than a routine physical, according to the study by HCMS Group, a human capital risk management firm that analyzes data to help employers reduce waste in health benefits.

While not mandatory under the Affordable Care Act for adults, you may consider vision coverage for your employees as it may help decrease your overall health insurance outlays in the future.

The ACA requires that pediatric vision care coverage be embedded in medical benefits for children up to age 19 in group health plans purchased by employers with 100 or fewer employees.

The ACA’s vision care requirement for kids has exposed a gap in coverage for adults that is prompting an uptick in interest in voluntary vision benefits.

According to the “2020-2021 WorkForces Report” by the life insurer Aflac, 67% of U.S. employers surveyed offered voluntary vision benefits in 2020.

And nearly eight out of 10 employees said they would enroll in vision benefits if they were offered by their employer.

Early detection

The main reason vision benefits can help with early detection of illnesses is that comprehensive eye exams provide the only possible non-invasive view of blood vessels and the optic nerve.

As a result, eye doctors can detect early signs of chronic diseases before any other health care provider.

Eye doctors were the first to identify in patients signs of:

  • Diabetes (34% of the time) — The HCMS study estimates savings of $3,120 per employee due to early identification of diabetes.
  • High blood pressure (39% of the time) — The study estimates savings of $2,223 per employee due to early identification of high blood pressure.
  • High cholesterol (62% of the time) — The study estimates savings of $1,360 per employee due to early identification of high cholesterol.

The case for vision insurance

Vision insurance policies typically cover routine eye tests and other procedures, and provide specified dollar amounts or discounts for the purchase of eyeglasses and contact lenses. Some vision insurance policies also offer discounts on refractive surgery, such as LASIK and PRK.

Vision insurance only supplements regular health insurance. Regular health insurance plans pay for eye injuries or ocular disease.

Vision insurance, on the other hand, is a wellness benefit designed to reduce your costs for routine, preventative eye care such as eye exams, eyewear and other services.

With the prospect of reduced health care costs among your employees, which in turn would reflect well in your health insurance premiums, if you have not considered vision benefits before, it may be time to take a second look.

Contact us for more information on how a vision plan can be incorporated into your employee benefits offerings.

Addressing Pandemic Fatigue Among Your Staff

As the country and our businesses continue trudging along and hope that vaccines will pave the way out of the COVID-19 crisis, employers are increasingly seeing the effects of pandemic fatigue among their workers.

The same issues people are grappling with in their personal lives — exhaustion with social distancing and masking, a sense of loss of community and camaraderie, sadness over lost loved ones — are also spilling over into workplaces and affecting job performance. 

Pandemic fatigue can manifest itself in noticeable changes in employees’ mood or demeanor and result in an inability to concentrate due to anxiety and sleeplessness.

And now that vaccines are being administered at a quickening pace and word is that we may be able to soon resume normal activities, people have a sense of unbridled excitement. It’s like how kids feel when they’ve had a year of school and summer vacation is right around the corner.

It’s important for all employers to stay the course on their safety protocols, while at the same time acknowledging what their employees are going through. Keep requiring mask-wearing and social distancing.

The effects

Pandemic fatigue is real and can result in:

Employee disengagement — This can lead to poor productivity and mistakes in their work.  

Employee conflicts — Many people are stressed and exhausted, which can lead to arguments and irritation with co-workers. It can also happen if one employee doesn’t take COVID-19 precautions seriously, wearing a mask below their nose or chin (or not at all) and angering a co-worker who is serious about safety.

Failing to observe social distancing rules of being 6 feet apart can also result in arguments between co-workers.

Lost concentration — Pandemic fatigue can also lead to employees not focusing well on their jobs and safety regimens. This can result in workplace accidents.

What you can do

There are steps you can take to combat pandemic fatigue in the workplace, but the first and foremost thing you should do is consistently enforce safety rules and make sure that COVID-19 protocols should be part and parcel of the rest of your safety procedures.

You should do this by incentivizing good safety behavior, and rewarding that good behavior.

But you must also be cognizant of the emotional toll the pandemic has had on your workers. You can do this by boosting morale through:

Giving compliments — Provide positive feedback when merited, even for smaller achievements. Compliments go a long way these days due to the stress people have been through.

Showing compassion — Be consistent in your treatment of staff and consider checking in with employees to ensure that they are doing well. Ask how they’ve been faring and show empathy and sympathy for the issues they may be wrestling with.

Remember, some of your employees may have family that has succumbed to the virus or may be currently battling it.

Being calm and patient — It’s important that management shows calm and measured leadership, which can reassure the ranks that things aren’t so bad. Also, if management and supervisors can be patient when workers are dealing with stress, it can in turn tamp down any stress building among staff.

Exuding confidence — Part of being a steady and calming force includes expressing confidence that better times are ahead. This too can help your employees feel more relaxed about the future. Supervisors and managers should also express confidence in and appreciation for the employee’s individual commitment to stay the course.

The final word

These are tough times for most everyone, and for many people their work and personal lives have been upended and replaced with little to no social activity and feelings of isolation and frustration.

By providing steady leadership, continuing to enforce safety protocols and paying attention to the struggles your staff are facing, you can help any workers dealing with pandemic fatigue to better weather the storm that we may soon be exiting.

100% COBRA Subsidy in Effect Through Sept. 30

The recently enacted American Rescue Plan Act of 2021 includes a 100% COBRA subsidy for up to six months for employees laid off during the COVID-19 pandemic. The subsidy is in effect through September 30.

Due to the short ramping up period, it’s imperative that employers who have laid off workers, or who plan to do so, start preparing to notify them.

The Consolidated Omnibus Budget Reconciliation Act requires group health plans sponsored by employers with 20 or more employees to offer staff and their families the opportunity for a temporary extension of health coverage (called continuation coverage) after they have quit or been laid off for 18 months. The employees will usually be responsible for the entire premium.

Who is eligible?

Eligible individuals include:

  • Workers who were previously laid off or lost their benefits and became eligible for COBRA continuation coverage but chose not to purchase it, as long as they would still be eligible now. Example: A worker who was laid off in November 2020 but rejected the offer of COBRA coverage then.
  • Individuals who previously elected COBRA continuation coverage, but later dropped it, as long as they would still be eligible now. Example: A worker was laid off in August 2020, elected and purchased COBRA coverage, but dropped the coverage in January.
  • Individuals who were involuntarily terminated or experienced a reduction in hours, and who timely elect COBRA continuation coverage after April 1.

Individuals are not eligible for a subsidy:

  • If they voluntarily resigned from their job.
  • They become eligible for other employer coverage or Medicare.
  • They are beyond their maximum COBRA coverage period (which under federal law is 18 months, and under California law may be up to 36 months).

What’s covered

The subsidy applies to all health coverage that COBRA usually covers: health insurance, and dental and vision coverage too. Generally, the coverage that employers offer Assistance Eligible Individuals (AEIs) should be the same coverage in effect prior to their COBRA-qualifying events. 

Individuals who qualify for the COBRA subsidy are not required to pay a premium.

The group health plan will cover the cost of the coverage, which will be reimbursed (including any administrative fee) by the U.S. government via a payroll tax credit.

Notice requirements

When notifying newly eligible individuals, the information can be included with the COBRA election notice or a separate notice that would come along with the election packet.

The notices must include:

  • Notification of the availability of subsidies.
  • A prominently displayed description of the AEI’s right to the subsidy and conditions.
  • The forms necessary to establish eligibility.
  • A description of the special election period.
  • A description of the qualified beneficiary’s obligation to notify the plan when they are no longer eligible for coverage.
  • Contact information of the plan administrator and any other person maintaining relevant information in connection with the subsidy.

Important: The Department of Labor is expected to provide model language for these notices by April 10.

What you should do

There are a number of steps employers need to take as the ramping up period is quite short:

  • Coordinate with your COBRA administrator to ensure that you agree about who should identify eligible individuals and who will be sending out notifications.
  • If that is you, identify those individuals who may be eligible for the COBRA subsidy and who may be eligible to make a new election.
  • Prepare notification documents.
  • Notify all eligible individuals.

Group Health Plans Must Cover COVID-19 Testing for Asymptomatic People

The Centers for Medicare and Medicaid Services announced in late February that private group health plans cannot deny coverage or impose cost-sharing for COVID-19 diagnostic testing, regardless of whether or not the patient is experiencing symptoms or has been exposed to someone with the disease.

The CMS said it had issued the new guidance to make it easier for people to get tested with no out-of-pocket costs if they are planning to visit family members or take a flight, for example. Up until now, some health plans have not covered testing if a person is not experiencing symptoms or has not come into contact with someone who is later confirmed as being infected with COVID-19.

The guidance covers the part of the Families First Coronavirus Response Act of 2020 that required that plans and issuers must cover COVID-19 diagnostic testing without any cost-sharing requirements, prior authorization or other medical management requirements. Still, many people were denied getting tests because they had no symptoms or hadn’t been exposed to someone infected with the virus. 

According to the guidance:

“Plans and issuers must provide coverage without imposing any cost-sharing requirements (including deductibles, copayments, and coinsurance), prior authorization, or other medical management requirements for COVID-19 diagnostic testing of asymptomatic individuals when the purpose of the testing is for individualized diagnosis or treatment of COVID-19.

“However, plans and issuers are not required to provide coverage of testing such as for public health surveillance or employment purposes. But there is also no prohibition or limitation on plans and issuers providing coverage for such tests.”

How a New Law Affects Group Health Plans

The newly enacted Consolidated Appropriations Act, 2021 contains a number of provisions that will affect group health plans, with most changes aimed at helping insured workers with flexible spending accounts (FSAs), cost transparency and surprise billing.

Some of the provisions are permanent while others are temporary, slated to run through the anticipated end of the COVID-19 pandemic. Here’s a look at the highlights that will affect employer-sponsored health benefits.

FSA carryover rules loosened

The new law authorizes employers to amend their cafeteria plans and FSAs to either:

  • Allow participating staff to carry over unused amounts from the 2020 plan year to the 2021 plan year (and from 2021 to 2022 as well), or
  • Provide a 12-month period at the end of the 2020 and 2021 plan years.

Under existing law, employers can only allow employees to carry over $550 from one plan year to the next.

The law also allows employees who stop participating in their FSA because they were terminated to continue receiving reimbursement from unused funds through the end of the year during which they stopped participating.

Finally, under the CAA, employees can change how much they set aside into their FSA mid-year (usually they can only change their contribution levels ahead of a new plan year).

In all of the above cases, employers must approve these changes and update them in their plan documents.

Health plan transparency

The CAA also bars “gag clauses,” which bar health insurers from entering into contracts that restrict a plan from accessing and sharing certain information. This is effective as of Dec. 27, 2020.

The goal of these new rules is to increase transparency in pricing and quality information for health care consumers and plan sponsors. 

In addition, there are new requirements for health plan ID cards for enrollees, and they will be required to include the following information starting with the 2022 plan year:

  • Deductibles that are applicable to their coverage
  • Out-of-pocket maximum limits
  • Phone number and website address that enrollees can access for assistance.

Surprise billing

The CAA also created the No Surprises Act, which will, starting with the 2022 plan year, cap a plan enrollee’s cost-sharing obligations for out-of-network services to the plan’s applicable in-network cost-sharing level for the following three categories of services:

  • Emergency services performed by an out-of-network provider or facility, and post-stabilization care if the patient cannot be moved to an in-network facility;
  • Non-emergency services performed by out-of-network providers at in-network facilities, including hospitals, ambulatory surgical centers, labs, radiology facilities and imaging centers; and
  • Air ambulance services provided by out-of-network providers.

The takeaway

With so many changes, employers who sponsor group health plans for their workers need to have a plan to make sure they and their health plans comply.

 What to do now: If you offer FSAs to your staff and want them to be able to carry over funds from 2020 to 2021, and next year as well, you will need to make those changes to your plan documents.

Employers that sponsor group health plans should review their agreements with their health insurers and ensure that their plan contractors include language indicating that the contract complies with the prohibition on gag clauses.

What to prepare for: Starting with the 2022 plan year, employers should check with us or their insurer to make sure that the transparency changes are reflected in their plan documents and that their employees’ health plan cards also include the changes required by the new law. 

Plans should also reflect the new rules created by the No Surprises Act.