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Self-Insured Health Plan Trends: A Closer Look at the Small-Employer Market
RECORDED
EBRI [Employee Benefit Research Institute]

Make Way For The HRA!
December 7, 2018 WEBCAST
McDermott Will & Emery LLP

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Text of Draft 2018 Instructions for IRS Form 8941: Credit for Small Employer Health Insurance Premiums (PDF)

31 pages, Nov. 20, 2018. "Certain small employers whose principal business address is in a county with no qualified health plan through a Small Business Health Plan Options Program (SHOP) Marketplace may be able to claim the credit for small employer health insurance premiums." Internal Revenue Service [IRS]

Nondiscrimination Testing for Health Plans: Code Section 105(h) and Post-ACA Design Alternatives

Dec. 5 webinar. Understand rules and develop cost effective strategies to meet the compliance obligation, avoid lawsuits, and develop health benefit offerings that are both facially and operationally nondiscriminatory. BenefitsLink discount .

Text of CMS Proposed Regs: Modernizing Part D and Medicare Advantage to Lower Drug Prices and Reduce Out of Pocket Expenses

185 pages. "This proposed rule would amend the Medicare Advantage (MA) program (Part C) regulations and Prescription Drug Benefit program (Part D) regulations to support health and drug plans' negotiation for lower drug prices and reduce out-of-pocket costs for Part C and D enrollees." Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

Text of CMS Fact Sheet: Contract Year 2020 Medicare Advantage and Part D Drug Pricing Proposed Rule

"CMS is proposing or outlining for consideration by stakeholders a number of provisions that implement these four strategies. [1] Providing plan flexibility to manage protected classes.... [2] E-prescribing and the Part D prescription drug program ... [3] Medicare advantage and step therapy for Part B drugs ... [4] Part D explanation of benefits ... [5] Prohibition against gag clauses in pharmacy contracts ... [6] Pharmacy price concessions in the negotiated price."
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

Proposed Rule Expands HRA Usage and Forecasts Safe Harbors for ACA Employer Mandate Compliance

"By moving to a 'defined contribution' model, employers would be able to cap their annual health care spending and shift the risk to insurance companies. However, unless employers provide substantial HRA contributions, employees would bear the brunt of cost increases imposed by insurers in the individual market. Further, without the combined risk pool that comes with a group health plan, employees may find it difficult to replicate their current coverage without increasing their out-of-pocket expenditures." Littler

Agencies Issue Final Regs on Contraceptive Coverage Exemptions

"The final regulations generally adhere to the [2017] interim final regulations (IFRs) ... [which] significantly broadened the exemptions from the contraceptive coverage mandate ... Exempt employers that wish to provide access to contraceptive services without providing the coverage themselves may use a voluntary accommodation process in which the insurer or third-party administrator (TPA) provides the coverage. The final regulations take effect on January 14, 2019." Willis Towers Watson

Best Practices When Introducing a Qualified High Deductible Health Plan

"[1] [C]onsider offsetting 30?40% of the deductible so that the contribution is also meaningful. [2] Consider a 3-year commitment to the HSA contribution.... [3] Offering drug benefits tied to coinsurance or copays after the deductible is met will continue to promote the consumerism aspect of these plans.... [4] Employers should research the cost transparency tools their vendor offers.... [5] [A] strong communication strategy is needed.... [6] [F]actor in the company's cost impact to determine how much employees may contribute to the premium (cost of the plan) or how much employers should fund into an HSA." Findley

CMS Takes Action to Lower Prescription Drug Costs by Modernizing Medicare

"The proposal would ensure that Medicare Advantage and Part D plans have more tools to negotiate lower drug prices, and the agency is also considering a policy that would require pharmacy rebates to be passed on to seniors to lower their drug costs at the pharmacy counter.... CMS is also considering for a future plan year, which may be as early as 2020, a policy that would ensure that enrollees pay the lowest cost for the prescription drugs they pick up at a pharmacy, after taking into account back-end payments from pharmacies to plans." Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

Medicare Plans Could Gain Drug Pricing Leverage Under CMS Proposal

"Health plans would be required to cover at least two drugs per protected class. But they would gain new latitude to exclude additional drugs. One of the proposed exceptions would allow plans to exclude drugs based on price hikes that exceed inflation. The idea is to tamp down costs by giving plans a stronger arm in their negotiations with drug makers." HealthLeaders Media

Cost-Sharing and Drug-Price Transparency in New York

"In New York, prescription drug cost-sharing is rigidly defined by state law for most health-insurance markets, except federally regulated employer-sponsored insurance or Medicare plans.... Although drug-price transparency may be welcomed for its political effects, the disparity between list prices and those actually paid by individuals covered by various insurance plans would tend to mislead rather than inform.... Although most insurers offer price-comparison websites, few enrollees use them. To get more value from price transparency, insurers should be allowed more flexibility in designing cost-sharing so that they may provide more appropriate incentives for consumer engagement." Manhattan Institute

NY Approval Clears the Way for $69 Billion CVS Acquisition of Aetna

"CVS Health Corp. has agreed to spend $40 million for health insurance education and other conditions to win approval from New York regulators, clearing the way for its acquisition of Aetna Inc., state officials announced [Nov. 26]. CVS announced it expects to close on the $69 billion deal by Wednesday." InsuranceNewsNet.com

Press Releases

Employee Benefit Research Institute Launches New Website and Branding EBRI [Employee Benefit Research Institute]

Transamerica Selects Timothy Jones as Head of Innovation Transamerica

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An Employer's Guide to Navigating the ACA Reporting Requirements (PDF) The Wagner Law Group, via The Practical Lawyer

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