by US Rx Care | Apr 28, 2022 | Uncategorized
An expired provision that authorized high-deductible health plans to reimburse for telehealth and other remote health care services before the deductible has been met, has been revived.
The provision was extended from April 1 through Dec. 31 after President Biden signed the Consolidated Appropriations Act of 2022.
Due to the COVID-19 pandemic and ensuing emergency legislation, HDHPs had been required to cover telehealth services with no out-of-pocket costs for the health plan enrollee, but those rules expired at the end of 2021.
The extension was included in the budget bill as telemedicine has grown in popularity because it’s convenient particularly for people who have to travel far to their appointments. It also expands provider choice and access, proponents say.
HDHPs are usually only required to cover preventative care and 10 essential services mandated by the Affordable Care Act with no out-of-pocket costs for the policyholder. All other medical care must be paid for by the enrollees until they meet their deductible.
If a health plan were to violate this rule, it would result in the enrollee being barred from contributing to their attached health savings account (HSA).
The HDHP exemption was initially codified by the Coronavirus Aid, Relief, and Economic Security Act (CARES Act), a sweeping relief package to keep the economy afloat at the start of the pandemic.
The technical language of the act stated that HDHPs remain qualified for the purposes of HSA contributions if they cover telehealth or remote medical services before the enrollee has met their deductible. The exemption expired on Dec. 31, 2021.
That means there is a gap of three months through March 31 when coverage for telehealth before meeting their deductible would result in an HDHP enrollee being ineligible from contributing to their HSA.
This could result in confusion among enrollees, so employers need to be prepared for this.
What employers should do
As a result of this change, you should review your plan documents and summary plan descriptions to see if they have been updated to reflect this new HDHP exemption starting April 1. If not, contact your insurer to get updated documents.
You should also inform your staff about the changes via usual company communications, memos and as an agenda item at your next company meeting.
by US Rx Care | Apr 19, 2022 | Uncategorized
Telemedicine got a big boost during the COVID-19 pandemic, and now a number of states have been moving to ensure that health plan enrollees still have access to it and pay for it just as they would in-person visits.
During the pandemic, insurers agreed to pay for virtual visits just as they would for a face-to-face appointment, doctors who had been reluctant to try new technology embraced it as a way to limit patient exposure, and lawmakers loosened federal regulations that for years had restricted telemedicine’s use.
But more than two years into a public health emergency, some health insurers have begun to roll back their pandemic-era coverage policies or fallen into a pattern of extending coverage for only a few months at a time. There are now efforts in a number of states to require that health insurers cover telemedicine visits the same as face-to-face ones.
Thirty-one states mandate both coverage parity and payment parity. The language of the payment parity mandates differs by state. In eight of them, the mandated payment applies only to the deductibles, copayments and coinsurance faced by the insured. For example, in Texas, coinsurance, copayments and deductibles for telemedicine “may not exceed” those for the same service provided in person.
Other states mandate parity in how insurance plans reimburse providers. For example, in Arkansas and California, reimbursement for health care services provided via telemedicine must be “on the same basis as in-person services.”
Telemedicine improves outcomes, saves money
Recent studies have shown that telemedicine can yield significant savings for group health plans and covered employees — but only if the employees actually use it.
The main thrust of telemedicine is to give workers the option to talk to a health care provider over the phone or by video link about a health issue they may be having. Maybe waiting for an appointment slot to open with their doctor would take too long, or perhaps driving to the doctor’s office may be unfeasible for whatever reason.
Experts say that allowing health plans to charge for telemedicine visits the same as they do for in-person visits can reduce the likelihood that an illness is left untreated, which increases treatment costs in the end, especially if they have to go to the emergency room for treatment.
Telemedicine benefits
Convenience — For many people it’s hard to take time out of the day to go to the doctor, particularly in areas where access to care is limited. For non-serious cases, telemedicine is a good option. If the physician or nurse feels that symptoms are serious, they can always ask the covered individual to come in for an appointment.
Cost savings — Just by its nature, telemedicine can save money, particularly for individuals who habitually go to ER or urgent care for routine services. Telemedicine can be marketed to employees as a much less expensive alternative for after-hours care.
Managing chronic illness — Telemedicine is ideal for workers with chronic conditions who may have a hard time getting to regular doctors’ appointments. Technology exists that can transmit health data from a patient’s home to a doctor’s office.
Addressing concerns
Many people are uneasy about working with a provider over a video link if they have had no prior patient relationship with them.
You can address these concerns by:
- Highlighting credentials of doctors in the telemedicine network.
- Working with us or your health insurer to try to change plan designs in order to eliminate copays for telemedicine.
- Setting aside a room at your offices where your staff can access telehealth services, particularly if they have chronic conditions that may need monitoring on a regular basis.
- Choosing the right vendor, which is crucial. Evaluate vendors based on patient satisfaction, the quality of the providers and the breadth of specialties available.
by US Rx Care | Apr 12, 2022 | Uncategorized
One way you can give your staff more choice in the employee benefits they receive is to offer them a cafeteria plan, which allows them to put together a benefits package that works best for them.
Employers fund these flexible benefit plans with funds that are deducted from their employees’ salaries on a pre-tax basis. Since the salary reductions are not received by the employee, they are not considered wages for income tax purposes.
Cafeteria plans are particularly good for participants who have regular expenses related to medical issues and childcare.
The worker can choose from a menu of options into which they want to funnel the funds, and how they want those funds allocated. Options can include:
- Health insurance,
- Voluntary benefits premiums (like vision and dental),
- Life insurance,
- 401(k), and
- Flexible spending account.
Besides the fact that your employees use money that hasn’t been taxed to pay for these benefits, the payroll deductions for them also reduce their taxable income while raising take-home pay.
A cafeteria plan is especially attractive because it lets them choose which benefits they want. This is great since one size does not fit all in the world of employee benefits.
Set-up and tax implications
Cafeteria plans are also called Section 125 plans because they were created by Section 125 of the IRS Code.
When a plan is created, the benefits are available to employees, their spouses, and their dependents. Depending on the circumstances and details of the plan, Section 125 benefits may also extend to former employees, but the plan cannot exist primarily for them.
Section 125 plans offer a number of tax-saving benefits for employers. For each participant in the plan, employers save on the Federal Insurance Contributions Act (FICA) tax, the Federal Unemployment Tax Act (FUTA) tax, the State Unemployment Tax Act (SUTA) tax, and workers’ compensation insurance premiums.
Combined with the other tax savings, a Section 125 plan usually funds itself because the cost to open the plan is low.
Also, it’s estimated that participating employees can save 20% to 40% of every dollar put into the plan. The employee chooses how much they want to put into the plan each year and this is deducted from their paycheck automatically for each payroll period.
Remember: Flexible benefit plans are not without their drawbacks. But if you want to attract and retain key personnel with competitive benefit packages while keeping your own costs low, they can be an attractive alternative to standard benefit plans.
Call us for more information on how you can set up a flexible benefit plan for your staff.
There are several types of flexible benefit plans, including cafeteria plans and flexible spending accounts.
Flexible spending accounts
An FSA lets your employees pay for medical-related expenses and dependent care that may not be covered by their health plan. They can later use these funds to pay for an array of expenses such as:
- Out-of-pocket medical costs,
- Acupuncture, chiropractic services and the like,
- Medical equipment,
- Day-care provider fees,
- Elder care
Also, employers can allow the employee to carry over a portion of the funds in an FSA to the first few months of the next year. The maximum permitted carryover amount is $550.
by US Rx Care | Apr 6, 2022 | Uncategorized
The Department of Health and Human Services has issued some new “frequently asked questions” for its Affordable Care Act pages, and new guidelines that require group health plans to expand what they are required to cover with no cost-sharing.
The new FAQ section expands the age group for which insurers must cover colonoscopies and adds some women’s services that must also be covered with no out-of-pocket costs on the part of the insured patient.
Additionally, the HHS updated its rules on women’s breastfeeding supplies, coverage for obesity treatment in some women, as well as adding screening for suicide risk for some age groups.
The new FAQs and rules by the HHS will require health plan sponsors to ensure that their health plans have made the necessary policy changes to comply with the new guidance.
It’s also important that employers inform their employees about these rule changes, so they know of the added services and treatments that are available without out-of-pocket costs on their part.
Here’s a rundown of the new rules:
Colonoscopy rules
Under current Affordable Care Act rules, non-grandfathered health plans are required to cover without cost-sharing regular colorectoral screening starting at the age of 50 and through the age of 75. That includes:
- Required specialist consultant prior to the screening procedure;
- Bowel preparation medications prescribed for the screening procedure;
- Anesthesia services performed in connection with a preventive colonoscopy;
- Polyp removal performed during the screening procedure; and
- Any pathology exam on a polyp biopsy performed as part of the screening procedure.
The new rules extend that coverage to people between the ages of 45 and 49 if they get abnormal results from a stool-based test.
These new rules take effect on health plan years that start on or after May 31, 2022. That means most people won’t see the changes until Jan. 1, 2023 since most plans run on calendar years.
Coverage of contraceptives
The ACA requires non-grandfathered health plans to cover FDA-approved contraceptives with no cost-sharing. More importantly, if a patient’s doctor recommends a particular service or specific FDA-approved based on their determination that is of medical necessity, the plan must cover that service with no patient out-of-pocket costs.
However, the HHS says it’s been receiving complaints about health plans sometimes denying some of these FDA-approved services despite the patients’ doctors determining it to be of medical necessity. In some cases, the insurer is requiring patients to try other services first or fail in their use of other services before approving use of the FDA-approved contraceptive method.
The HHS is reminding plans and insurers of their obligation to cover these contraceptives, regardless of if they are in the current FDA Birth Control Guide or not, as it does not include every FDA-approved method.
Other changes
HHS guidelines allow for certain breastfeeding services and supplies to be covered with no cost-sharing. There are a number of services and supplies already covered, but the new guidelines add coverage for double breast pumps.
The HHS also approved a new guideline aiming to prevent and reduce obesity in midlife women (ages 40 to 60) through counseling with no cost-sharing required.
The HHS has also issued new guidelines requiring universal screening for suicide risk to the current Depression Screening category for individuals ages 12 to 21, and new guidance for behavioral, social and emotional screening. There are also new guidelines for assessing risks for cardiac arrest or death for individuals ages 11 to 21 and assessing risks for hepatitis B virus infection in newborns to 21-year-olds.
These too are services that would have to be covered with no out-of-pocket costs to the insured patient.
Employer responsibility
You should check with your plan sponsor that their plans will add the new guidelines to their coverages.
If your plan does not run on a calendar year, you’ll have to do this earlier. Additionally, during the next Open Enrollment, make sure to cover these changes when you hold your Open Enrollment meeting for your staff.
by US Rx Care | Mar 23, 2022 | Uncategorized
It’s no secret that most employees do not fully understand all of their health insurance benefits, which can lead to worse health outcomes and them spending more money than they need to for some medical procedures.
A recent survey of 226 executives by Harvard Business Review Analytic Services concluded that employees and employers could enjoy better outcomes if it were easier for employees to find, understand and use the benefits available to them.
One of the biggest roadblocks to making that possible, the survey indicates, is the difficulty workers have in navigating their benefits programs.
Fortunately, a number of health technology companies have come to the fore to help employees see better health outcomes, shop around for medical services, educate themselves about their health and disease management, and choose the health plan that is best for them.
These tools can help employees make informed health care decisions, while their employer can save money. The tools can help them choose proper care that meets their needs and is within their budget. Some of the new tools on the market include:
Quizzify — This tool gamifies learning about health care through humorous, trivia-style quizzes, reviewed by doctors at Harvard Medical School. The system can help employees build knowledge about diagnostics, medical procedures, dental care, how to shop around for health services, and more.
The creators of Quizzify said they want to address the problem of Americans making far too few primary care visits, while they also receive too much health care that is unnecessary. All of that costs employees because:
- Missing regular doctor’s appointments and preventative services can result in health emergencies later, and
- Overtreatment and unnecessary treatments can lead to worse health outcomes and higher out-of-pocket costs.
Employees who use the tool rave about it, particularly how it helps them negotiate medical costs and provides them with advance knowledge that can help them save thousands of dollars in health care expenses.
Jellyvision’s Alex platform — This tool gives employees advice about accessing their health benefits and using their health savings accounts (HSAs) more effectively. It’s mainly geared towards large companies, but there are similar products being developed for the small and mid-sized employer market.
Some of Alex’s features include:
- Personalized guidance during enrollment and ongoing engagement during the year, as it sends out reminders and tips about an employee’s health insurance and health maintenance.
- A focus on reducing the cost to employers of employee confusion.
- A built-in HSA that actively promotes investing in the account throughout the year.
- Chronic disease management tools.
- Benefits videos.
- Engagement tools that help employers and staff improve their health literacy and save money.
League — This online tool and app is designed to help your employees choose which health plans are best for them, and to identify health risks and help them access preventative care. The platform also includes a mobile-first communications channel for employers.
League provides employees with a personalized health profile, as well as a digital wallet that holds employee assistance program information and other programs that you may be providing, such as HSAs.
The main features for employees include:
- Digital wallet — This also holds HSA funds and allows your employees to pay for health and wellness services, review benefit coverage, and keep tabs on their HSA balance.
- Marketplace — League can help your staff book appointments with over 1,000 local, vetted health professionals and access discounts on services and products.
- Health concierge — They can talk to a registered nurse directly for instant advice.
- Claims reimbursement — They can submit claims digitally to get reimbursed for services.
- Tailored content — They can receive AI and data-driven recommendations and nudges regarding healthy behavior or recommendations for health screenings or procedures.
The takeaway
Online or digital tools alone won’t work for every worker. Some need a more human-centered approach to help them understand their benefits, how to get the most out of them and improve their health.
But tools like the above can go a long way towards educating them about their health and health benefits.
While many of your workers will easily adopt electronic price transparency tools, others will need time to get used to them. It’s important that you provide training for any benefit tool you roll out, and also leave the door open for employees to access one-on-one advice so they can make the right choices.
by US Rx Care | Mar 18, 2022 | Uncategorized
With more lawsuits proliferating against employers during the COVID-19 pandemic, businesses have to be more diligent than ever about their record-keeping.
Besides facing lawsuits alleging a business didn’t do enough to protect its employees or the public, employers are also contending with a tougher regulatory climate thanks to a number of new state and federal laws and regulations that have grown out of the pandemic.
Failing to keep adequate records can result in penalties and make it harder to defend against lawsuits that may arise.
Here are two of the main issues that employers should pay attention to:
OSHA COVID-19 rules
Work-related COVID-19 cases are recordable events and need to be logged in a company’s records of workplace injuries and illness. Guidelines from OSHA state that:
- If a worker comes down with a confirmed case of COVID-19, the employer next must investigate whether there was workplace exposure. If the employers finds the case was most likely contracted at work, the confirmed case will need to be recorded. If the investigation finds no workplace exposure, no record-keeping is required.
- If the case is work-related, the employer must investigate whether other employees were possibly exposed. If other workers had possibly been exposed, the employer will need to notify them of their possible exposure. Employees will need to keep records of those actions.
All work-related COVID-19 cases must also be recorded on the employer’s OSHA Forms 300 and 300A. OSHA requires all records to be kept for five years.
Records in case of litigation
Businesses are being sued by a number of parties as a result of the pandemic. They may be sued by a customer who blames lax safety standards at a store for them contracting COVID-19.
Lately, family members are suing employers when an employee contracts the coronavirus at work and spreads it at home.
Since most of these claims zero in on a business’s alleged missteps in COVID-19 safety protocols, it will be incumbent on those businesses to prove otherwise.
During this time of heightened litigation, companies need to keep records of their efforts to reduce the spread of COVID-19 among staff and customers, and to show they comply with OSHA workplace safety standards.
Records you may want to retain include:
- A list of all COVID-19 safety protocols, including when they were created or modified. Retain records of training and any documentation you circulated among your employees on the requirements they need to abide by. The documents should show what standards the business was relying on for guidance, such as OSHA, the Centers for Disease Control and the Equal Employment Opportunity Commission.
- Records showing that employees were following safety protocols.
- Records of workplace COVID-19 outbreaks and the steps you took to conduct contact tracing and contain the outbreak. Also, you should have documentation of any staff you ordered to isolate at home.
- Any other records your counsel may recommend.
If you are sued, do not destroy any records. You have to keep them all. Not doing so can result in penalties as well as losing the case.
The takeaway
The above are some of the main records you should be keeping. But there may be more, depending on where your business is located. Consult your counsel about any local or state requirements that may not be on your radar.
