Healthcare Reform
Federal Updates
HHS Releases Chart for Determining Whether Federal or State Independent Dispute Resolution Process Applies
Retirement Update
Reminder
It’s MLR Rebate Time Again!
The ACA requires insurers to submit an annual report to HHS accounting for plan costs. If the insurer does not meet the medical loss ratio standards, they must provide rebates to policyholders. Rebates must be distributed to employer plan sponsors between August 1, 2022, and September 30, 2022. Employers should keep in mind that if they receive a rebate, there are strict guidelines as to how the rebate may be used or distributed.
For more information, please review this edition's FAQ
FAQ
The time has come again for MLR rebates. Could you provide a refresher on what we can do with those rebates?
State Updates
Florida
Employers’ Right to Request a Loss Run Statement
August 16, 2022
On June 26, 2022, Gov. DeSantis approved SB 156 into law. The new law requires group health insurers to provide a loss run statement to an employer plan sponsor within 15 days of request. For this purpose, a loss run statement is defined as a report that contains: the premiums paid, the number of insureds on a monthly basis and the dependent status, policy number, the period of coverage, the number of claims, the paid losses on all claims and the date of each loss. The law was effective upon signature.
Employers with plans regulated by the state should be aware of their ability to access this information.
Hawaii
Discrimination Related to Gender Identity Prohibited
August 16, 2022
Oregon
Coverage for Human Monkeypox Virus Vaccination
August 16, 2022
On August 10, 2022, Commissioner Stolfi published Bulletin No. DFR 2022-4, which addresses coverage for human Monkeypox virus (hMPXV) vaccination. According to the bulletin, all health benefit plans (including grandfathered health benefit plans) in Oregon must provide coverage for approved hMPXV vaccines and their administration in accordance with this bulletin. The coverage required under the bulletin includes vaccines administered to an individual after exposure to the virus as post-exposure prophylaxis (PEP). In addition, a health benefit plan may not restrict coverage for an approved hMPXV vaccine and its administration to in-network providers and must not require employee cost-sharing for the vaccine. The coverage requirements became effective on August 5, 2022.
Employers should work closely with insurers to ensure that the coverage is provided according to the bulletin, and to address any related employee questions relating to hMPXV.
Vermont
Coverage for Hearing Aids
August 16, 2022
Gov. Scott recently signed H 266 into law, which requires group health insurance policies issued on or after January 1, 2024, to provide coverage for hearing aids. Each group policy will be required to cover the cost of a medically necessary hearing aid for each ear and the associated hearing aid professional services when the hearing aid or aids are prescribed, fitted, and dispensed by a hearing care professional. The coverage shall include hearing aid batteries when prescribed by a hearing care professional. Coverage may be limited to one hearing aid per ear every three years. The coverage may be subject to the plan’s normal cost-sharing requirements (deductible, copayment and coinsurance).
Further, the Departments of Vermont Health Access and of Financial Regulation intend to modify the essential health benefits in Vermont's benchmark plan to include coverage of hearing aids and related services beginning in plan year 2024. This means that self-insured employer plans which have chosen Vermont as their benchmark plan would be required to provide such coverage for plan years beginning in 2024.
There is no action required of employers now. However, when the law becomes effective, employer plan sponsors will need to work with their insurer or administrative services only carrier to modify coverage, if necessary.
This material was created by PPI Benefit Solutions to provide accurate and reliable information on the subjects covered but should not be regarded as a complete analysis of these subjects. It is not intended to provide specific legal, tax or other professional advice. The service of an appropriate professional should be sought regarding your individual situation. PPI does not offer tax or legal advice. "PPI®" is a service mark of Professional Pensions, Inc., a subsidiary of NFP Corp. (NFP). All rights reserved.