"substance
Uncategorized

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.

"accident
Uncategorized

Accident Insurance Can Save Your Workers from Ruin

Even if you are providing your staff with health benefits, they could be left under great financial pressure if one of them has a major accident off the job that leaves them debilitated and unable to work.

Millions of working Americans struggle with managing out-of-pocket costs for non-medical and medical expenses after suffering an unexpected event such as an accident.

If you are already offering your employees health insurance coverage, you can help fill the gap by also offering voluntary accident insurance, which can pay for:

  • Lost wages,
  • Deductibles and other expenses not covered by insurance,
  • Transportation to and from hospitals and doctors, and
  • Home modifications.

Many Americans are ill-prepared financially

According to a survey by Prudential Insurance Co.:

  • Two-thirds of Americans say it would be very or somewhat difficult to meet their current financial obligations if their next paycheck were delayed for just one week.
  • Half of all households say they have less than $10,000 in liquid assets available for use in an emergency.

Why your employees need coverage

  • Health insurance only covers a portion of expenses, and only after the employee has paid their deductible and copay.
  • Employees sometimes have to pay out of pocket for medicines, medical equipment and visits to out-of-network physicians.
  • Employees have to pay out of pocket for travel to appointments, home accommodations, caregiving and housekeeping if they cannot do those things on their own after an accident.
  • Lost wages are a sometimes-overlooked cost of illness or injury. This can be an issue not only for the employees directly impacted by illness or injury, but also for family members who are providing care for them.

The types of accident insurance

Traditional treatment-based plans. These pay benefits based on the occurrence of an accidental injury and the type of treatment or procedure required to treat an injury.

The injured individual will often submit a separate claim for each service they receive related to the accident. For example, if they were in a car accident in which they broke both legs, they would file individual claims for:

  • The costs not covered by health insurance for each service to treat the injury.
  • The cost of paying for transportation to doctors’ visits and physical therapy sessions.
  • Each time a home caregiver visits them to provide care.

Incident-based plans. These pay benefits based upon the incident and type of injury. This can simplify the claims process by reducing the number of claims that must be submitted.

In the case of the car accident victim with broken legs above, they would likely be required to submit evidence only for the fractures and for their hospital stay to be reimbursed.

Benefits to the employer

A more robust benefits package — Offering accident insurance paid for by employees allows you to provide a more robust benefits package that can improve employees’ satisfaction with their jobs.

A smoother transition to high-deductible health plans — Employers replacing traditional medical insurance with an HDHP may find the transition more readily accepted by employees if it is accompanied by an offer of a voluntary accident insurance plan.

Potential for improved productivity — Employees under financial pressure may be less productive than those who are not, and knowing they have accident insurance can put their fears to rest.

Low cost and administrative burden — Most employers offer accident insurance that is paid for by the employee, meaning there is little or no cost to the organization.

"PBM"/
Uncategorized

PBM Trade Association Sues Over Transparency Rules

As the federal government continues rolling out new laws and regulations aimed at increasing price transparency in the health care industry, one group is fighting back: pharmacy benefit managers.

The Pharmaceutical Care Management Association, a trade association for PBMs, has sued the Department of Health and Human Services, Internal Revenue Service and Department of Labor, all of which were instrumental in rolling out transparency regulations in 2020, which took effect Jan. 1, 2021.

The rules specifically require health plans (including PBMs) and health insurers to disclose on their websites their in-network negotiated rates, billed charges and allowed amounts paid for out-of-network providers, and the negotiated rate and historical net price for prescription drugs.

PBMs were included in the transparency rules because numerous reports have found that some of them rely on opaque contracts with pharmacies and drug companies, and that they allegedly fail to pass on rebates and lower drug prices they negotiate to their enrollees.

The lawsuit comes as PBMs are feeling the heat over their practices. At least seven states and the District of Columbia are investigating them, mainly focusing on whether they fully disclose the details of their business and whether they receive overpayments under state contracts.

Also, attorneys general in four states have sued PBMs, mostly alleging that they misled state-run Medicare programs about pharmacy-related costs.

What the PBMs are saying

The PBMs allege in their lawsuit that the rule will not benefit consumers because their knowing what the contracted drug prices are won’t have an effect on them as there are no actions they can take knowing this information.

The trade association said: “The rule offers consumers no actionable information because net prescription drug prices are not charged to consumers and never appear on a bill.” Instead, the information will likely confuse consumers, it alleges.

The trade body in its court filing said PBMs maintain that their business model hinges on their ability to negotiate confidentially and keep the details of their manufacturer contracts as trade secrets that are not available to other drug manufacturers or otherwise disclosed to the public.

“Confidentiality, in turn, allows PBMs to bargain from a position of strength to reduce drug prices,” it wrote. “Government-enforced information sharing will raise costs by reducing PBMs’ ability to negotiate deeper discounts on drug prices.

“The regulation threatens to drive up the total drug price ultimately borne by health plans, taxpayers and consumers by advantaging drug manufacturers in negotiations over price concessions,” it added.

"conference"/
Uncategorized

An Employer Guide to Open Enrollment for the 2022 Policy Year

With the COVID-19 pandemic continuing to throw a wrench into the economy and the workplace, employers are gearing up for another unusual open enrollment for their group health plans for the 2022 policy year.

As a result of the pandemic, your employees’ priorities may have changed and some of them may be looking at enhanced benefits, or to change their plans’ deductibles or out-of-pocket maximums.

The coronavirus is obviously not in the rear-view mirror, so employers need to consider workers’ new priorities when choosing health insurance plans and other employee benefit offerings.

Employees’ new priorities

Here’s what’s become a priority for many workers today:

  • Mental health support
  • Access to telehealth
  • Higher interest in health savings accounts (HSAs).

Employers should consider their staff’s new priorities when designing health and benefit programs. If you decide to make changes to your plans or if your health plans have changed, you’ll need to effectively communicate those changes to your workforce.

More health plans are rolling out more and improved access to mental health support, the demand for which has surged during the pandemic as many people struggled with the sudden changes and isolation spawned by stay-at-home orders.

Additionally, because many people were afraid or because of doctor’s office restrictions, many tried telehealth video-conferencing services for the first time in 2020 or in 2021. Insurers see telehealth as a viable option for reducing the cost of care, and they have invested heavily in the infrastructure to enable health plan enrollees to meet virtually with their doctors.

More health plans are also covering mental health video-conference sessions as well.

Many plans have expanded these services, but you’ll need to check to see if the ones you are offering include these enhancements.

Additionally, the pandemic has resulted in more employees looking for ways to set aside funds during the year to pay for health care and medications. This can be done through HSAs and flexible spending accounts (FSAs). which are funded by the employee using pre-tax dollars. The funds in those accounts can be used to reimburse for a wide variety of qualified medical expenses.

HSAs, however, can only be offered to employees who are enrolled in a high-deductible health plan (HDHP). HSAs can be kept for life and can be transferred from one employer to the next if a worker switches jobs. FSAs are easier to set up, but they are not kept for life and cannot be transferred to another employer when an individual leaves your employ.

There are some changes to these plans that you should know about.

The Coronavirus Aid, Response and Economic Security (CARES) Act, signed into law in March 2020, allowed HSA-qualified HDHPs to cover telehealth services before plan enrollees reached their deductible. This provision expires Dec. 31, 2021.

However, another change brought by the CARES Act is permanent: Employees with HSAs, health reimbursement arrangements or health FSAs are now allowed to use those accounts to reimburse for over-the-counter medications without a prescription, and for certain menstrual care products, such as tampons and pads.

Communications and planning

During your open enrollment meetings and in your communications material, you’ll want to highlight any new services that the health plans you are offering your staff will cover.

Since COVID-19 is still present and is raging in some communities, you may want to consider:

Holding a ‘virtual benefits fair’ — In these virtual fairs, employees and families can go online and check out the offerings of all the plans available to them, so they can learn more about their offerings and provider networks. These events can be done on the employees’ and families’ own time.

Conducting virtual open enrollment meetings — Consider holding teleconference open enrollment meetings to go over the employees’ health plan choices, and the deductibles, copays, premium amounts and what the maximum out-of-pocket is for each choice.

Sending out more frequent and targeted communications — Targeted communications can be sent to various cohorts of your employees, such as information on plans that would be of most interest to people in their 20s and 30s. What you send them in terms of recommended options would be different than what you send older employees, who have other priorities.

Using technology for enrollment — Some health plans offer apps through which employees can choose and sign up for the plan of their choice. Talk to us about what’s available to you.

Schedule it

The Society for Human Resources Management recommends that you do the following in the two months prior to open enrollment (September through October). This is the time to get the word out about the upcoming open enrollment. Consider:

  • Distributing a pre-enrollment flier (printed and online) in September.
  • Holding a virtual benefits fair in mid-to-late September.
  • Distributing the enrollment packet at the end of October (printed and online).
"COBRA
Uncategorized

COBRA Subsidies Ending and Employers Must Send Out Notices

The 100% COBRA health insurance subsidies for workers who lost their jobs during the COVID-19 pandemic are about to expire on Sept. 30, and that means employers who have former staff receiving those subsidies must notify them of their expiration.

If you have former employees who are still on COBRA benefits and receiving the subsidy that was required by the American Rescue Plan Act, you will need to send them a timely notice that the 100% subsidy will end at the end of September and that they will have to start paying premiums if they wish to continue coverage after it has ended.

The expiration notice must be sent out 15 to 45 days before the expiration of the subsidy or before COBRA benefits expire (laid-off employees are only eligible to purchase COBRA health insurance continuation coverage for 18 months after they are laid off or quit).

In other words, employers have to send out expiration notices to some former employees who have been receiving COBRA coverage that their 18 months is up.

Some employers should already have sent out expiration notices.

Employers or plan administrators must notify employees receiving COBRA subsidies no more than 45 days before Sept. 30 and no less than 15 days before they will lose the subsidy. Sept. 15 is the absolute last day to send the notices.

Who should you send notices to?

If you have any former employees who are receiving COBRA premium assistance you must send them an expiration notice, even if they have reached their maximum coverage period of 18 months.

There were three ways a former employee could qualify for the subsidy:

  • Eligible individuals who had a COBRA election in place as of April 1, 2021.
  • Eligible individuals who did not have a COBRA election in place (but were previously offered COBRA under federal law) could start to receive the subsidy on April 1.
  • Eligible individuals who experience a COBRA qualifying event between April 1 and Sept. 30.

What should the notice say?

The IRS has created a model expiration notice, which you can find here.

While it is not mandatory that you use the model notice, it’s a good idea, because using it demonstrates “good faith” compliance with the law.

Here are the details you’ll need to include in the notice:

  • Date of the notice.
  • Names or status of the beneficiary.
  • Name of the group health plan or insurance policy.
  • Whether the beneficiary is receiving the notice because their maximum COBRA continuation period is ending (18 months) or because the subsidy is expiring.
  • Date on which the maximum period of continuation coverage will end, or the date of the end of the COBRA subsidy. Depending on their premium period, their subsidized COBRA coverage can last beyond Sept. 30, according to the IRS.
    Under the rules, the subsidy continues until the end of the last “period of coverage” beginning on or before Sept. 30. In other words, if premiums are usually assessed on a monthly period basis, including the period from Sept. 26 to Oct. 26, the subsidy would cover the entire period ending on Oct. 26.
  • Monthly premium cost that the beneficiary must pay to keep their continuation coverage going after the subsidy expires. It must also include other coverage options.
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