HHS Announces 2017 Out-of-Pocket Maximums

Money and gavelThe Department of Health and Human Services (HHS) has announced the 2017 out-of-pocket maximums applicable to self-funded and fully insured employer health plans. The maximums for 2017 have been set as follows:

Read More
 

More Large Employers Self-funding Pharmacy Benefit Plans

self-funding prescription drug benefit plansAccording to a recent survey conducted by United Benefit Advisors (UBA), more large employers are selecting to self-fund their prescription drug benefit plans. According to the survey, an increasing number of employers are turning to the cost-containment benefits of self-funding to avoid the Affordable Care Act (ACA)’s impact on the cost of fully insured health coverage.

Read More
 

How Partnering with a TPA that Offers an Integrated Pharmacy Benefit Management Solution Can Reduce Your Workers’ Compensation Plan Costs

worker' comp PBM partnerAs a risk manager, you are focused on every aspect of your workers’ compensation plan that holds the potential to reduce your bottom line. As part of your responsibility to financially manage your organization’s cost exposure, one of your goals is to identify key strategic partnerships that can result in cost mitigation. By integrating a strategic pharmacy benefit manager (PBM) into your workers’ compensation plan, you have the potential to realize significant savings, as part of an effective pharmacy management strategy that can reduce overpayments of medical expenses. Consider the following benefits of choosing an integrated PBM model for your workers’ compensation plan:

Read More
 

Supreme Court Limits ERISA Healthcare Plan’s Reimbursement Rights in Montanile Decision

business process outsourcing (BPO)Recently the United States Supreme Court upheld a decision in the case of Montanile v. Board of Trustees of the of National Elevator Industry Health Benefit Plan which held that a healthcare benefit plan that follows regulations set forth in the Employee Retirement Income Security Act (ERISA), with reimbursement rights, can only obtain “appropriate equitable relief” when enforcing its lien against a third-party settlement. This decision limits the plan’s recovery to settlement funds still held by, or on behalf of, the participant.

Read More
 

How The Latest Impairment Guidelines Are Impacting Scheduled Loss of Use Awards

The Importance of Safety Training for Part-Time EmployeesAny avoidable workplace accident or injury can be devastating, but when a worker is permanently, physically altered from the incident, structured protections are placed on the compensation provided to that worker in the form of scheduled loss of use (SLU) awards. An SLU award is an additional cash payment made to a worker who suffers a workplace injury that leaves him with less ability in a body part than he had before the injury. Changes to the impairment guidelines used to allocate SLU awards are having significant impact on workers’ compensation plan costs. Understanding the factors that impact SLUs can guide your risk management plan strategy.

Read More
 

Updated IRS Guidance on 2015 and 2016 Qualified Transit Benefits

Money and gavelOn January 11, 2016, the Internal Revenue Service (IRS) released new guidance on qualified transit benefits (QTB) that impacts both 2015 and 2016 employer plans. The IRS guidance includes a retroactive transit benefit increase that affects employers offering a commuter or transit benefit plan in 2015 that provided both pretax and after tax benefits.

Read More
 

Premium Cost Trends in Medical Stop Loss

Quantifying the Population Health Management InvestmentSelf-funding allows for greater control over an employee benefits plan, however the one thing that no employer, or employee, can control, are unexpected catastrophic health issues. Stop Loss insurance provides a level of protection for employers to offset the financial burden of large dollar claims. With the cost of health care rising faster than inflation, and the cost of specialty drugs reaching unprecedented levels, stop loss will continue to be a prudent investment to protect the long-term viability of self-funded health plans.

Read More
 

Congress Delays Cadillac Tax Until 2020

BusinessmanPresident Obama has signed into law a two-year delay of the Cadillac Tax. The delay is part of Congress’s $1.8 trillion omnibus spending deal, the Consolidated Appropriations Act of 2016. In response to strong concerns expressed by employers and labor groups regarding the potential negative financial impact of the tax, Congress proposed the two-year delay.

Read More
 

Deadline for ACA Reporting Extended

Quantifying the Population Health Management Investment

The Internal Revenue Service (IRS) has extended the deadline for applicable employers and other health coverage providers to furnish 1094 and 1095-B and C series forms required by the Affordable Care Act (ACA). The deadline for furnishing individuals with 2015 Form 1095-B and 2015 Form 1095-C has been extended from February 1, 2016, to March 31, 2016. The IRS’s recent notice also extends the due date for employers and other health coverage providers to file with the IRS 2015 Form 1094-B and 2015 Form 1094-C from February 29, 2016, to May 31, 2016, if not filing electronically, and from March 31, 2016, to June 30, 2016, if filing electronically. Any employer filing 250 or more forms is still required to file electronically.

Read More
 

A CFO’s Guide to Making Benefit Plan Determinations

What Questions Should You be Asking?

Simplifying AdministrationEmployee benefits are one of the most significant bottom line costs for any organization. Chief financial officers play an essential role in determining what benefit plan solutions not only fit into the organization’s budget, but have the potential for the greatest cost savings. As you plan for the coming year’s expenses and work with your human resources director and benefits consultant to determine the right employee benefit solutions for your employees, ask the following questions:

Read More