ERISAPros News
2019 Limits for Welfare Benefit Plans
The IRS has released the 2019 inflation-adjusted limits for certain welfare benefit plans and the amounts used for discrimination testing.
The salary reduction limitation for health flexible spending account coverage for 2019 is $2,700, an increase of $50 over the amount for 2018.
The 2019 health savings account (“HSA”) limit will increase […]
Form W-2 Reporting of Employer-Sponsored Health Coverage
The ACA requires large employers to report the total cost of employer-sponsored group health coverage on employees’ W-2s, which are due to employees by January 31, 2019. Reporting the cost of health care coverage on the Form W-2 does not mean that the coverage is taxable. It is for informational purposes only […]
Health Plans Must Explain Reasonable and Customary
Lawsuits from non-network providers have been on the rise recently due to the sharp rise in their billing rates, more providers moving out-of-network, and self-insured health plans reducing reimbursement rates. One of the ways that health plans have curtailed out-of-network reimbursement rates is through reasonable and customary reductions. A health plan […]
No More Secrecy— New Laws Ban Pharmacist ‘Gag Clauses’ on Drug Prices
According to a 2013 study published in JAMA in March, people with Medicare Part D drug insurance unknowingly overpaid for prescriptions by $135 million. Copays in those plans were higher than the cash price for nearly 25% of drugs purchased. Patients overpaid by more than 33% for 12 of the […]
Bipartisan Legislation to Protect Against Surprise Medical Bills
Concern over surprise medical bills—those from out-of-network physicians that patients had no role in choosing—has grown tremendously in recent years. Some states have taken steps to mitigate this problem. However, these measures do not apply to the roughly half of Americans enrolled in self-insured health plans because ERISA precludes states from […]
The Pros and Cons of Telehealth
The term telehealth encompasses clinical diagnosis, education, management, and the monitoring of health via technology. It is not a specific service, but rather an umbrella term for a variety of strategies to enhance medical care delivery.
The greatest advantage of telehealth is ease of access. Patients can quickly and easily speak with doctors […]
Q&A on Employer Shared Responsibility Provisions Under the ACA
The IRS answers FAQs regarding The Affordable Care Act’s employer shared responsibility provisions related to:
- Basics of the Employer Shared Responsibility Provisions
- Employers Subject to the Employer Shared Responsibility Provisions
- Identification of Full-Time Employees
- Offers of Coverage
- Affordability and Minimum Value
- Liability for the Employer Shared Responsibility Payment
- Calculation […]
Does Your Parental Leave Policy Pass the Smell Test?
Last year the EEOC sued cosmetics and fragrance giant Estée Lauder, claiming its parental leave policies discriminated against men. Estée Lauder provided eligible new mothers with six weeks of paid parental leave for child bonding (in addition to leave for recovery for childbirth), but it only offered new fathers two […]
Recent Promises to Control Drug Prices Are Disingenuous
Promises from drug makers to control persistent increases in drug costs seem to last only as long as it is politically expedient to make them. To counteract this behavior, the Trump administration has floated proposals such as promoting competition from generic drugs and changing Medicare drug-purchase policies. Some experts are […]
87% Increase in Million Dollar Claims in Last 3 Years
The number of patients with claims in self-funded plans from $1 million to $1.5 million rose from 104 in 2014 to 194 in 2017 according to a new Sun Life Financial report. Over the four year period, high claims totaled $6.9 billion. Cancer represented $798.7 million, followed by metabolic disorder and hemophiliac […]