The Health Insurance Portability and Accountability Act (HIPAA) established national standards to secure and protect the privacy of health information. The Health Information Technology for Economic and Clinical Health Act (HITECH) requires the Department of Health and Human Services’ (HHS) Office for Civil Rights (OCR) to conduct audits of covered entities and business associates in … Continued
On July 8, 2016, Pennsylvania Governor Tom Wolfe signed legislation (H.B. 60) regarding health insurance coverage for oral chemotherapy medications. Pursuant to the bill, whenever a health insurance policy provides coverage that includes coverage for intravenously administered or injected chemotherapy medications which have been approved by the U.S. Food and Drug Administration for general use … Continued
In 1990, Health Affairs* reported “The escalating costs of prescription drugs and competition among pharmaceutical firms for customers are drawing the attention of policymakers, pharmacies, and individual and institutional purchasers. Mail-order pharmacies recently have grown in prominence as a competitive alternative to the local community pharmacy.” With the improvements in retail pharmacy pricing, that motivation … Continued
In the early 2000s, prescription costs were around 20 percent of total medical claim spend. This number stayed relatively unchanged for a number of years. Recently, this number has been increasing at an alarming rate. In the early- to mid-2000s, prescription costs were largely held in check with the rise of generic utilization, meaning the … Continued
Applicable large employers and self-funded employers of all sizes have now completed the first round of required IRS reporting under the Patient Protection and Affordable Care Act (ACA). The ACA requires individuals to have health insurance, while applicable large employers (ALEs) are required to offer health benefits to their full-time employees. In order for the … Continued
With the passage of the Affordable Care Act (ACA), the federal government became much more involved in what had always been a heavily regulated, but predominately private industry. What many people have forgotten is that the ACA was not the first legislation to be passed that involved private and employer-sponsored health and welfare plans. The … Continued
From 2013 to 2015, a series of Supreme Court cases and government updates have changed the landscape of the way employers must consider same-sex spouses in relation to employee benefits. Most recently, in June 2015, the Supreme Court ruled in Obergefell v. Hodges, that the 14th Amendment requires a state to license a marriage between … Continued
The U.S. Department of Labor (DOL) has issued its 31st FAQ on the implementation of the Patient Protection and Affordable Care Act (ACA), dedicated to coverage of preventive services, rescissions of coverage, out-of-network emergency services, clinical trial coverage, cost-sharing limitations, the Mental Health Parity Act, and the Women’s Health and Cancer Rights Act. Some highlights … Continued
In serving 36,000 employers and 5 million employees, our UBA Partners get this question frequently: What federal guidance prohibits employers from reimbursing individual health insurance policies? Answer: The IRS has issued extensive guidance prohibiting employers from reimbursing health insurance policies on an individual basis. It issued two notices in 2015 that addressed this issue. In … Continued
The government was busy recently, issuing the massive Benefit Payment and Parameters rule in addition to numerous other updates. Our recent blog reviews the updates to the Benefit Payment and Parameters rule; for more detailed information as it relates to standardized plans, small employer definition, reinsurance fees, rating areas, guaranteed availability, exemptions, and more, download … Continued
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