December 16, 2020
Compliance Recap | November 2020
November was a relatively busy month in the employee benefits world. The U.S. Supreme Court (Supreme Court) heard oral arguments in the case of California v. Texas, which is the case challenging the constitutionality of the ACA. The Internal Revenue Service (IRS) released the updated ...
December 16, 2020
Blue Cross Blue Shield Tentative $2.67 Billion Antitrust Settlement
Blue Cross Blue Shield Association (BCBSA) has recently reached a tentative $2.67 billion settlement arising out of a class action lawsuit filed more than eight years ago by subscribers seeking injunctive and compensatory relief arising out of BCBSA’s alleged violation of federal antitrust ...
December 16, 2020
Proposed 2022 Benefit Payment and Parameters Rule
The Centers for Medicare & Medicaid Services (CMS) has released a proposed rule and fact sheet for benefit payment and parameters for 2022. CMS has also released its draft 2022 actuarial value calculator and draft 2022 actuarial value calculator methodology. According to CMS, the proposed ...
December 16, 2020
Highlights of the Patient-Centered Outcomes (PCORI) / Comparative Effectiveness Fee
The Patient-Centered Outcomes Research Institute (PCORI) fee initially applied from 2012 to 2019. However, in December 2019, the Further Consolidated Appropriations Act, 2020 extended the fee to 2029. The fee is due based on plan/policy years ending on or after October 1, 2012, and before ...
December 14, 2020
Frequently Asked Questions about the Patient-Centered Outcomes / Comparative Effectiveness Fee
You have a PCORI filing and payment obligation if: You sponsor a major medical self-insured health plan You sponsor a fully-insured health plan and a self-funded health reimbursement arrangement (HRA) You sponsor a health plan that meets minimum essential coverage only (MEC) Employer-sponsored ...
December 5, 2020
PCORI, TRF and HIP Fee Highlights
The IRS and the Department of Health and Human Services have issued final regulations that provide details on several fees that will be due as part of the Patient Protection and Affordable Care Act (ACA). Self-funded plans will calculate and pay these fees directly. Insurers will calculate and ...
December 1, 2020
Spending Bill Extends PCORI Fee and Repeals Cadillac Tax, HIP Fee, and Medical Device Excise Tax
On December 20, 2019, President Trump signed the Further Consolidated Appropriations Act, 2020 (Act) to keep the federal government running through September 2020. The Act significantly affects provisions under the Patient Protection and Affordable Care Act (ACA), largely though one fee ...
November 24, 2020
Scam Alert | Beware of PreTexting
Earlier this afternoon, two Purple Card clients independently reported that a team member of theirs received a fraudulent phone call. The callers represented themselves to be with a company contracted by the health plan for their prescription benefits and made it sound as if they already knew ...
November 17, 2020
When Boundaries Collide: Holidays & COVID-19
The holidays are often associated with friends, family, and food. It is a great excuse to get folks together whom you may not have seen all year. Calendars resemble a bingo card as celebrations fill dates for weeks, if not months, in advance. Historically, the biggest obstacle you had to work ...
November 14, 2020
Advocacy in Action | Prescription Appeal Assistance
A member was having a problem filling a brand name prescription medication she had been taking for the last 4 years. A formulary pharmacy benefit change had been made to the insurance plan and the cost of the brand name prescription medication had risen several hundred dollars. Because of the ...
