GPAHU Pulse – Early October 2021

GPAHU - Monthly State and Legislative Updates

The Fact of the Month

Here’s something to talk about when discussing plan design options and employer contribution strategy with group clients in the New Year.

A recent study conducted to help employers better understand and support their employees’ mental health needs and assess the impact of work disruptions of COVID-19 found that two in five employed adults reported symptoms of anxiety or depression disorder. This is a four-fold increase from pre-pandemic levels. Anxiety and depression disorders affected certain demographic groups more than others, with young adults (18-24) having the highest likelihood of experiencing mental health issues. Women were more likely to suffer (42.9%) compared to men (34%). Employees who had to telework due to the pandemic reported the most significant levels of anxiety or depression disorder (40.9%) compared to employees who continued to work in person (36.1%) or were already teleworking before the pandemic (35.1%). Ensuring employees receive counseling reduced the likelihood of employees reporting mental health symptoms by 8% to 36%, depending on counseling sufficiency.

Source: Integrated Benefits Institute, “Impact of COVID-19 on Employee Mental Health,” September 26, 2021

The Big Three

Each month GPAHU identifies three top public policy or legal developments that could impact our members and clients.  Here are this month’s big three!

Biden Administration In Regulatory Overdrive

Over the past few weeks, the Biden Administration has released a flurry of regulations that will affect carriers and employers who offer group health insurance coverage to their employees.  Most of the changes were to delay upcoming requirements or to provide implementation guidance.  This table summarizes the changes coming in the year ahead.

Recent Action Impact Applicability Data Other Important Information
Delaying the Health Plan Transparency Rule requirement that all carriers and group plan sponsors publish machine-readable files of provider reimbursement data online. Affects both carriers and all employers that offer group health coverage. Delayed the requirement from January 1, 2022, to July 1, 2022. Groups with renewal dates between January 1-July 1, 2022, need to start publishing this data on July 1, 2022, and those with later renewals start posting on renewal.
Delaying the requirements to publish machine-readable RX cost information online. Affects both carriers and all employers that offer group health coverage. Delayed until further notice.  
Delaying the requirement to publish an online price comparison tool for plan participants. Affects both carriers and all employers that offer group health coverage. Delayed from January 1, 2022, to plan years starting on or after January 1, 2023.  
Delaying the new employer reporting requirement that affects all group plans.  Plans will have to report a large volume of group-specific demographic, premium and RX, and medical claims information to the federal government annually. Affects all employers that offer group health coverage regardless of size or funding structure. Delays the reporting due date until more implementation guidance is issued.  Reporting was initially scheduled for the first time on December 27, 2021, and then again every June 1.  Employers were notified that they should be prepared to submit all of their 2020 and 2021 data by December 27, 2022 and then 2022 data by June 1, 2023.
Provide plan participants with “advance EOBs” before they incur a claim. Affects both carriers and all employers that offer group health coverage. Delays enforcement until the publication of implementation guidance. Biden administration plans to align this requirement with a similar one in the plan transparency rule due by January 1, 2023.
Surprise Balance Billing Requirements Affects both carriers and all employers that offer group health coverage. Providers are also affected. Plan years starting on or after January 1, 2022.  Good faith compliance until all related rules are finalized. Group plans need to issue a new notice starting with January 1, 2022, renewals.
Changes to health plan ID cards so that they include more price information. Affects both carriers and all employers that offer group health coverage. Plan years starting on or after January 1, 2022.  Good faith compliance until all related rules are finalized.  
Broker compensation disclosure requirements for the individual market. Carriers offering individual coverage – for the individual coverage requirements only, brokers do not have to report to clients directly. Coverage issued on or after December 27, 2021. There is still no guidance available for brokers and other consultants that get compensation from group plans.  Compliance is still due for contracts with employer group plans issued on or after December 27, 2021.
Air ambulance claims data reporting – Proposed Rule Affects both carriers and all employers that offer group health coverage. 2022 and 2023 Plan Years This rule is not final yet.  If it is finalized, it will impact all groups but carriers and TPAs may be able to report for their group clients.  Group plans will need to make sure that satisfying this reporting obligation is part of their contracts with carriers and TPAs moving forward.

Wolf Administration Imposes State-Employee Vaccine Mandate in Advance of Coming Federal Requirement For Large Employers To Require COVID-19 Vaccinations or Routine Testing

The Wolf Administration has been taking significant steps to increase the number of Pennsylvanians vaccinated against COVID-19.  These steps are similar to the actions of the Biden Administration at the federal level.  Activity by the Wolf Administration includes requiring all Commonwealth employees to be fully vaccinated against COVID-19 by September 7, 2021.  Employees who cannot or will not meet this requirement must undergo weekly COVID-19 testing. In addition, the Administration will require all new hires to be vaccinated before starting work.  State employees are eligible for paid time off to get vaccinated. The Wolf Administration is also releasing much more vaccination data to the public, including data about vaccinations by legislative districts.  The Governor announced the release of new data in a recent letter to state legislative leaders asking for their cooperation and more legislative action to increase vaccine rates in the state and further improve public health.

The Pennsylvania measures come at the same time as more aggressive action by the Biden Administration to increase vaccination rates nationally. The President’s new COVID-19 Action Plan requires vaccination or regular testing for federal employees.  It also states that the Occupational Safety and Health Administration will soon be issuing rules to mandate that all private businesses with 100 or more employees require employee vaccinations or testing.  Furthermore, the plan indicates that any organization that gets funding from the Centers for Medicare and Medicaid Services (which includes almost all health insurance carriers due to premium tax credit funds and Medicare and Medicaid monies) will also need to require employee vaccinations or testing. GPAHU and NAHU are watching for more rules and guidance about implementing these plans and will make sure our members are informed as soon as they become available.

IRS Sets Affordability Rate for Coverage in 2021

Each year, the IRS sets a household income percentage to determine if the amount an employee must contribute toward their group health insurance coverage premiums on a monthly basis meets a legal “affordability test.”  For 2022, the affordability percentage will be 9.61 percent of household income. As long as the amount an employee might pay per month for single coverage in the lowest-cost minimum value plan offered by their employer is no more than 9.61 percent of their household income, the coverage is deemed “affordable.” Applicable large employers need to understand the new affordability percentage each year. If they do not offer “affordable” coverage to eligible individuals, they may be subject to employer responsibility penalties. However, all employers who offer group health coverage should also keep the affordability level in mind because it affects employee subsidy eligibility potential.

The new rate of 9.61 percent is a decrease from the 2021 affordability rate of 9.83 percent of household income. When establishing premium contribution rates for their next plan year, companies should keep the new 2022 rate in mind. Since the rate is lower, employers may need to increase the amount they pay toward the cost of employee coverage.

Check This Out!

If you want to expand your health policy knowledge beyond this newsletter, here is a resource to check out!

There is federal legislation under consideration to expand Medicare coverage, so that vision and dental expenses are covered.  A new issue brief from the Kaiser Family Foundation  explains what Medicare beneficiaries are currently paying for dental and vision expenses and how current Medicare Advantage coverage options may or may not meet their needs.


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