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 survey conducted by America’s Health Insurance Plans (AHIP) shows how much group health insurance coverage supports access to mental health services in the United States. Some key findings include: • Forty-one million Americans – nearly 1 in 4 enrolled in employer-provided coverage (EPC) – received mental health support in 2020 • Six million children received mental health services and treatment through a parent or guardian’s employer-provided coverage in 2020 • There was a 100-fold increase in telehealth appointments for mental health in 2020
Source : “How Employer-Provided Coverage Improves Access to Mental Health Support,” America’s Health Insurance Plans, May 12, 2022, https://www.ahip.org/resources/how-employer-provided-coverage-improves-access-to-mental-health-support
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!
Pennsylvania Legislature Advances Claims Data Transparency Legislation
The Pennsylvania legislature recently took H.B. 947 “off the table” and referred it to the House Appropriations Committee for consideration. The measure has already been approved by the House Insurance and Rules Committees. This measure would ensure that employers with 50-99 employees who sponsor fully insured group health insurance coverage may access aggregate health claims data about their group upon request.
Currently, there are no provisions in state law affirmatively allowing this practice, and there is nothing in state law that prohibits carriers from providing employers with aggregate de-identified claims data. The PA Insurance Department does not currently have the authority to require that insurers turn over the information at an employer’s request. H.B. 947 will allow group plan sponsors to request their group-specific aggregate data to make fully informed group health plan decisions.
PAHU is actively monitoring the progress of this legislation, and our state chapter is on record with lawmakers in Harrisburg as supporting its passage.
Delaware Joins The Group of States with Paid Leave Requirements
Delaware recently joined New Jersey and ten other states by passing paid family leave requirements. Employers will need to start paying for the program’s cost on January 1, 2025, and benefits will be available beginning January 1, 2026. The new law will require qualified employers to guarantee eligible employees up to 12 weeks of paid parental leave, six weeks of paid leave for medical reasons (including caregiving for another person), and six weeks of paid military leave. Unless a business qualifies to opt out because they already offer comparable or more generous paid leave benefits, employee-paid leave benefits will flow through a new state-run leave program.
The available benefits under this program are keyed to employer size. At companies with more than 25 employees, employees are eligible for all leave types available under the new rules. At companies with 10 to 24 employees, employees are only eligible for parental leave. At companies with fewer than ten employees, none of the benefits created by this program are mandated, but employers may “opt-in” to participate.
A benefit-eligible individual must: (1) be employed by the company for an entire 12-month period before taking leave; and (2) must have completed 1,250 hours in the 12 months preceding their leave. Program benefits include job protection and payments equivalent to up to 80% of the covered employee’s average weekly wage. Total benefits are capped at $900/week for 2026 and 2027 and indexed afterward.
Program benefits will be made available through a new Family and Medical Leave Insurance Account Fund. Contributions to this Fund in the form of a 0.8% payroll tax for employers with greater than 25 employees will begin on January 1, 2025. This contribution amount drops to .32% for employers with 10 to 25 employees that elect to only provide for parental leave. Employers can pass on 50% of the new payroll tax to employees or make contributions in full on behalf of their employees. An employer may also elect to opt-out if they have an established paid leave program that offers comparable benefits. All such private plans require approval from the Delaware Department of Labor.
IRS Announces 2023 Account-Based Plan Limits
The Internal Revenue Service issued Revenue Procedure Notice 2022-24 establishing the 2023 calendar year contribution limits for Health Savings Accounts (HSAs) and the maximum deductibles out-of-pocket limit for HSA-qualified high-deductible health plans (HDHPs). The notice also sets the contribution limit for excepted benefit health reimbursement arrangements (HRAs). In the calendar year 2023, the limits are as follows:
|Health Coverage Option||Calendar 2023 Limitations|
|Health Savings Account||Annual Contribution Limit for Self-Only Coverage:||$3,850|
|Annual Contribution for Family Coverage:||$7,750|
|HSA-Qualified High Deductible Health Plan||Minimum Deductible for Self-Only Coverage:||$1,500|
|Minimum Deductible for Family Coverage:||$3,000|
|Maximum-out-of-Pocket Limit for Single Coverage:||$7,500|
|Maximum-out-of-Pocket Limit for Family Coverage:||$15,000|
|Excepted Benefit HRA||Maximum Contribution Amount:||$1,950|
Check This Out!
If you want to expand your health policy knowledge beyond this newsletter, here is a resource to check out!
The Kaiser Family Foundation broadcasts monthly “Health Wonk Shop” webinars. These events dig deep into a wide range of cutting-edge health policy topics. While you can register to attend the webinars live on the www.kff.org website, you can also watch them on-demand on YouTube. https://www.youtube.com/c/KFFvideos/videos