Pulse

Here is something to mention when discussing cost and benefit trends with clients in the month ahead. The average annual premium for employer-sponsored health insurance in 2023 is $8,435 for single coverage and $23,968 for family coverage. The average annual single premium and the average annual family premium each increased by 7% over the last year. Comparatively, there was an increase of 5.2% in workers’ wages and inflation of 5.8%2. The average single and family premiums increased faster this year than last year (2% vs. 7% and 1% vs. 7% respectively). Source: Kaiser Family Foundation, “2023 Employer Health Benefits Survey,” October 18, 2023. Available online at: https://www.kff.org/report-section/ehbs-2023-section-1-cost-of-health-insurance/ 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! The Pennsylvania Department of Insurance (PID) released Bulletin 2023-16, on November 4, 2023 The Pennsylvania Department of Insurance (PID) released Bulletin 2023-16, on November 4, 2023, which establishes that in order to meet mental health parity requirements, all commercial health insurers in the Commonwealth offering fully-insured major medical coverage that includes any autism service benefits must provide complete coverage for autism spectrum disorders no later than … Read More

Here is something to mention when discussing cost and benefit trends with clients in the month ahead. IRS Notice 2019-45 allows health savings account (HSA)-eligible health plans the flexibility to cover 14 medications and services used to prevent the exacerbation of chronic conditions prior to meeting the plan deductible. A 2021 Employee Benefit Research Institute (EBRI) survey of employers collected information on their response to the 2019 guidance and found that many employers added pre-deductible coverage as a result of the IRS notice. A recent EBRI report based on claims data from about 2 million HSA-eligible health plan enrollees confirmed the findings from the 2021 EBRI survey — fewer enrollees in HSA-eligible health plans have deductibles for services impacted by the IRS notice, and cost sharing has shifted from deductibles to copayments and coinsurance. The same shift was not observed for enrollees in other types of health plans. IRS Notice 2019-45 appears to have had a negligible impact on overall cost sharing as a percentage of total spending on a number of services impacted by the notice. This may be due to the fact that employers were more likely to change their cost sharing approach instead of eliminating it. Source: … Read More

Here is something to mention when discussing cost and benefit trends with clients in the month ahead. Mental health needs among workforces continued to climb this year, with 77% of large employers reporting an increased interest in mental health coverage and another 16% anticipating one in the future, according to Business Group on Health’s 2024 Large Employer Health Care Strategy Survey. This represents a 33 percentage-point surge over last year when 44% of employers saw increased employee mental health concerns. Source: Business Group on Health. 2024 Large Employer Health Care Strategy Survey. August 2023. Available at: https://www.businessgrouphealth.org/resources/2024-large-employer-health-care-strategy-survey-intro/ 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 Insurance Department Considers 2024 Rate Increases  The Pennsylvania Insurance Department announced it is currently reviewing the proposed 2024 rate increases for individual and small group health insurance offered in the state.  The PID is accepting public comments on the rates and filings through September 8, 2023, which may be emailed to ra-in-comments@pa.gov. The PID plans to approve final 2024 rates later this Fall. Based on the initial proposals submitted by Pennsylvania’s health insurers, the average … Read More

Here is something to mention when discussing cost and benefit trends with clients in the month ahead. Research by the Kaiser Family Foundation shows the 80/20 rule, whereby 80% of cost/effort is attributable to 20% of the people, is alive and well in the Medicare Part D Program. Analysis shows that the ten prescription drugs most prescribed to Part D participants in 2021 accounted for 22% of gross Medicare prescription drug spending that year. However, these medications only represent .3% of the total drugs covered by the Medicare program. The top 100 medications represent just 3% of covered drugs but comprised 66% of total Medicare prescription drug costs in 2021. Source: Cubanski, Juliette and Neuman, Tricia. “A Small Number of Medicare Part D Drugs Account For a Large Portion of Medicare Spending.” Kaiser Family Foundation, July 12, 2023, https://www.kff.org/medicare/issue-brief/a-small-number-of-drugs-account-for-a-large-share-of-medicare-part-d-spending/ 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! Michael Humphreys Confirmed as PA Insurance Commissioner   On June 26, 2023, the Pennsylvania Senate unanimously confirmed Michael Humphreys as Insurance Commissioner for the Commonwealth of Pennsylvania.  Governor Shapiro nominated Humphreys, who had served … Read More

Here is something to mention when discussing cost and benefit trends with clients in the month ahead. For the second year in a row, the actuarial firm, Milliman, surveyed employers about the importance of offering mental health benefits to their employees. Virtually all respondents indicated they offer some form of mental health resources to employees. Well-being was the most popular reason cited for offering mental health resources (94%), but there were clearly several other considerations. Most respondents (73%) also indicated that mental health offerings are either ‘important’ or ‘very important’ to recruiting and retaining employees. The cost of mental health resources was only the fourth most important consideration (58%), behind provider access and availability, such as provider gender, race, and social considerations (69%). Source:Hart, Ryan. Milliman, “Pulse Survey Results: Mental Health Benefits 2023,” June 13, 2023. https://www.milliman.com/en/insight/pulse-survey-mental-health-benefits-2023 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! New State Law on Insurance Cybersecurity   On June 14, 2023, Governor Josh Shapiro signed the Pennsylvania Insurance Data Security Act (H.B. 739) into law. The new measure creates specific state cybersecurity requirements for both insurance … Read More

Here is something to mention when discussing cost and benefit trends with clients in the month ahead. In addition to being the most reported reason for not offering health insurance, cost is also a critical problem for those offering health insurance. Almost all (98%) of small employers offering health insurance are concerned that the cost of providing health insurance to their employees will become unsustainable in the next 5-10 years. Fifty-eight were very concerned, 27% moderately concerned, and another 13% mildly concerned. Two percent are not concerned at all and 1% did not know. Source:National Federation of Independent Businesses, Small Employer Health Insurance Survey, March 2023 https://strgnfibcom.blob.core.windows.net/nfibcom/Health-insurance-survey-NFIB.pdf 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! New Law Mandates First-Dollar Coverage of Cancer Screening Tests Pennsylvania Governor Josh Shapiro recently signed S.B. 8 into law, which will require all fully insured health plans in the state to cover certain cancer screenings at no cost. All fully insured major medical policies issued in Pennsylvania after December 27, 2023, will need to comply with these requirements. The measure will prevent the application of out-of-pocket … Read More

Here’s something to talk about when discussing plan design options and employer contribution strategy with group clients in the New Year. Typically, medical inflation outpaces inflation in the rest of the economy. But currently, medical prices are growing at a similar rate as in past years, while prices in some other parts of the economy are growing much more rapidly than in the past. Using the CPI, overall prices grew by 6.0% in February 2023 from the previous year, while prices for medical care increased by only 2.3%. As a result, overall prices excluding medical care grew by 6.4%. Source: Rakshit, Shameek; Wagner, Emma; Hughes-Cromwick, Paul; Cox, Cynthia; Amin, Krutika. “How Does Medical Inflation Compare to the Rest of the Economy?” Kaiser Family Foundation, March 29, 2023. https://www.kff.org/health-costs/issue-brief/how-does-medical-inflation-compare-to-inflation-in-the-rest-of-the-economy 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! New Guidance on the End of Federal COVID-19 Health Coverage Protections The Departments of Labor, Health and Human Services and Treasury recently issued FAQs explaining the impact the wind-down of the COVID-19 national emergency period and the related public health emergency (PHE) will have on … Read More

Here’s something to talk about when discussing plan design options and employer contribution strategy with group clients in the New Year. According to findings of the Employee Benefit Research Institute (EBRI)/Greenwald Research Consumer Engagement in Health Care Survey, 19 percent of respondents reported being enrolled in a health savings account (HSA)-qualified high deductible health plan (HDHP) in 2022. Enrollment in health plans with high deductibles not eligible to be paired with an HSA was 12 percent in 2022, according to the survey. Other findings include: Younger people are more likely to enroll in traditional health coverage, while older people are more likely to be in an HDHP or another high deductible plan. Men are more likely to enroll in an HDHP or other high deductible plan, while women are more likely to be in traditional health coverage. People in lower-income households are more likely to enroll in traditional health coverage, while those in higher-income households are likely to be in an HDHP or another high deductible plan. College-educated individuals are more likely than individuals without a college degree to be in an HDHP or another high deductible plan. Married individuals are more likely than individuals who were never married to … Read More

Here’s something to talk about when discussing plan design options and employer contribution strategy with group clients in the New Year. Research from Voya Financial conducted in November of 2022 found that 63 percent of employees are likely to participate in voluntary benefits offered by their employers, such as critical illness coverage, hospital indemnity, disability income and accident insurance. That is up from the previous year when 45 percent said they were interested. This trend of increased interest in voluntary benefits is also significantly higher among working Americans with children at home (76%) — which is up from 52% in 2021. From a generational standpoint, 71% of millennials indicated that they are likely or extremely likely to participate in more voluntary benefits offered by their employer, which is up from 52% in 2021. Source: Voya Financial Survey, November 23-24, 2022, https://www.voya.com/voya-insights/voluntary-benefits-101-what-are-they-and-how-do-they-work 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! PA House of Representatives Flips to Full Democratic Control After a month of chaos and disputes over which party controlled the Pennsylvania House of Representatives, Democrats regained a clear one-vote majority on … Read More

Here’s something to talk about when discussing plan design options and employer contribution strategy with group clients in the New Year. A new survey shows just how much Americans with private health insurance coverage value their telehealth benefits. Key findings include: • Over 40% of the 498 respondents with private insurance used a telehealth benefit in the past year. • The majority (65%) used these benefits because it was more convenient than an in-person appointment. • Nearly 4 in 5 (78%) said telehealth made it easier to seek out care when they need it. • Eighty-five percent of respondents said there were an adequate number of telehealth providers available for their health needs. • More than half (53%) of respondents used telehealth services between 2-5 times in the past year. • Nearly 3 in 4 people (73%) want Congress to make the provisions that allow telehealth services to be paid for before the application of the deductible in High Deductible Health Plans permanent. Source: https://www.ahip.org/documents/AHIP-Telehealth-Survey-Results-12012022.pdf 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! PA House of Representatives Elects Independent Speaker After … Read More

Here’s something to talk about when discussing plan design options and employer contribution strategy with group clients in the New Year. Over one-third of consumers find the stress of figuring out what is covered under their employer’s health plan to be more stressful than their current job. As a recent survey by the Wakefield Group and Gravie of over 1000 employees with group coverage reveals that 86% of consumers are concerned that their health benefits will not cover a portion or all of their exams, treatments, or procedures for this year. Additionally, 71% of consumers stated that their health plan does not cover mental health, and two-thirds of consumers are concerned that their current mental health coverage does not address the needs of themselves and their families. Source: https://www.prnewswire.com/news-releases/new-study-shows-consumer-concern-for-rising-healthcare-costs-this-open-enrollment-season-301639999.html 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! New Jersey Moves to Mandate Coverage of Abortion Services in All Fully Insured Plans The New Jersey Department of Banking and Insurance (NJDOBI) is taking steps to mandate that all fully-insured policies sold in the state cover access to abortion services as part of … Read More

Here’s something to talk about when discussing plan design options and employer contribution strategy with group clients in the New Year. Mothers are more likely to be the provider of group coverage for the whole family and are replacing fathers as the providers of family coverage. On the other hand, group policy-holding rates have been steady for both childless men and women. Source: Eden Volkov, EBRI Issue Brief, “The Dynamics of Health Insurance Within Families: 2012-2021” 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! New PA Law Updates Prior Authorization, External Review, and Emergency Care Requirements On November 3, 2022, Pennsylvania Governor Tom Wolf signed S.B. 225 into law as Act 146. The intent of the new law is to speed up the prior authorization process for consumers and place more controls over the use of step-therapy. The measure only applies to fully insured health insurance coverage offered in the Commonwealth. It will require health insurers and managed care entities, as well as the state Medicaid and Children’s Health Insurance Programs (CHIP), to handle prior authorization requests consistently and transparently. It … Read More

Here’s something to talk about when discussing plan design options and employer contribution strategy with group clients in the New Year. Despite recent regulations to ensure consumers have access to the true cost of their medical care, research shows that most Americans may not be currently using the data. According to a survey conducted in March of 2022 and released in early October, two-thirds (64%) of the more than 2,000 Americans questioned said they have never tried to find the price of a healthcare service. Thirty-six percent of respondents have researched healthcare prices, and younger adults between ages 18 and 34 were more likely than older adults (55+) to do so—55% versus 27%, respectively. Source https://akasa.com/press/healthcare-consumers-conditioned-to-not-shop-around/ 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! Federal Regulation To End Family Glitch Could Impact 180K Pennsylvanians The Biden Administration just finalized a regulation that will allow dependents offered “unaffordable” family or dependent coverage through an employer group plan to potentially qualify for premium tax credits to purchase individual health insurance through health insurance exchange marketplaces. The rule will take effect on January 1, … Read More

Here’s something to talk about when discussing plan design options and employer contribution strategy with group clients in the New Year. Paid sick leave provides workers with job-protected paid time off to address short-term illnesses or seek preventive care for themselves and their family members. Currently, 15 states, including New Jersey and Delaware, have enacted laws to require employers to provide paid sick leave. Recent research shows that state implementation of paid sick leave mandates was associated with a 5.6 percent reduction in emergency room visits, equivalent to 23 fewer visits per 1,000 population per year. Visits related to adult dental conditions, adult mental health or substance use disorders, and pediatric asthma notably declined. Source Ma, Yanlei; Johnston, Kenton J.; Hao, Yu; Wharam, J. Frank; Wen, Hefei. “State Mandatory Paid Sick Leave Associated With A Decline in Emergency Department Use in the US, 2011-2019.” Health Affairs, Vol. 41, No. 8, August 2022 June 3, 2022. 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! Round-up on Federal Activity Affecting Health Insurance and Employee Benefits Over the past few weeks, the federal government … Read More

Here’s something to talk about when discussing plan design options and employer contribution strategy with group clients in the New Year. In April 2022, overall consumer prices rose by 8.3% from the previous year, while prices for medical care increased by only 3.2%. This is unusual, as health prices historically outpace prices in the rest of the economy. However, the relatively high rate of inflation seen in the rest of the economy may eventually translate to higher prices for medical care. This may lead to steeper premium increases in the coming years. Source Source: Wagner, Emma; Ortaliza, Jared; Hughes-Cromwick, Paul; Krutika, Amin; Cox, Cynthia. “Overall Inflation Has Not Yet Flowed Through to the Health Sector,” Peterson-KFF Health Systems Tracker. June 3, 2022. 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! Impact of the Dobbs Decision on Health Insurance Coverage and Group Benefit Plans Pennsylvania House Insurance Committee Chair, Tina Pickett (R-110), introduced legislation in April intended to protect Pennsylvania insurance consumers in the advent of a cybersecurity attack. The bill, known as H.B. 2499, is based on model legislation created and … Read More

Here’s something to talk about when discussing plan design options and employer contribution strategy with group clients in the New Year. About six in ten adults say they are currently taking at least one prescription drug and a quarter indicate they take four or more prescription medications. While about eight in ten adults (83%) say the cost of prescription drugs overall is unreasonable, most people say affording their personal prescriptions is easy (69%). However, certain groups are much more likely to report difficulty affording medication. These groups include those who take four or more prescription drugs, those with chronic conditions in their households, and those with an annual household income of less than $40,000. Source : Hamel, Liz; Lopes, Lunna; Kirzinger, Ashley; Sparks, Grace; Kearney, Audrey; Stokes, Mellisha; and Brodie, Mollyann. “Public opinion on Prescription Drugs and Their Prices.” Kaiser Family Foundation, April 5, 2022. https://www.kff.org/health-costs/poll-finding/public-opinion-on-prescription-drugs-and-their-prices/ 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! PA House Insurance Committee Considers Model Cybersecurity Legislation Pennsylvania House Insurance Committee Chair, Tina Pickett (R-110), introduced legislation in April intended to protect Pennsylvania insurance consumers in … Read More

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 … Read More

Here’s something to talk about when discussing plan design options and employer contribution strategy with group clients in the New Year. Even though over 90% of United States residents have some form of health insurance, medical debt remains a persistent problem. Approximately 9% of adults – or roughly 23 million people – owe more than $250 due to health costs. About half of those reporting significant medical debt owe more than $2,000. A small share (representing about 1 percent of all adults) owes more than $10,000, and the group accounts for the majority of the total medical debt owed by people in the United States. Source Matthew Rae, Gary Claxton, Krutika Amin, Emma Wager, Jared Ortaliza, and Cynthia Cox, “The Burden of Medical Debt in the United States,” The Kaiser Family Foundation, March 10, 2022,https://www.healthsystemtracker.org/brief/the-burden-of-medical-debt-in-the-united-states/ 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 Proposes End To “Family Glitch” The Biden Administration recently issued a proposed rule to change the eligibility rules for individual market exchange-based premium tax credits and to eliminate the Affordable Care Act’s (ACA) “family glitch.”  Right … Read More

Here’s something to talk about when discussing plan design options and employer contribution strategy with group clients in the New Year. A recent workplace survey shows that 70% of employees feel like they understand their health benefits extremely or very well. Just over half express the same level of understanding about other benefits. However, 64% of employees are confident in their ability to make informed decisions about employee benefits. Four in ten rely on information from a spouse or partner when making decisions about their benefits and one in four looks to their employer or Human Resources department. Just under six in ten say they would take advantage of advice from an online enrollment program. Source 2021 Workplace Wellness Survey, Employee Benefits Research Institute and Greenwald Research,https://www.ebri.org/docs/default-source/wbs/wws-2021/2021-workplace-wellness-short-report.pdf?sfvrsn=c4553b2f_6 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! Access to Telehealth Protections Included in Federal Omnibus Spending Legislation President Biden just signed $1.5 trillion federal spending package that includes provisions to extend access to telehealth services supported by the National Association of Health Underwriters. GPAHU members who attended NAHU’s Capitol Conference in Washington, DC … Read More

Here’s something to talk about when discussing plan design options and employer contribution strategy with group clients in the New Year. Telehealth use skyrocketed during the early months of the pandemic. While it has since decreased somewhat from that high, it still represents a much more substantial share of health care than before COVID. From March through August 2021, 8% of all outpatient visits were conducted via telehealth – down from 13% in the first six months of the pandemic but well above pre-pandemic levels, when telehealth accounted for a negligible share of outpatient visits. Source Lo, Justin, Rae, Matthew, Amin, Krutika, and Cox, Cynthia. “Outpatient Telehealth Soared Early In the COVID-19 Pandemic But Has Since Receded.” Kaiser Family Foundation, February 10, 2022, https://www.healthsystemtracker.org/brief/outpatient-telehealth-use-soared-early-in-the-covid-19-pandemic-but-has-since-receded/ 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 Updates Guidance on “Free” COVID-19 Home Tests In response to consumer and stakeholder questions, the Biden Administration recently updated its guidance requiring all private health insurance issuers and group health plans to cover home-based COVID-19 diagnostic tests without applying cost-sharing or utilization management requirements.  The Pennsylvania Insurance … Read More

Here’s something to talk about when discussing plan design options and employer contribution strategy with group clients in the New Year. New federal protections that are part of the “No Surprises Act” will prevent insured patients from receiving surprise medical bills when they unexpectedly receive care from an out-of-network provider without providing consent. Surprise balance bills have been a significant concern for Americans for years. According to Kaiser Family Foundation research, approximately 1 in 5 emergency visits and about 1 in 6 inpatient admissions at in-network facilities resulted in surprise balance bills before this year. More than any other type of hospitalization, surgery admissions are more likely to result in an out-of-network charge (21%), followed by admissions for mental health or substance abuse (20%). Milliman, Jason. Milliman, Jason. “Before New Ban, the Prevalence of Surprise Bills,” Kaiser Family Foundation, January 7, 2022. 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! DOL Releases Guidance on Broker Compensation Disclosure Requirements Federal officials have started 2022 by taking significant actions related to the COVID-19 pandemic that will affect health insurance coverage and employee benefit … Read More

Here’s something to talk about when discussing plan design options and employer contribution strategy with group clients in the New Year. The direct economic effect of the need for caregiving is nearly $44 billion a year. It comes from the loss of more than 650,000 jobs and almost 800,000 caregivers suffering from absenteeism issues at work. Much of the impact comes from people who spend a significant amount of time per day in their caregiving role, assisting loved ones with the most serious of health conditions. The overall economic impact of caregiving across the direct and indirect channels is $264 billion a year. Source: TThe Economic Impact of Caregiving, Blue Cross Blue Shield Association, November 8, 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! Telehealth Waiver About To Expire In Pennsylvania Pennsylvania is one of only seven states that does not have a law on the books that defines what services are “telemedicine” or “telehealth” and requires insurers to reimburse for telehealth services. Since the COVID-19 pandemic made the importance of telehealth services clear, the Wolf Administration implemented a temporary … Read More

Here’s something to talk about when discussing plan design options and employer contribution strategy with group clients in the New Year. The Kaiser Family Foundation recently released its annual benchmarking report, the oldest survey of its kind and considered the industry gold standard. According to this year’s report, which results from 1,686 interviews with non-federal public and private companies of all sizes, the average annual premiums for employer-sponsored family health coverage reached $22,221 this year. This number is up 4% from last year, with workers on average paying $5,969 toward the cost of their coverage. The average deductible among covered workers in a plan with a general annual deductible is $1,669 for single coverage. Fifty-eight percent of small firms and 99% of large firms offer health benefits to at least some of their workers, with an overall offer rate of 59%. Source: Spiegel, Jake and Fronstin, Paul. Source: 2021 Employer Health Benefits Survey, Kaiser Family Foundation, November 10, 2021. https://www.kff.org/health-costs/report/2021-employer-health-benefits-survey/ 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 Halts Enforcement of its COVID-19 Testing or Vaccination Policy Mandate for … Read More

Here’s something to talk about when discussing plan design options and employer contribution strategy with group clients in the New Year. The Employee Benefit Research Institute (EBRI) annually analyzes its unique database of information about more than 11.4 million HSAs, to shed light on the ways HSA account holders contribute to, withdraw from, and invest in their HSAs. Their 2021 analysis shows that employer contributions can play a role in fostering accountholder’s engagement with their HSAs. Accounts that received an employer contribution showed several signs of optimal usage, including higher total contributions and a greater likelihood of investments other than cash. However, EBRI’s analysis also reveals that these account holders were more likely to take a distribution. These distributions were more significant than those by account holders who did not receive an employer contribution too. Source: Spiegel, Jake and Fronstin, Paul. Health Savings Account Balances, Contributions, Distributions, and Other Vital Statistics: Evidence From the EBRI HSA Database., Benefits Research Institute, October 14, 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! New Federal Guidance Addresses How COVID-19 Vaccines May Affect Employers … Read More

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 … Read More

Here’s something to talk about when discussing plan design options and employer contribution strategy with group clients in the New Year. Hospital admissions remained below expected levels in early 2021. This suggests much of the care people put off during the early months of the COVID-19 pandemic may never happen. Though admissions for COVID-19 in March 2021 were down from their peak in January 2021 as vaccines became available, the virus continued to drive a significant share of admissions to hospitals. Health spending more broadly remains below pre-pandemic levels. Source: Source: Kaiser Family Foundation and Epic Health Research, August 2021, https://www.healthsystemtracker.org/brief/early-2021-data-show-no-rebound-in-health-care-utilization/ 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! PA Health Insurance Markets Will Be More Competitive in 2022 The Pennsylvania Insurance Department (PID) is currently approving rates and policy options for 2022. In the year ahead, eight insurers will offer health plans in the Commonwealth–the highest number since the Affordable Care Act. Plus, in all 67 of Pennsylvania’s counties, Pennsylvanians will have multiple choices for individual and small group coverage. Specifically, 22 counties will gain one insurer, and three counties … Read More

Here’s something to talk about when discussing plan design options and employer contribution strategy with group clients in the New Year. New federal surprise billing protections will shield consumers from many payment nightmares starting on January 1, 2022, but the new law does not protect against surprise bills related to ground ambulance transportation. Making clients aware of this limitation is critical. A national analysis of 2018 large employer claims data found that “51% of emergency ground ambulance rides and 39% of non-emergency ground ambulance rides included an out-of-network charge for ambulance-related services, putting the patient at risk of a surprise medical bill.” Source: Amin, K., Pollitz, K., Claxton, G., Rae, M., and Cox, C. “Ground Ambulance Rides and Potential for Surprise Billing.” Kaiser Family Foundation, June 24, 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 Issues Initial Surprise Billing Regulations In December of 2020, Congress included federal protections against surprise balance medical bills in COVID-19 relief legislation known as the Consolidated Appropriations Act of 2021.  The provisions impact almost all individual and group health plans and will go … Read More

Here’s something to talk about when discussing plan design options and employer contribution strategy with group clients in the New Year. Proposals to lower the age of Medicare, either to 60 or younger, may be considered by Congress over the next few years. A recent analysis shows that lowering the age of Medicare eligibility to 60 could reduce costs for employer health plans by as much as 15 percent, provided all eligible employees shifted from employer plans to Medicare. Another study demonstrates that 60- to 64-year-olds who move from employer plans to Medicare could be covered more cheaply because Medicare payments to hospitals, physicians, and other healthcare providers are generally lower than employer plan reimbursement rates. But, of course, these analyses don’t take into consideration the Medicare secondary payer nondiscrimination requirements! Source: Source: Kaiser Family Foundation, Coverage Implications of Policies to Lower the Age of Medicare Eligibility, May 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! PAHU Testifies Before House Insurance Committee In Support of Claims Data Bill On June 9, 2021, Pennsylvania Association of Health Underwriter’s member and Central … Read More

Here’s something to talk about when discussing plan design options and employer contribution strategy with group clients in the New Year. Flexible spending arrangements (FSAs) are an employee benefit more likely to benefit older members of the workforce. According to recent research from the Employee Benefits Research Institute, older workers are more likely to incur health care expenditures than younger workers. Perhaps resulting from that, when it came to FSAs, older accountholders tended to contribute more, take distributions more frequently, and were less likely to have money left over at the end of the year. This mirrors the evidence found in EBRI’s earlier analyses of HSAs. So brokers and employers should keep in mind that as accountholders age, they are more likely to take fuller advantage of these tax-advantaged spending vehicles. Source: FSA Utilization Differs by Age, Employee Benefits Research Institute, April 29, 2021 Source: FSA Utilization Differs by Age 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! New Federal Regulatory Guidance Affects COBRA Subsidy Recipients and People Buying Exchange-Based Coverage The American Rescue Plan Act (ARPA) provides health insurance purchasing … Read More

Here’s something to talk about when discussing plan design options and employer contribution strategy with group clients in the New Year. Even though 64% of Americans say they are “completely” or “mostly” satisfied with their personal experience of the healthcare system, the cost of care is a significant concern. In the past year, one in four Americans skipped a medical treatment because of cost. During the same period, Americans collectively borrowed an estimated $88 billion to cover healthcare costs. Source: The U.S. Healthcare Cost Crisis, a study by West Health and Gallup 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! Federal Lawmakers Issue New Guidance on CAA and ARPA Requirements Over the past month, federal regulators have released several critical pieces of guidance for employers and health care advisors to implement new requirements related to the Consolidated Appropriations Act of 2021 and the American Rescue Place Act. Some of the most critical include: The Department of Labor issued the first round of guidance for employers and others to use when administering the COBRA subsidies created by the American Rescue Plan Act. … Read More

Here’s something to talk about when discussing plan design options and employer contribution strategy with group clients in the New Year. In a recent study, the Employee Benefits Research Institute examined the differential effect of copayments and coinsurance on health care services. They found that coinsurance reduces inpatient care and specialist physician office visits, but copayments do not. Specifically: For inpatient health care, each 1 percent increase in coinsurance led to a 0.18 percent decrease in utilization. For specialty physician office visits, each 1 percent increase in coinsurance led to a 0.19 percent decrease in utilization. Those who were more likely to want a telehealth visit but did not receive one were more likely to have an unmet need for care because of the pandemic. There was no evidence that demand for inpatient and specialty visits correlates with copayments. Source: EBRI Fast Facts: Evidence That Health Care Coinsurance Reduces Use of Certain Care More Than Copayments Do 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! The Latest COVID-19 Stimulus Law Includes Many Health Insurance Provisions Last week, President Biden signed the … Read More

Here’s something to talk about when discussing plan design options and employer contribution strategy with group clients in the New Year. Telehealth now constitutes 6 percent of outpatient visits, compared with less than 1 percent before the pandemic, according to recent research by the Urban Institute, One-third of adults had a telehealth visit in the first six months of the coronavirus outbreak. Adults who were more likely to use telehealth than their respective counterparts include those in fair or poor health, adults with multiple chronic conditions, and Black and Hispanic/Latino adults. Those who were more likely to want a telehealth visit but did not receive one were more likely to have an unmet need for care because of the pandemic. Fewer than 10 percent of adults did not see a provider because they did not want a telehealth visit or the provider did not offer telehealth visits. Source: https://www.urban.org/research/publication/one-three-adults-used-telehealth-during-first-six-months-pandemic-unmet-needs-care-persisted The Urban Institute, January 12, 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! Pennsylvania Announces New Exchange Special Enrollment Period Pennsylvania state officials recently announced that the new state-based health insurance … Read More

Here’s something to talk about when discussing plan design options and employer contribution strategy with group clients in the New Year. Premium contributions and deductibles in employer plans took up a growing share of workers’ incomes over the past decade. Those costs together accounted for 11.5 percent of median household income in 2019, up from 9.1 percent a decade earlier. On average, the employee share of premium amounted to 6.8 percent of the median income in 2019. The number is up from 5.8 percent in 2010 but has remained relatively constant since 2015. The average deductible for a middle-income household amounted to 4.7 percent of income in 2019, up from 3.3 percent in 2010. If premiums and deductibles do not fall this year, household income lost during the current economic crisis will increase middle-income families’ cost burdens. Source: State Trends in Employer Premiums and Deductibles, 2010–2019 The Commonwealth Fund, November 20, 2020 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! Consolidated Appropriations Act of 2021 Includes Broker-Specific Reporting Requirements On December 27, 2020, President Trump signed the Consolidated Appropriations Act of … Read More

High health plan deductibles are an increasingly common strategy to enhance health care consumerism and lower health care spending. Proponents speculate cost-sharing is a tool for teaching plan members to “choose wisely” when it comes to the services they use. But does this work? Perhaps not as well as many have hoped. A study recently released by the Employee Benefits Research Institution concludes that people are 83 percent more likely to stop “choosing wisely” and gravitate towards low-value health care once they satisfy their plan’s deductible! Source: https://www.ebri.org/health/content/do-people-choose-wisely-after-satisfying-health-plan-deductibles-evidence-from-the-use-of-low-value-health-care-services 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! Election Season is ALMOST Over! This year, Election Day decided to stretch into Election Season. Pennsylvania and many other states still haven’t officially certified results (which is more typical than many would lead you to believe). Despite that, it seems 99.99% certain that former Vice President Joseph R. Biden is the President-Elect of the United States, and that Senator Kamala Harris is the Vice President-Elect. Democrats remain in control of the federal House of Representatives, but the GOP picked up at least five seats. Control … Read More

Employer group health plan sponsors are committed to their health benefits, even as the coronavirus pandemic means they’ll likely face higher costs in 2021. According to a poll by the National Alliance of Healthcare Purchaser Coalitions, 71% of employers will keep or accelerate their health benefit strategies for 2021, while 63% plan to do so for 2022. Source: https://www.nationalalliancehealth.org/www/news/news-press-releases/employers-remain-committed 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! Recent Trump Administration Actions with Health Plan Impact Several recent and significant federal executive actions could impact GPAHU members and their clients. These include a delay in the 2020 health coverage information reporting deadline, an extension of the public health national emergency period, a new regulation related to the Families First Coronavirus Response Act’s (FFCRA) paid leave provisions, and a presidential executive order about health care. Internal Revenue Service (IRS) Notice 2020-76 gives applicable large employers (ALEs) and health insurance issuers (including self-funded-health plans) an extra month to distribute Forms 1095 B & C. These statements now must go out to eligible employees and covered individuals by March 2, 2021.  The notice gives all … Read More

The total cost of health benefits will rise by 5.3% in 2021, taking cost management initiatives into account. The increase is slightly higher than the 5% increase that employers projected in each of the last five years. Including premiums and out-of-pocket costs for employees and dependents, the total cost of health care will be $14,769 per employee this year, an increase of $197 from last year. The total price will rise to an average of just over $15,500 in 2021. In line with recent years, employers will cover nearly 70% of costs while employees will bear about 30%, or almost $4,700. Source: Business Group on Health 2021 Large Employers’ Health Care Strategy and Plan Design Survey 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 Insurance Department Releases 2021 Rates Pennsylvania Insurance Commissioner Jessica Altman released the 2021 rate filings for ACA compliant fully-insured policies in August.  According to the Insurance Department, average rates across the Commonwealth will decrease in the individual market by 2.6 percent, and small group premiums will rise on average by 2.1 percent.   According to Commissioner Altman, … Read More

A new study based on data from 6 million Americans continuously enrolled in health coverage offered through the same employer between 2013-2018 provides some interesting information about coverage and cost-sharing trends. Some of these include: High-Deductible Health Plan/Health Savings Account enrollment more than doubled between 2013-2018, whereas the number of people covered through a health reimbursement arrangement has remained level since 2014. Deductibles for employee-only coverage rose 54 percent between 2013-2018. Family coverage deductibles rose by 45 percent during the same period. Each year, copayments have gone up by the following percentage rates by service—5 percent for emergency room visits, 3 percent for specialist visits, 2 percent for primary care visits, and 1 percent for inpatient admissions. Source: Employee Benefit Research Institute, “Trends in Cost-Sharing for Medical Services, 2013-2018″ Pennsylvania Gets Federal Approval for its State Individual Market Reinsurance Program Waiver The federal Department of Health & Human Services (HHS) approved Pennsylvania’s application for an Affordable Care Act (ACA) Section 1332 waiver. Pennsylvania will use the waiver to create a reinsurance program to lower individual health insurance market costs. The waiver, which will start on the first day of 2021 and run through 2025, will allow for partial reimbursement of … Read More

Living through a pandemic certainly puts the spotlight on public health resources. However, more than three-quarters of Americans live in states that spend less than $100 per person annually on public health. According to the State Health Expenditure Dataset project, spending ranges from $32 in Louisiana to $263 in Delaware. Source: Kaiser Health News and the Associated Press, https://khn.org/news/us-public-health-system-underfunded-under-threat-faces-more-cuts-amid-covid-pandemic Significant Changes to the Federal Paycheck Protection Program This month, President Trump signed legislation extending the Paycheck Protection Program (PPP) loan application deadline through August 8, 2020. The new law gives eligible business owners five more weeks to apply for the estimated $130 billion left in low-interest and largely forgivable federal loan funds. PPP loans are intended to help employers make payroll, including health insurance costs, and pay other qualified expenses. This legislation merely extends the application PPP deadline and makes no structural changes to the program.  However, the Small Business Administration, which oversees the PPP, has made some structural program changes, mainly to implement the Paycheck Protection Program Flexibility Act of 2020 (PPPFA). The PPPFA was signed into law in June of 2020.  It gives new PPP borrowers and existing loan recipients more options and eases the path towards complete … Read More

The estimated costs of COVID-19 treatment for private insurers range from $30.0 to $546.6 billion over two years. Enrollees or beneficiaries in private insurers out of pocket expenses could be between $2.8 billion and $48.6 billion of the costs. This data does not include the effects of insurers voluntarily waiving treatment cost-sharing or current mandate requirements in individual states. Source: COVID-19 Cost Scenario Modeling: Treatment – Estimating the Cost of COVID-19 Treatment for U.S. Private Insurer Providers, by Wakely Consulting Group, LLC for America’s Health Insurance Plans, June 8, 2020 Federal Policymakers Act on Multiple Forms of COVID-19 Related Policy Relief Over the past month, federal lawmakers continued to help individuals and employers with the economic disruption caused by the coronavirus pandemic. Many of these actions have, or could have, an impact on private health insurance coverage. One of the most significant measures is a new law that creates more flexibility for Paycheck Protection Program (PPP) loan borrowers when it comes to payroll expenses, including health benefit costs. The Internal Revenue Service (IRS) issued two new notices that increase Section 125 cafeteria plan options in 2020.  Members of the House of Representatives also passed the Health and Economic Recovery Omnibus … Read More

Seventy-seven percent of the workforce wants to continue working from home at least weekly even after stay-at-home orders are lifted, according to the Global Workplace Analytics Survey. That’s a 132 percent increase over those who wanted to work from home before coronavirus. Source: Global Workplace Analytics Survey Data, Spring 2020 Trump Administration Makes Significant Changes to COBRA and Other Group Plan Deadlines The Department of Labor issued Disaster Relief Notice 2020-01, and also issued an emergency rule jointly with the Internal Revenue Service that makes significant deadline changes that apply to almost all employer-sponsored health insurance plans. The changes are retroactive back to March 1, 2020, and last until up to 60 days following the end of the COVID-19 national emergency, as determined by the Trump Administration (called the “Outbreak Period”). These deadline changes impact COBRA, special enrollment periods, claims deadlines, and other critical aspects of group health plan administration, so it is important that they are understood by health insurance agents and brokers. COBRA Changes: Effective March 1, group health plans subject to federal COBRA requirements cannot consider a person’s COBRA election period deadline if it occurs during the Outbreak Period. Regardless of when a person’s election period starts … Read More

Due to mandated COVID-19 closures, many previously thriving businesses in our area have been forced to close their doors temporarily or are experiencing a significant decline in revenues due to “social distancing.” As they look to cut costs just to stay afloat, many employers are seriously reevaluating their health coverage benefits. When helping your clients make tough choices and communicate with employees, it may be helpful to have data in hand about how employee benefits play a major role in employee retention. According to this survey data from America’s Health Insurance Plans, employees typically significantly underestimate the amount their employer pays for their benefits, but favorability towards their employer significantly increases when they have accurate knowledge. The survey, which was conducted far before the current crisis, showed that 77% of employees felt much better about their employer when they learned the company was paying between 70-80% of their health coverage costs. Federal Policy Activity to Provide COVID-19 Relief What a difference a month makes! Over the course of March, the United States has been overwhelmed by the COVID-19 pandemic. So far, three major pieces of legislation have been enacted to provide economic and health coverage protections for individuals and American … Read More

The Affordable Care Act may have lowered the number of uninsured Americans. Still, the number of people in this country who have private health insurance coverage and are considered underinsured is rising. According to research from the Commonwealth Foundation, in 2018, 45% of Americans with private health coverage (including employer-sponsored coverage) qualified as underinsured.  This number is way up from 16% in 2005.  People are underinsured if: – Their deductible is 5 percent or more of their household income; or – Their annual out-of-pocket costs (excluding premiums) exceed 10 percent of income; or – If their household income is under 200 percent of the federal poverty level, and their annual out-of-pocket costs (excluding premiums) exceed 5 percent of income. For reference, 45% of the U.S. population in 2018 was roughly 147 million people. That’s equal to all of the people who live in our seven most populous states—California, Texas, New York, Florida, Illinois, Pennsylvania, and Ohio. It’s also equal to all of the people who live in the 40 least populous states! Source: https://www.commonwealthfund.org/publications/issue-briefs/2019/feb/health-insurance-coverage-eight-years-after-aca Pennsylvania State Exchange Board Is Considering Producer Commission Schedules and Other Issues The board of directors of the new Pennsylvania state-based health insurance exchange is considering … Read More

Even though there is a wealth of evidence to support the importance of primary care in an effective healthcare delivery system, people’s views on primary care providers vary significantly by generation. The Employee Benefits Research Institute’s 2019 Consumer Engagement in Health Care Survey of 2,068 privately insured adults shows that Boomers are far more likely to have a primary care physician (82%) than Millennials (65%), with Gen X falling in the middle at 74%.  Boomers also have a far higher degree of trust and attachment to their primary care provider, whereas Gen Xers preferred an office with all physicians in one place. Millennials were slightly more likely to rely on themselves regarding health care. End-of-Session Legislative Activity in New Jersey Includes Significant Health Policy Action In our neighboring state of New Jersey, the end of the 2019 state legislative session led to some significant policy action. Lawmakers passed a bill to cap prescription drug cost-sharing for fully-insured coverage offered in the state.  However, Governor Murphy elected not to sign legislation passed by the New Jersey General Assembly on January 13, 2020, to limit stop-loss insurance coverage for small business owners with self-funded or level-funded health plans. Beginning with January 1, … Read More

Our lawmakers, both in Washington, DC, and in Harrisburg, continue to work on legislation to end surprise balanced billing. A new study, published in the journal Health Affairs highlights why they need to agree on these measures sooner rather than later.  The author reviewed roughly 4 million insurance claims and found that at in-network hospitals, 11.8 percent of anesthesiology care, 12.3 percent of care involving a pathologist, 5.6 percent of claims for radiologists, and 11.3 percent of cases involving an assistant surgeon were billed out-of-network. If these specialists (who patients do not choose) were not able to charge out-of-network rates, it would lower physician payments for privately insured patients by 13.4 percent and reduce health care spending for people with employer-sponsored insurance by 3.4 percent (approximately $40 billion annually). New Jersey Lawmakers Move to Limit Self-Funding in the Small Group Market Just across the river in New Jersey, the state legislature is moving quickly on a bill to significantly limit small employer access to stop-loss insurance related to self-funded or level-funded employee benefit plans.  The New Jersey State Senate amended and advanced S.3270 on December 16, 2019. The legislation should be finalized in early 2020 and signed by Governor Murphy. The bill would limit … Read More

Many people are working a second unpaid job providing care to a loved one, and it’s having a significant impact on their health, so employers need to take notice.  According to a recent study by the National Business Group on Health, one out of every four traditional employees is also a caregiver.  Of these people, 88% believe their health is affected by the strain of caregiving responsibilities. Data bears that out.  Caregivers are twice as likely to suffer from mental health conditions and chronic physical conditions personally. Being a caregiver puts a strain on people’s finances and impacts their workplace productivity too.  Brokers can show value by encouraging clients to be forward-thinking about the needs of caregivers, including support through innovative employee benefits strategies. The Pennsylvania Health Insurance Exchange Authority Selects A Technology Vendor The Pennsylvania Health Insurance Exchange Authority Board recently approved a seven-year contract with GetInsured. GetInsured will power the new state-based exchange’s technological, enrollment, and customer service platform. GetInsured provides a technology platform for the state exchanges in California, Idaho, Minnesota, Nevada, and Washington.  Beginning with the 2021 plan year, they will serve the Pennsylvania state exchange too.  The cost of this contract is significantly less than … Read More

A small minority of health care consumers consistently spend most health care dollars. The Employee Benefits Research Institute (EBRI) reports that, generally, 20 percent of those insured by employer-based health benefits in the United States account for 80 percent of total spending on health care services. Ten percent of the population accounts for 70 percent of expenditures, five percent are responsible for 56 percent of the expenses, and one percent accounts for 28 percent of spending. When considering the persistence of these high-cost claims, a recent EBRI study found 27 percent of these claimants were in the top ten percent of spending for at least one year, while 73 percent were never in the top ten percent. Among the 27 percent who were ever in the top ten percent, 21 percent were in the top ten percent only one or two years, four percent were in the top ten percent for three or four years, and only two percent were in the top ten percent each of the five years. Despite a small percentage of employees controlling most of the spending on health care services, employers offer health plans that mainly look and feel the same to plan enrollees regardless … Read More

Medicare’s annual election period begins on October 15th, so it’s a good time to increase your knowledge about this thriving market segment. Over one-third of all Medicare beneficiaries (34% or 22 million people) are enrolled in private Medicare Advantage plans and enrollment in this market space has nearly doubled over the past ten years.  Cost is a huge reason why—more than half of these beneficiaries (56%) pay no additional premium for their coverage, other than the Medicare Part B premium, even though they have access to enhanced benefits.  Among Medicare Advantage enrollees who pay a premium for their plan, the average premium was $65 per month in 2019, and premiums in this sector declined by $5 per month between 2018 and 2019 Source: The Kaiser Family Foundation, https://www.kff.org/medicare/issue-brief/a-dozen-facts-about-medicare-advantage-in-2019/ Pennsylvania Legislator Wants to Help Mid-Sized Groups Access Claims Data Representative David Zimmerman (R-99), who represents Lancaster County and serves on the House Insurance Committee and the Health Committee, has announced a plan to introduce legislation to give employer group health plan sponsors with 50-99 employees greater access to aggregate claims data for their plan. Currently, it is very difficult, if not impossible, for fully-insured groups of this size to access deidentified claims data or other details … Read More

People like to cite high insurance premiums and expensive prescription drug costs when talking about the rising cost of medical care in this country when really, hospitals are much more of a problem.  According to a new Rand study, hospital spending represents 44 percent of privately insured people’s health expenses.  Another recent study published in the journal Health Affairs shows that between “2007–14 hospital prices grew substantially faster than physician prices. For inpatient care, hospital prices grew 42 percent, while physician prices grew 18 percent. Similarly, for hospital-based outpatient care, hospital prices grew 25 percent, while physician prices grew 6 percent. Pennsylvania Health Insurance Exchange Leadership Announced Earlier this month, the Wolf Administration announced the incoming leadership of the new Pennsylvania Health Insurance Exchange Authority. The Exchange Authority is the entity that will create, manage, and maintain Pennsylvania’s new state-based health insurance marketplace. The Authority’s Executive Director will be Zachary Sherman, who currently serves as the director of HealthSource Rhode Island.  The Administration revealed the members of the Authority’s Board of Directors as well.  Appointments to the Exchange Authority’s Advisory Council, which will include a representative appointed by the Pennsylvania Association of Health Underwriters will be forthcoming The next step is for the Senate … Read More

Have you been sticking your head in the sand when it comes to the impact artificial intelligence has on healthcare and the insurance industry? Better pull your head out. According to an Accenture Consulting study titled “Healthcare: Walking the AI Talk”, healthcare ranks as the top industry using artificial intelligence, and the insurance industry ranks 5th. Potential cost savings and health outcome improvements are why 72 percent of health insurance executives rank artificial intelligence as a top strategic objective for the coming year. House Repeals Cadillac Tax On July 17, the U.S. House of Representatives passed legislation to eliminate the excise tax on high-cost group health plans created by the ACA (aka the “Cadillac tax”). Full repeal of the 40 percent excise tax has been a top federal policy priority for GPAHU and our parent organization, the National Association of Health Underwriters. GPAHU members met with our members of Congress about the excise tax during NAHU’s Capitol Conference in February, and we are pleased to report the entire Pennsylvania delegation voted for the repeal. The next step is for the Senate to take up the legislation. Senators Mike Rounds (R-SD) and Martin Heinrich (D-NM) have sponsored a companion bill with … Read More

The Trump Administration released a new regulation and a FAQ document on June 13, 2019, that provides a legal window for employers to pay for their employees’ individual health insurance premiums beginning on January 1, 2020. There has been a lot written about the new rule since its release last month, but GPAHU wants to make sure our members know the essential details that could impact you and your clients Under the new rules, any size employer will be able to create an “individual coverage HRA” to directly reimburse all employees or specific classes of employees for qualified individual coverage and Medicare premiums using pre-tax dollars, provided that specific conditions are met An employer that chooses to provide the individual HRA option may not also offer those employees traditional group health insurance.  The business will have to make a binary choice to either offer the individual coverage HRA or conventional group benefits. A company can limit the individual coverage HRA to certain classes of employees and provide traditional coverage to other classes, but the regulation contains strict rules and size limitations about what constitutes an acceptable class, to prevent discrimination. Any employer that elects an individual coverage HRA must provide … Read More