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Brown & Brown — Conference Presentation (January 2023)
33 slides from Brown & Brown's conference presentation, Jan 19, 2023
Slide 1: This Webinar Will Start Momentarily
This Webinar Will Start Momentarily. Thank you for joining us.
Slide 2: 2022 Year in Review and Looking Ahead to 2023
2022 Year in Review and Looking Ahead to 2023 January 19, 2023 Presented By: Presented by the Regulatory and Scott Wold and Daniel Brady Legislative Strategy Group
Slide 3: Disclaimer
DISCLAIMER Brown & Brown, Inc. and all its affiliates, do not provide legal, regulatory or tax guidance, or advice. If legal advice counsel or representation is needed, the services of a legal professional should be sought. The information in this document is intended to provide a general overview o
Slide 4: Group Health Plan Transparency
Group Health Plan Transparency
Slide 5: Surprise Medical Bill Rules
Surprise Medical Bill Rules • Applicable beginning with plan years beginning in 2022 • Rules generally apply to all group medical plans (also apply to health care providers) • Rules apply to three types of claims: » Out-of-network (OON) emergency services » Services provided by an OON provider durin
Slide 6: Surprise Medical Bill Rules
Surprise Medical Bill Rules • Rate that is ultimately paid to the OON provider • Recent FAQ guidance (FAQs Part 55) answers the facility equals: following questions (among others): » An amount determined by an applicable All- » Do rules apply to plans without networks (e.g., Payer Model Agreement un
Slide 7: Surprise Medical Bill Rules
Surprise Medical Bill Rules NOTICE REQUIREMENTS • Post information about rules on a public website of the plan or issuer » If a plan does not have a public website, requirement can be satisfied by entering into a written agreement with a health insurance carrier or a third-party administrator (TPA)
Slide 8: Transparency Rules
Transparency Rules Prohibition on Gag Clauses Continuity of Care Requirements • A plan may not enter into an agreement regarding a • Plans must ensure continuity of care when contract provider network that would directly or indirectly terminations result in changes in provider or facility restrict t
Slide 9: Transparency Rules
Transparency Rules Provider Directory Requirements • Establish a database on the plan’s public website containing a list of each in-network health care provider/facility with name, address, specialty, telephone and digital contact information (must be kept up-to-date) • At least once every 90 days,
Slide 10: Transparency Rules
Transparency Rules Publicly Available Machine-Readable Files • One file must include the rates negotiated between the plan and in- network providers for all covered items and services; another file must include data showing the historical payments to, and billed charges from, out-of-network provider
Slide 11: Transparency Rules
Transparency Rules Reporting on Prescription Drug and Other Costs (RxDC Reporting) • Applies to group health plans regardless of employer • Current instructions available at: size https://regtap.cms.gov/uploads/library/RxDC-Section- » Exemptions for HIPAA excepted benefits and 204-Reporting-Instruct
Slide 12: Transparency Rules
Transparency Rules Reporting on Prescription Drug and Other Costs (RxDC Reporting) • Who is responsible for filing the reports? • Complete data for each plan » Carriers and group health plans » Transition Relief: “the Departments will not take » Third party can file reports for group health plan enf
Slide 13: Transparency Rules
Transparency Rules Price Comparison Tool (TiC regs) • Self-service tool available on a public website; paper copy must be provided upon request • Real-time responses that are accurate as of the date on which the request is made • Participants must be able to search for information for a covered item
Slide 14: Transparency Rules
Transparency Rules Advanced EOBs • Plans must issue EOBs in advance of scheduled care • Triggered by 1) receipt of notice from provider/facility that care has been scheduled; or 2) participant request • Must be provided not later than either one (1) or three (3) business days (depending on circumsta
Slide 15: Telemedicine & HSA Eligibility
Telemedicine & HSA Eligibility
Slide 16: First Dollar Coverage for Telemedicine
First Dollar Coverage for Telemedicine Background • Availability of telehealth benefits typically makes an employee ineligible to make or receive HSA contributions • Employers with HSA programs that also offer telehealth benefits (either through the HDHP or through a stand- alone telehealth benefit)
Slide 17: First Dollar Coverage for Telemedicine
First Dollar Coverage for Telemedicine CAA of 2022 • Extended CARES Act relief • Applies during the period of April 1 through December 31, 2022 » Note: Potential gap between 12/31/21 and 4/1/22 CAA of 2023 • Enacted on December 23, 2022 • Extends CARES Act and CAA of 2022 relief • Applies during pla
Slide 18: ACA Reporting Deadlines
ACA Reporting Deadlines
Slide 19: ACA Reporting
ACA Reporting Deadlines for Forms 1094/1095-B and 1094/1095-C Final Regulations Issued in December • Must prominently post on the reporting entity’s • Finalize proposed regulations issued in late 2021 on website a “clear and conspicuous” notice with which employers and plan sponsors were relying inf
Slide 20: Family Glitch Regulations
Family Glitch Regulations
Slide 21: Family Glitch
Family Glitch W H E N A N E M P L O Y E E ’ S FA M I LY M E M B E R S M AY Q U A L I F Y F O R P R E M I U M TA X C R E D I T S Historically Final Regulations Issued in October A premium tax credit (PTC) was available to an Employer-sponsored coverage for certain spouses and employee and their famil
Slide 22: New Exception to Irrevocable Elections
New Exception to Irrevocable Elections NOTICE 2022-41 Background • Section 125 of the Internal Revenue Code prohibits mid-year changes to pre-tax elections unless an exception applies • Previously no exception applied when an employee’s spouse and/or dependents enrolled in Exchange coverage BROWN &
Slide 23: New Exception to Irrevocable Elections
New Exception to Irrevocable Elections NOTICE 2022-41 New Rule • Election of family coverage under group health plan (not coverage including one or more already covered including health FSA) may be revoked when: related individuals) » One or more related individuals are eligible for a » May rely on
Slide 24: COVID-Related Rules
COVID-Related Rules
Slide 25: FFCRA and CARES Act
FFCRA and CARES Act B E N E F I T P L A N M A N D AT E S F O R C O V I D - R E L AT E D C A R E Coverage for Diagnostic/Testing Items and Preventive Services (Including Services (including OTC tests) Immunizations) • Applicable to all plans (grandfathered and non- • Plans are required to cover COVID
Slide 26: Notice 2020-15
Notice 2020-15 HDHP COVERAGE AND COVID CARE Transition Relief • Allows HDHPs to provide first dollar coverage for COVID testing and treatment without jeopardizing status as HDHP and without affecting enrollee’s HSA eligibility • Applies until further guidance is issued • Potentially could end when t
Slide 27: Joint IRS and DOL Rule
Joint IRS and DOL Rule R U L E I S S U E D O N 5 / 4 / 2 0 E X T E N D I N G VA R I O U S D E A D L I N E S Deadlines extended include: If National Emergency is not renewed: • HIPAA Special Enrollment • Outbreak Period will end on April 29, 2023 • COBRA elections and premium payment grace • All toll
Slide 28: Section 125 Plan Relief
Section 125 Plan Relief Notice 2021-15 • Provided various types of permissible relief for Section 125 plans and FSAs (both Dependent Care and Health Care FSAs) for plan years beginning in either 2020 or 2021 • Relief included: » Unlimited carryovers » Extended grace periods » Less restrictive mid-ye
Slide 29: On the Horizon?
On the Horizon?
Slide 30: EEOC Regulations Under ADA
EEOC Regulations Under ADA Background New ADA Regulations Are Expected Any • Wellness programs that request medical information Time or involve medical testing are subject to ADA (e.g., • Until they are issued, the amount of programs that involve HRAs or biometric testing) incentives/rewards that ma
Slide 31: Things to Look for in 2023
Things to Look for in 2023 1 2 3 4 Ground Mental Health PBM Regulation Rx Drug Ambulance Parity Regulation Surprise Billing Proposed legislation House-passed bill requires PBMs to report Oct. 2022 Executive expands DOL’s ability to data to plan sponsors; Order with purpose of Federal Advisory many s
Slide 32: HRCI and SHRM Credits
HRCI and SHRM Credits This Program, ID No. 614752, has been approved for 1.00 HR (General) recertification credit hours toward aPHR™, aPHRi™, PHR®, PHRca®, SPHR®, GPHR®, PHRi™ and SPHRi™ recertification through HR Certification Institute® (HRCI®). Brown & Brown is recognized by SHRM to offer Profess
Slide 33: Find your solution at BBrown.com
Find your solution at BBrown.com DISCLAIMER: Brown & Brown, Inc. and all its affiliates, do not provide legal, regulatory or tax guidance, or advice. If legal advice counsel or representation is needed, the services of a legal professional should be sought. The information in this document is intend
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