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BCBS Settlement of Antitrust Litigation

Blue Cross Blue Shield Association has reached a settlement in a class action antitrust lawsuit.

Many companies and/or their employees have or will receive either mailers or emails concerning the settlement. The total settlement is $2.67 billion, which will certainly catch anyone’s attention.

The class action lawsuit charged that the 36 independent and locally operated BCBS companies in the US had violated antitrust laws by entering into an agreement with each other to limit competition amongst themselves in selling health insurance and administrative services for health insurance. The BCBS companies have denied any wrongdoing.

Note that there are 36 BCBS companies nationwide and that the BCBS companies provide health insurance to 1 in 3 Americans across all 50 states, the District of Columbia and Puerto Rico.  BCBS NC is just one of the 36 companies. Of the $2.67 billion, it is expected that $667.5 million will be applied toward legal expenses and $100 million toward Administrative Costs. The expected Net Settlement Fund will be $1.9 billion. Affected persons and companies (plan sponsors) are;

  • Individuals and fully insured groups (and their covered employees) with coverage (at any time) from February 7, 2008 through October 16, 2020 (12.5 years),
  • Self-funded groups and their employees with coverage (at any time) from September 1, 2015 through October 16, 2020 (5 years).

The court must still approve the Settlement but is expected to do so.

Please download from below the Long Form for action items and deadlines between today and November 2021. You may also download the full Settlement Agreement for review. Visit www.BCBSsettlement.com for more information and to file a claim.

Downloads:

Settlement Agreement (1.9mb)

BCBS Long Form (295kb)

Springtime HSA Eligible Expenses

Spring brings more sunshine, longer days and for many people, allergy problems. We’ve posted a list of HSA eligible expenses that you might be able to take advantage of now that Spring is in the air. 

Download the brochure here and let us know if we can help with any questions. 

 

COVID-19 vaccines are being administered nationwide

North Carolina is now permitting Group 3 vaccinations. 

You may want to develop a company policy at your firm.

We have secured a number of documents targeted to answer your questions and communicate your policy to your employees.
Note that the mandatory compliance letters are samples only and we are not advocating for any particular position on the vaccines.

Please review the attached and let us know if you have any questions.

COVID-19 FAQ’s For Employers – pdf (94kb)

Facts About COVID-19 Vaccinations – pdf (500kb)

Facts About COVID-19 Vaccinations (Spanish) – pdf (500kb)

Employer’s Mandatory Vaccine Letter – Word DOCX – (23kb)

Employer’s Mandatory Vaccination Policy – Word DOCX – (41kb)

Employer’s Overview Of COVID-19 Vaccines – Word DOCX – (300kb)

Are you feeling late payment anxiety?

We hope everyone is doing well and staying safe.

During the past 2 or 3 months many of our clients have experienced late payment status and even near-termination of their benefit plans because their premium payments were delayed by the USPS. 

We have been able to work through the issues but it has caused a great anxiety for the clients.

You may want to consider one of the following as we do not expect the performance at USPS to improve any time soon.

  • Mail your premium payments earlier to ensure they arrive on time
  • For online banking, set the delivery date earlier than normal
  • Make a direct payment through the insurer’s portal
  • Set up auto pay with the insurer

Please feel free call, e-mail or use the form below to contact us with any questions.

Can Employers Require Workers to get a Covid Vaccine?

As health and political leaders craft strategies for distributing Covid-19 vaccines nationwide, questions about workforce implications of the rollout are top of mind for many employers.

The first and perhaps most obvious of these questions: Can I require my employees to get vaccinated? According to Diane Hoffmann, a professor at the University of Maryland School of Law, the answer is yes.

A vaccination is legally considered a medical procedure, which employers can require their employees to receive if deemed necessary to perform their jobs safely and successfully, said Hoffmann, who serves as director of the school’s Law and Health Care Program. Given the highly infectious nature of Covid-19, a vaccine mandate may be considered particularly in workplaces where employees must work on site and in close proximity to one another, or in those where they interact extensively with the public.

But just because employers can legally mandate getting a coronavirus vaccination doesn’t mean they all will.

There is some precedent for large-scale vaccine mandates, Hoffmann said. For example, most K-12 schools across the country require children to provide proof of certain immunizations before they can attend, and health-care organizations such as hospitals and nursing homes often require their employees to get several vaccinations, including an annual flu shot.

However, vaccine mandates in other areas of private industry are relatively unprecedented.

Hoffmann said some employers may worry about the legal repercussions of mandating a vaccination, including exposing themselves to a lawsuit if an employee has an adverse reaction to the vaccine. Additionally, employers who do opt to require their employees to be vaccinated will have to allow exceptions for people with a religious belief or medical condition that legally precludes them from receiving vaccines. Employers may have to make special accommodations for those who cannot be vaccinated if they establish a mandate.

However, there is also a risk that employees will sue if they are required to come back to a workplace without a vaccine mandate,and they end up contracting Covid-19, Hoffmann pointed out.

“For a lot of businesses, this will be uncharted territory,” Hoffmann said. “I expect lots of employers will be talking to their lawyers about the legal frameworks here.”

The vaccine formulations being brought to market are reported to be more than 90% effective, and are cleared for use under the U.S Food and Drug Administration’s “emergency use authorization,” a system that expedites the availability of certain health interventions during public health emergencies. Hoffmann said employers may want to wait until the vaccines have received full standard FDA approval before they consider making vaccination a job requirement.

That seems to be the route that Maryland-based health system MedStar Health is taking. MedStar CEO Kenneth Samet said although his was one of the first health systems in the country to mandate flu vaccinations for its workers, it is not requiring Covid vaccinations for now.

At this point, MedStar leaders are strongly encouraging employees to get the vaccine if they can. Samet said he would be “first in line” if he were among the essential workers at the front of the distribution hierarchy, but he understands some people may be nervous about the vaccines and will want to wait until more data is in.

While employers mull their options with counsel, human resources expert Amy E. Polefrone said every employer should at least be developing a game plan for when vaccines are widely available.

“These vaccines have big implications for everyone getting back to work,” said Polefrone, who is CEO of Ellicott City’s HR Strategy Group. “Employers should be preparing, and doing everything they can to encourage employees to get the vaccine.”

Polefrone said for many companies, the Covid vaccines represent a path to getting truly back to business. She said business owners should be laying plans for how a phased return-to-work strategy might go, and maintaining open communication with their employees. She recommended employers share educational materials about vaccines and invite science and health experts to speak to workers about any questions or concerns they may have.

She also advised that business owners make the process of getting vaccinated as burden-free as possible for employees. Health insurers are expected to cover the costs of Covid vaccinations for their individual and group policy holders. But for those businesses that do not offer health benefits, Polefrone said employers may want to consider subsidizing or covering the costs of vaccinations.

Polefrone said it will take many more months before we have mostly vaccinated workforces, but she is excited to see the first steps in that direction happening. In the meantime, she said companies should expect to continue operating with mask and social-distancing requirements, as well as increased cleaning schedules for the foreseeable future.

From the Triangle Business Journal:
https://www.bizjournals.com/triangle/news/2020/12/10/employers-may-require-workers-get-covid-vaccine.html

Morgan Eichensehr
Reporter
Baltimore Business Journal

LabCorp Has At-home Covid-19 Testing Kit – No Prescription Required

LabCorp, a leading global life sciences company, has announced that the U.S. Food and Drug Administration granted Emergency Use Authorization (EUA) for the use of its Covid-19 home test.

The Pixel by LabCorp Covid-19 Test Home Collection Kit will be the first to be available over-the-counter without requiring a prescription. The RT-PCR (reverse transcription polymerase chain reaction) test does not detect antibodies or immunity.

“With the first over-the-counter at-home collection kit ever authorized by the FDA for Covid-19, we are empowering people to learn about their health and make confident decisions,” said Dr. Brian Caveney, chief medical officer and president of LabCorp Diagnostics.

“With this authorization, we can help more people get tested, reduce the spread of the virus and improve the health of our communities.”

The kit is currently available through the Pixel by LabCorp website and this approval will enable LabCorp to potentially distribute the kit through retail channels.

The kit can be billed to insurance or covered by federal funds if uninsured. For those who choose not to have the test covered by an insurance company, the cost is $119.

The kit allows consumers to self-collect their sample in the privacy of their own home, which helps minimize transmission of the virus. Users then send the sample for processing at LabCorp.

Upon purchase, users register their Pixel by LabCorp Covid-19 collection kit at the Pixel by LabCorp website and follow the instructions included.

The at-home test has a five-step process:

Complete a short eligibility survey
Choose a billing option
Receive sample collection kit via FedEx
Collect and send sample back to laboratory for testing
Access results online via Pixel by LabCorp portal

Test results are securely delivered to the consumer via the Pixel by LabCorp portal. A healthcare provider will counsel consumers who test positive to assist with healthcare treatment and further actions.

The Pixel by LabCorp Covid-19 collection kit is not a substitute for visits to a healthcare professional and is for use by adults 18 and older.

Although LabCorp’s Covid-19 PCR test has not been FDA cleared or approved, it has been authorized by FDA under an Emergency Use Authorization (EUA) and has been authorized only for the detection of nucleic acid from SARS-CoV-2, not for any other viruses or pathogens.

The test is only authorized for the duration of the emergency declaration that circumstances exist justifying the authorization of emergency use of in vitro diagnostic tests for detection and/or diagnosis of Covid-19, unless the authorization is terminated or revoked sooner.

Retailers interested in selling Pixel by LabCorp Covid-19 collection kits can contact the company.

From the Triangle Business Journal:
https://www.bizjournals.com/triangle/news/2020/12/10/labcorp-at-home-covid-testing-no-prescription.html

Trajan Warren
Reporter
Triad Business Journal

How much will your visit to the doctor cost? UNC Health app lets you know.

One of the largest health care systems in the state has released an online “cost estimator” tool it says will provide greater price transparency in the murky world of medical billing.

On Wednesday, UNC Health unveiled its new online tool, saying the goal is to “improve transparency for consumers who struggle with rising medical costs, and provide more information to help inform their medical care and decisions.”

“UNC Health is a leader in providing innovative care and services for our patients,” CEO Dr. Wesley Burks said in a statement. “We understand the importance of price transparency in health care. This estimator is about improving our patients’ experience and giving them more control in managing their health.”

According to the system, the estimator is, for now, designed for “services such as office visits, simple procedures and some inpatient services.” Inpatient services include some at UNC Rex Health Care in Raleigh and UNC Medical Center in Chapel Hill.

The company says future plans include expanding the services covered and adding more hospitals and clinics affiliated with UNC Health across the state.

At release, the service can provide estimates for out-of-pocket costs for 50 services, including cardiology, orthopedics, rehabilitation, sleep studies and some office visits.

The tool works through the system’s “My UNC Chart” application and website and automatically takes into account insurance benefits and other factors from a patient’s account to generate a cost estimate.

The service comes amid years of national and international concern about the inadequacies of health care billing in the U.S. with many complaining that its system leaves patients with no way to understand how much they’ll be billed until after the fact.

Price transparency also became a central topic after North Carolina Treasurer Dale Folwell launched a redesign of the state’s employee insurance plan following complaints about a lack of transparency with the major health systems in the state.

From the Triangle Business Journal:
https://www.bizjournals.com/triangle/news/2020/12/10/unchealth-cost-estimator-health-care-bill.html

Seth Thomas Gulledge
Staff Writer
Triangle Business Journal

The Mental Health Parity and Addiction Equity Act of 2008

MEDICAL PLANS

The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) is a federal law that generally prevents group health plans and health insurance issuers that provide mental health and substance use disorder (MH/SUD) benefits from imposing less favorable benefit limitations on those benefits than on medical and surgical coverage.

On Nov. 13, 2013, the Departments of Labor, Health and Human Services and the Treasury jointly issued a final rule implementing the MHPAEA. The final rule increases parity between MH/SUD benefits and medical and surgical benefits in group and individual health plans. The final rule applies for plan years beginning on or after July 1, 2014 (Jan. 1, 2015 for calendar year plans).

BACKGROUND

The MHPAEA was enacted on Oct. 3, 2008, to strengthen federal mental health parity requirements for health coverage. The MHPAEA supplemented the Mental Health Parity Act of 1996 (MHPA), which required parity with respect to aggregate lifetime and annual dollar limits for mental health benefits. The MHPAEA also extended the parity requirements to substance use disorder benefits. The MHPAEA became effective for plan years beginning after Oct. 3, 2009.

Under the MHPAEA, the financial requirements and treatment limits that group health plans and health insurance issuers apply to MH/SUD benefits generally cannot be more restrictive than those applicable to medical and surgical benefits.

AFFECTED HEALTH PLANS

The MHPAEA generally applies to plans sponsored by employers with more than 50 employees, including self-insured plans and fully-insured arrangements.

The MHPAEA does not require large group health plans and their health insurance issuers to cover MH/SUD benefits.The MHPAEA’s requirements apply only to large group health plans and their health insurance issuers that choose to include MH/SUD benefits in their benefit packages. However, other state and federal laws may require a plan to provide these benefits.

The Affordable Care Act (ACA), builds on the MHPAEA and requires some plans to cover MH/SUD services as an essential health benefit. Specifically, non-grandfathered health plans in the individual and small group markets are required to provide essential health benefits (which include MH/SUD services), as well as comply with the federal parity law requirements, beginning in 2014.

The MHPAEA contains the following parity requirements:The financial requirements (such as deductibles, copayments, coinsurance and out-of-pocket limits) applicable to MH/SUD benefits cannot be more restrictive than the predominant financial requirements applied to substantially all medical and surgical benefits.

Treatment limitations (such as frequency of treatment, number of visits, days of coverage or other similar limits on the scope or duration of coverage) must also comply with the MHPAEA’s parity requirements.

Nonquantitative treatment limitations (such as medical management standards, formulary design and determinations of usual, customary or reasonable amounts) are subject to a separate parity requirement.

If medical and surgical benefits are offered on an out-of-network basis, a plan or issuer must also offer MH/SUD benefits on an out-of-network basis.

In addition, the MHPAEA requires plans to make certain information available with respect to MH/SUD benefits, such as the criteria for medical necessity determinations and the reason for any denial of reimbursement or payment for MH/SUD services.

ENFORCEMENT

The MHPAEA’s provisions are included under ERISA. The Department of Labor (DOL) and the Internal Revenue Service (IRS) generally have enforcement authority over private sector employment-based plans that are subject to ERISA.

While ERISA does not contain a specific penalty for violations of the MHPAEA, plan participants and beneficiaries and the DOL may use ERISA’s civil enforcement provisions to enforce the MHPAEA. Also, when the DOL audits an ERISA covered health plan, it will often investigate the plan’s compliance with federal mental health parity requirements.

In addition, employers that violate the MHPAEA may be subject to an IRS excise tax. Generally, an excise tax of $100 per individual, per day will apply to MHPAEA violations, unless an exception applies. Any applicable excise taxes must be reported on IRS Form 8928, “Return of Certain Excise Taxes under Chapter 43 of the Internal Revenue Code.”

MORE INFORMATION

More information on the MHPAEA is available on the DOL’s website, including FAQs and a self-compliance tool.

This Legislative Brief is not intended to be exhaustive nor should any discussion or opinions be construed as legal advice. Readers should contact legal counsel for legal advice.
© Zywave, Inc. All rights reserved.

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