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This past year was eventful for group health plan compliance as COVID-related requirements continued in earnest throughout the year and the U.S. Supreme Court Dobbs decision put a spotlight on the coverage of reproductive health services, particularly in certain states. Additionally, the No Surprises Act and other group health plan transparency-related laws and regulations kept plan sponsors and their carriers/third-party administrators busy with various compliance requirements.
These transparency-related requirements are shaping up to be the most significant group health plan-related legislation since the Affordable Care Act (ACA) was signed into law in 2010.
Click here for a look back at the most noteworthy compliance developments for group health plans from 2022.
As we head into the final stretch of the year, employers sponsoring group health plans are advised to take note of and prepare for the following updates and deadlines for early 2023:
The Transparency in Coverage (TiC) Final Rules, finalized in November 2020, required non-grandfathered group health plans to provide a searchable, internet-based self-service tool that reflects accurate cost-sharing and rate information for plan participants. The first phase requires information for 500 specified items and services to be accessible to plan participants by January 1, 2023.
Since plan carriers and third-party administrators (TPA) are in the best position to create and maintain this TiC self-service tool for the first upcoming deadline of January 1, 2023. Click here for more information.
The CARES Act of 2020 created a temporary safe harbor that permitted Health Savings Account (HSA)-compatible high deductible health plans (HDHP) to cover telehealth and remote care services on a first-dollar basis, or prior to members satisfying their HDHP deductible.
On March 15, 2022, President Biden granted an extension of the temporary safe harbor HSA relief for telehealth services previously provided under the CARES Act of 2020. This temporary relief under the Consolidated Appropriations Act of 2022 is in effect from April 1, 2022, through December 31, 2022. Group health plan sponsors are advised to take note of the upcoming telehealth relief expiration date (December 31, 2022) for their HSA-compatible HDHPs.
UPDATE: On December 23, 2022, new legislation was passed that extends the telehealth relief until December 31, 2024. Please click here to learn more.
On August 16, 2022, President Biden signed the “Inflation Reduction Act” (IRA) into law. While the bulk of the IRA is packed with climate and tax-related legislation, the law includes several healthcare-related provisions that could impact prescription drug costs for employer-sponsored group health plans and Medicare Advantage plans in the long run.
A more immediate effect for group health plans is the IRA’s codification of a safe harbor to cover insulin products before individuals covered under a qualified HDHP meet the plan’s deductible. This safe harbor permits HDHPs to provide first-dollar coverage for insulin without jeopardizing an individual’s eligibility to contribute to a Heath Savings Account (HSA) and applies to plan years beginning on or after January 1, 2023.
Many HDHPs are already covering insulin on a pre-deductible basis since current IRS guidance permits insulin and other glucose-lowering agents to be treated as preventive care for individuals diagnosed with diabetes. If your HSA-compatible HDHP does not, take note of this new safe harbor in 2023.
The ACA affordability percentage threshold for plan years beginning January 1, 2023, is set at 9.12%. This change is a significant decrease from the 2022 standard of 9.61% and the lowest this percentage has ever been set since the rules were implemented. As a result, many employers may be required to lower their 2023 employee contribution rates to accommodate this adjusted percentage.
Stay informed on benefit plan limits with updated maximum amounts for 2023 when coordinating with benefit administration and payroll vendors. Most, but not all, plan maximum limits have changed from 2022 limits.
In accordance with the ACA, non-grandfathered group health plans must cover in-network preventive items and services without participant cost-sharing, such as copayments, coinsurance, or deductibles. The list of required preventive items and services is updated on a periodic basis and includes the following updates for 2023 plan years:
Group health plan sponsors are advised to update their summary plan descriptions (SPDs) and summaries of benefits and coverage (SBCs) to ensure that coverage of these preventive service updates is provided with no participant cost-sharing.
Planning now and taking action, when necessary, can help set your organization on the right compliance path going into 2023.
Risk Strategies is here to help your organization. Need assistance? Contact us at firstname.lastname@example.org.