- Ongoing ACA concerns. Large employers must still contend with the Affordable Care Act (ACA)’s employer shared-responsibility mandate – that is, the requirement to offer full-time employees minimum essential coverage that meets minimum value and affordability standards or face potential penalties – and associated reporting. Make sure your 2020 group health plans comply with ACA benefit mandates, including bans on lifetime and annual dollar limits for essential health benefits (EHBs), first-dollar coverage of specified preventive services, and annual in-network out-of-pocket maximums for EHBs.
- Preventive services. Confirm that your nongrandfathered health plans cover new or updated recommended preventive services – skin cancer behavioral counseling, exercise interventions to prevent falls in certain older adults, screenings for osteoporosis, cervical cancer, obesity and unhealthy alcohol use, perinatal depression counseling and Preexposure prophylaxis (PrEP) medication to prevent HIV infection.
- Health savings accounts and health reimbursement arrangements. Adjust your plan design, communications and administration for 2020 HSA/HDHP indexed amounts. Review health-related benefits that might provide first-dollar or predeductible HSA-disqualifying coverage (e.g., telehealth, onsite medical clinics, wellness programs, expert medical-opinion services, coupons for prescription drugs or manufacturer discounts, or specialized care or disease management) and decide if changes are merited. And consider whether to offer any of the two new types of HRAs.
- Wellness programs. If your wellness program includes a health screening, evaluate the need for design changes due to the removal of the Equal Employment Opportunity Commission (EEOC)’s incentive limit rules. If tied to a group health plan, wellness programs with incentives must also comply with HIPAA rules, including reasonable alternative standards for health-contingent wellness programs.
- Data privacy and security. New technologies allow quick access to health and welfare plan data often protected by HIPAA or other data protection and privacy laws. Review relationships with new technology vendors, including new tools offered by existing third-party administrators and carriers, to evaluate whether the data is covered by HIPAA or other privacy laws and how the data is used, disclosed and secured.
- Cross-plan offsetting by ERISA plan service providers. Review plan documents, administrative-service agreements and actual vendor cross-plan offsetting practices that recoup one health plan’s overpayments to out-of-network providers by docking their payments under another plan. Make sure you comply with ERISA fiduciary standards when selecting and monitoring service providers.
- Mental health parity. In light of the uptick in mental health parity enforcement, litigation over behavioral health benefits and the ongoing opioid crisis, review behavioral health benefits — including mental health/substance use disorder benefits — for compliance with ERISA claims review and fiduciary standards, mental health parity guidance, and best practices.
Once you’ve made it through this list of action items, there are a few additional issues you’ll want to monitor for the upcoming year. Items at the top of our watch list are:
- Prescription drug costs and coverage. Stay informed about federal prescription drug reforms that could drive changes in the private marketplace.
- Paid leave. Monitor developments for new and expanded paid leave mandates and programs and then evaluate processes for integrating state and local paid leave mandates with existing plans, and revise plans as needed to comply.
- State activity. Don’t forget about state initiatives that could affect plan design, health plan reporting mandates, pharmacy benefit manager regulations, new or continuing health plan assessments, and telemedicine laws.
Check out our latest comprehensive GRIST for more detailed information and resources related to each compliance priority.
By: Mercer's Law & Policy Group