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Friday, 24 August 2018 10:30

Healthcare Claims Get Even More Confusing

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At Fall River we are committed to helping our members understand their health benefits and provider bills. We know that navigating the benefits world can be confusing, and unfortunately, we are seeing more and more claims situations that prove it’s getting ever more complicated. 

Here are recent examples of some complex and downright outrageous claims issues we want you and your members to be aware of.

Monday, 13 August 2018 09:25

The Battle to Cut Pharmacy Costs

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This past May, the Trump administration released its plans to reduce pharmaceutical prices on four fronts. The policy was laid out in a blueprint which describes the various fronts the Center for Medicare and Medicaid Services (CMS) and the department of Health and Human Services (HHS) propose to take to alleviate the problem. The four areas the administration proposes to target for action are increasing competition, better negotiation, creating lower list prices, and reducing patient Out-of-Pocket spending. Since all employer plans are impacted by the rising costs of prescriptions, we are encouraged to see active steps proposed to address the problem.

On July 25, 2018, the House of Representatives passed two health care bills, H.R. 6199 and H.R. 6311, that would make significant changes to Health Savings Accounts (HSAs), Flexible Spending Accounts (FSAs) and Health Reimbursement Arrangements (HRAs). Republicans are pushing to expand HSA usage with a number of Democrats leaning toward supporting these bills as well. Both bills would still need at least 60 votes from the Senate to go into place, which may not be possible before the end of this Congressional session in December.

Employers with 15 or more employees whose wellness program include biometric testing or health risk assessments (HRAs) may need to reconsider their wellness incentives, as changes to the rules governing either of these wellness plan features go into effect January 1, 2019. 

Monday, 16 July 2018 12:54

Association Health Plans? Yes, No, Maybe

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The expansion of Association Health Plans (AHPs) has arrived. The U.S. Department of Labor announced regulations that will allow these plans to become effective as early as September 2018. AHPs allow small business to band together to purchase health insurance. Continue reading to understand whether these Association Health Plans might be a fit for your organization. 

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