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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. 

Published in Wellness

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. 

Published in Healthcare Reform

If you have a self-funded or partially self-funded plan (including all “Level Funding” plans), you need to know about New York State’s Health Care Reform Act (HCRA) of 1996, even if you don’t have employees in New York. The HCRA, which still applies today, was created to generate funding for a wide variety of health care initiatives in the state, and requires providers of health care services and Third Party Administrators (TPAs) to participate in that funding. In 1997, the State created the New York Public Goods Pool to collect funds for those initiatives and for indigent care in the state. 

Published in Industry Trends

The Patient Centered Outcomes Research Institute (PCORI) fee is due July 31, 2018 for employers with any type of self-funded plan and/or a Health Reimbursement Arrangement. The fee helps fund unbiased research that evaluates the clinical effectiveness of medical treatments regardless of the profit potential. This fee is also known as the Comparative Effectiveness Research Fee, or CERF.

Published in Compliance

When consumers need to access emergency health care services, they usually do not have the time nor presence of mind to determine whether a provider treating them is in-network or not. When those emergencies expose them to out-of-network providers, the provider or facility may “balance bill” the consumer for amounts beyond what the insurer paid. This out-of-network balance billing can create financial burdens and undermine the consumer’s confidence that health insurance will protect them from financial hardship.

Published in Industry Trends

Reference Based Pricing (RBP) is a cost containment strategy that some larger employers have implemented to help place a cap on the cost of larger medical services.  It’s a savvy strategy that, in the past, has worked best with self-funded large employers but is gaining steam across employers of all sizes.

Published in Industry Trends
Monday, 14 May 2018 09:48

The Latest ACA Regulatory Changes

The final Affordable Care Act provisions for 2019 have been released and they are in line with the regulations proposed on October 27, 2017. The provisions primarily concern the out-of-pocket maximums, Essential Health Benefits (EHBs), and the Marketplace.

Published in Healthcare Reform
Current benefit plans have given more purchasing and decision-making power to the members with higher out-of-pocket responsibilities. Members do not always understand what their benefit plans cover, and the costs associated to that coverage, which can cause a lot of confusion and frustration. 
 
We at Fall River Employee Benefits understand that benefit plans can be an intimidating and confusing subject. We want to empower and educate our client’s employees to be their own best health advocates and make informed decisions regarding their health care. 
 
We love helping our clients create year-round campaigns to teach their employees to be better consumers of health care. There are many topics to cover, so we’ll likely do several articles in this area. 
Published in Best Practices
Monday, 16 April 2018 15:08

HIPAA Compliance Made Easy

HIPAA is an important guideline for employers, health care practitioners, and insurance companies to follow. Since the fines for non-compliance can be in the tens of thousands of dollars, it’s imperative that employers pay attention to their obligations in keeping employees’ information private.

Published in Compliance
Wednesday, 25 January 2017 20:13

Update on ACA Repeal and Replace Strategy

It was no secret before President Trump signed the executive order that he wanted the Affordable Care Act (ACA) repealed, and now he has made his intentions clear. His first signed executive order requires federal agencies to ease the economic burden of the ACA “to the maximum extent permitted by law” until it is repealed. Although the executive order doesn’t grant the administration any powers that it didn’t already have, it does signal to the public that change is coming. 

Published in Healthcare Reform
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