Small groups can benefit from self-funding. There are four essential elements to a successful small group self-funded program. Experienced Third Party Administrator (TPA). For a small group, a TPA should have experience and staff that can handle the specific issues that may arise because many small groups do not have fully staffed Human Resource and […]
Every self-funded employer should consider how Reference-based Pricing (RBP) will affect their health plan. In addition to reducing the medical claims payments on behalf of members, reference-based pricing can have an impact on the risk assessment and pricing of stop-loss underwriters. A well-chosen stop-loss carrier is vital for the Self-Funded Planning team since it can be more […]
The No Surprises Act requires health plans to notify eligible members when a provider or facility is terminated from the network due to contract expiration or non-renewal. This notice informs the plan members of their right, as a “continuing care patient,” to elect to continue the course of treatment for a period of time from […]
New regulations, effective January 15, 2022, require group health plans and health insurance issuers to cover up to 8 at-home Covid tests per covered individual per month. The rules require group health plans and health insurance issuers to cover rapid at-home COVID-19 tests with: No cost-sharing applied No prior authorization required No medical management requirements. Here are […]
What is the No Surprises Act? The No Surprises Act (the “Act”) took effect on January 1, 2022. The Act restricts surprise and excessive out-of-pocket balance bills for consumers. It also ensures coverage of emergency services without prior authorization and regardless of network status. Does the No Surprises Act prevent balance bills? No. The law […]
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Proposed Rulemaking to Strengthen HIPAA Security and Cybersecurity Protections
Cost ContainmentThe Office for Civil Rights at the U.S. Department of Health and Human Services (“HHS”), which administers and enforces the HIPAA Security Rule (“Security Rule”), recently issued a Notice of Proposed Rulemaking (NPRM) to strengthen cybersecurity protections for electronic protected health information (ePHI). The proposed rule introduces several new requirements and clarifications that will have […]