America's Benefit Specialist April 2023

PUBLIC HEALTH EMERGENCY

Continued from page 7 will be terminated as of May 11, the 60-day period following the end of the national emergency will begin on May 12. Once this 60-day period ends (July 10), these suspended timeframes will begin to run again at pre-pandemic rates effective July 11 and include: • the 14-day deadline for plan administrators to provide COBRA-election notices to qualified beneficiaries • the 30-day period (or 60-day period, in some cases) to exercise HIPAA special enrollment rights in a group health plan following: birth, adoption or placement for adoption of a child; marriage, loss of other health coverage; or eligi bility for a state premium assistance subsidy • the 60-day deadline by which a participant or qualified beneficiary must provide notice of divorce or legal sepa ration, a dependent child that ceases to be an eligible de pendent under the terms of the plan) or a Social Security disability determination used to extend COBRA coverage • the 60-day deadline in which to elect COBRA coverage • the 45-day grace period for the payment of initial COBRA premium, and 30-day period for subsequent premium pay ments. Note: Presently, individuals electing COBRA outside of the initial 60-day election period (as referenced above) generally have one year and 105 days after the election no tice is provided to make the initial premium payment, and individuals electing COBRA within the generally applicable This can begin to sound like a great prospect for employers on all fronts, but if they are looking to capitalize on biosim ilars, they should also consider the important factors that drive market share when selecting a PBM and a biosim ilar strategy. Also ensure that driving the lowest net cost should benefit the plan sponsor as well as the patient. Vital factors that go into the pricing strategy include list prices, discounts, financial assistance and rebates. It’s imperative to recognize that not just choosing to offer biosimilars, but the right biosimilar, is integral to maintaining the balance in benefits between plan sponsors and employees. The success of biosimilars will also be heavily dependent on pre scribers feeling confident in the safety and efficacy of this format of medication. Understanding that it can be overwhelming to lean into modern healthcare for employers, brokers remain accessible

60-day election period have one year and 45 days after the date of their election to make the initial payment. • the deadline under the plan by which providers and participants may file a benefit claim (generally one year, under the terms of the plan) • the deadlines for appealing an adverse benefit determi nation (generally 30 days), requesting an internal review (generally six months) or an external review of a claim denial (generally four months). Importantly, the guidance that allowed HSA-qualified high-deductible plans to offer telehealth coverage on a first-dollar basis without affecting HSA eligibility is NOT impacted by the end of the public health/national emergen cy. However, this relaxation is in effect through 2024, per the Consolidated Appropriations Act.

Scott Stevens is an employee benefits and consumer-directed healthcare specialist, helping employer organizations of all types reduce their health insurance and related employee benefits costs. His career has included stints as vice president of sales/ marketing for a national insurance company, co-founder and executive vice president of a

TPA and founder of The HSA Toolkit (employer/employee education and sales system). Scott earned a B.S. in marketing/ economics from the State University of New York at Oswego.

BIOSIMILARS

and ready to provide information regarding solutions such as biosimilars. It can certainly be a smart option for organiza tions where it fits their needs and is based on the well-being of their employees.

Nathan Cassin is pharmacy director at Holmes Murphy. In addition to his decade of experience in the pharmaceutical industry, Cassin is respected as a financial thought leader and negotiator. He has expertise in financial analysis, strategic consulting and contract language, and provides financial savings and pharmacy contracts for Holmes Murphy clients.

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