America's Benefit Specialist December 2022

INDUSTRY ISSUES TO WATCH

termining factor in establishing the afford ability of family coverage. Depending on how an employer subsidized costs, family coverage could be deemed affordable even when the rates were significantly higher than coverage on the exchange. This created a Catch-22 where family members were not eligible for exchange subsidies because they were eligible for affordable family cover age, but also could not afford the employ er-sponsored coverage. This became known as the Family Glitch. This year, Treasury and the IRS issued final regulations amending Affordable Care Act regulations. These rulings stipulated the affordability for an employee’s family mem bers to participate in employer-sponsored healthcare. The amendments are effective at the start of the 2023 tax year and could al low more family members to be potentially eligible for a premium tax credit in the mar ketplace. While the long-term effects on the market remain to be seen, employers could see more employees with family members seeking coverage from the marketplace. NO SURPRISES ACT Portions of the Consolidated Appropria tions Act go into effect at the end of this year, but one piece being implemented in 2023 is key to keep in mind: The No Sur prises Act. The act protects patients from large and often unexpected out-of-network bills sent directly to their door. The secretary of Health and Human Ser vices, in consultation with the Federal Trade Commission and U.S. attorney general, are required to and will conduct an annual study on the effects of the CAA. INSURANCE INDUSTRY WILL CONTINUE TO EVOLVE While we’ve seen new models come to fruition for managing costs, there is still room for newer, more efficient offerings to

OVER THE PAST DECADE, THERE HAVE BEEN INCREDIBLE STRIDES IN TERMS OF THE VARIETY OF HEALTH INSURANCE PROVIDERS, PLANS FOR BUSINESSES AND OPTIONS TO MITIGATE THE DREADED “OUT-OF-NETWORK” PRICE TAG.

break through. Over the past decade, there have been incredible strides in terms of the variety of health insurance providers, plans for businesses and options to mitigate the dreaded “out-of-network” price tag. Health Care Share Ministries function similarly to health insurance but, in fact, aren’t actually health insurance providers. These types of organizations are based on shared religious or ethical beliefs and the financial contributions of members are used to reimburse healthcare costs for others. To ensure that the balance of contributions to spending is in equilibrium, members are required to be in good health and support the overall beliefs of the HCSM. Another innovation in lowering costs is reference-based pricing, which eliminates the gap between in-network and out-of-net work pricing. Primarily used by self-insured employers, RBP sets benchmark pricing for services, indexed to Medicare reimburse ment rates. This eliminates network require ments for covered employees, who can work with their providers of choice, as long as each provider agrees to accept the schedule rate amounts as payment in full. Brought to the market in 2020, Individual Coverage Health Reimbursement Arrange ments (ICHRAs) are formal, group health plans that allow tax-free reimbursement of individual health insurance. Available for businesses of all sizes, the employer can

reimburse employees for plans purchased from the marketplace. To receive the reimbursement, enrolled employees submit receipts for qualified expenses or premium payments. The best part? The reimburse ments are tax-free. What new models and offerings will we see in 2023? How will the industry continue to evolve and adjust to recent legislation? While we don’t know the answers now, we do know the issues and trends we should all be keeping an eye on.

Misty Baker is a compli ance and agent advocate, specializing in ACA, ERISA, FMLA, COBRA and legislative advocacy for over 20 years. She was a registered lobbyist in Texas

for four years and is a strategic leader focused on compliance, agent knowledge, legislative advocacy and ultimate client understanding of how to be successful in the changing world of compliance. Her passions incudes agent education, insurance advocacy inside and outside of the Capital, and compliance. Misty was named one of the most influen tial women in employee benefit advising by Employee Benefit Advisor in 2015. She’s been a member of NAHU since 1999 and currently chairs the Legislative Council.

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