America's Benefit Specialist December 2022

Industry Issues for 2023 How ICHRAs Solve Benefits Problems Traditional Medicare vs. Medicare Advantage

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D e c e m b e r 2 0 2 2

YOUR INDUSTRY

3 Noteworthy 4 Letter to the Editor 8 Industry Events 10 Industry Issues to Watch in 2023 By Misty Baker

12 Recent Mergers and Acquisitions 15 ICHRAs See Triple-Digit Growth The HRA Council 18 Product News 22 People on the Move

10

MEDICARE MATTERS 25 Analyses Show that a 27 The Key Factors

underlying Americans’ Choice of Traditional Medicare or Medicare Advantage

Small Share of Medicare Beneficiaries Compared

Plan Options or Switched Plans

28 The Average Medicare Beneficiary Has a

26 CMS Expands Medicare to Cover Medically Necessary Conditions Requiring Dental Services

Choice of 43 Medicare Advantage Plans and 24 Part D Stand-Alone Plans for Coverage in 2023

27

26 Medicare Conferences

29 Plan News

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YOUR SALES

31 How ICHRAs Solve Today’s Top Benefits Problems By John Kelly

33 Voluntary Disruption From the Backyard to the

Boardroom: Why Pet Benefits Are No Longer Optional By Eric Silverman

YOUR ASSOCIATION

31

42 NAHU’s Board of Trustees

34, 44 Where in the World

35 CPC Quiz

43 Your NAHU Staff

38 New Infographic

44 Association Events

40 Welcome to NAHU

33

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employees and their families,” explained Nieland. Employee insights such as these can be key tools for shaping a company’s ap proach to healthcare. Health benefits, which provide a competitive advantage when hiring, should be an integral part of any long-term recruiting and retention strategy. The report offered several strategies for addressing employees’ costs and concerns: • Review cost-sharing arrangements, in light of average employee income levels and other factors. • Consider a self-funded health plan or a group captive program (for small to mid size employers), which both offer signifi cant economic and strategic advantages. • Help address the complexity of care by offering price transparency tools and patient navigation services. “The goal of this report is to spark dia logue between employers and their benefit brokers. We hope it encourages employers to consider innovative solutions that can move the needle on costs and ease of use,” concluded Nieland. The findings come from a survey com missioned in March of 1,000 U.S. adults age 18 and older with employer-based health coverage, balanced across age, gender, U.S. region and employer size. NEARLY FOUR IN FIVE AMERICANS WHO HAVE USED VIRTUAL PRIMARY CARE SAY IT HELPED THEM TAKE CHARGE OF THEIR HEALTH As digital health technology continues to advance and the healthcare industry evolves, many Americans want the ability to utilize more digital methods when it comes to managing their health, according to a study recently released by Elevance Health (formerly Anthem Inc.). For people who have used virtual primary care, the

vast majority of them (94%) are satisfied with their experience, and nearly four in five (79%) say it has allowed them to take charge of their health. Survey respon dents also indicated that convenience and accessibility are among the top traits that attract them to digital methods like virtual primary care. Elevance Health commissioned The Harris Poll to conduct an online study of over 5,000 US adults age 18+ around virtual primary care. Specifically, the study aimed to gain insights into consumer interest in virtual primary care as a resource to im prove their health and wellbeing. “Consumers are using digital technologies at an accelerating pace and, consistent with this, we’re seeing at Elevance Health use of telehealth that is nearly 20 times greater than pre-pandemic levels,” said Rajeev Ronanki, president of digital platforms at Elevance Health. “Virtual primary care gives individuals the opportunity to work with innovative services that make healthcare more convenient, accessible, and fit into their increasingly busy schedules.” While telehealth and online healthcare services are rising in popularity, Elevance Health found that Americans’ familiarity with virtual primary care is divided, with around half (48%) being familiar with the term. Nearly three-quarters of Amer icans (73%) like virtual primary care/ find it appealing. Convenience (35%) and accessibility (31%) are among the top traits that Americans like or find appealing about virtual primary care. The overall ease of use (30%) is also appealing. Even though a majority like/find virtual primary care appealing, people still have questions. Around three in 10 Americans who have not used virtual primary care as a source of primary care (31%) believe that doctors need to see their problem in person to know what is wrong. Around a fifth say they do not know if it is covered by their in

HEALTHCARE PRESSURES FACING EMPLOYEES

U.S. employees are feeling the pressure of healthcare costs, with eight in 10 concerned about the cost of care and more than half re porting that they have skipped medical tests, office visits or prescriptions. These findings come from the 2022 Health Care Pressures Facing U.S. Employees report by Berkley Accident and Health. “Cost-sharing is a major problem for U.S. employees, who are struggling with increased out-of-pocket costs due to high deductibles and coinsurance,” said Brad Nieland, president and CEO of Berkley Accident and Health. “These costs can place the largest burden on those who are least able to pay, forcing patients to skip care, self-pay and take on medical debt.” Key findings of the survey: • Despite having health insurance, re spondents worry about their ability to pay for care, with 84% concerned about affordability. • Sixty-one percent admit to skipping a med ical test, visit or prescription due to cost. Fifty-six percent have paid cash because it was cheaper than using their insurance. • Thirty-eight percent report having medical debt, with the majority owing between $1,000 and $10,000. The top rea son cited for medical debt was an unmet deductible or coinsurance. Most respondents find health costs and billing hard to decipher. Sixty-nine percent have received a medical bill they did not expect—typically between $500 and $3,000. Others found it hard to get a price estimate before scheduling a medical service or filling a prescription. “With these findings in mind, employers and benefit professionals should consid er how they can make healthcare more affordable, easier and more transparent for

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LETTER TO THE EDITOR

Dear Martin,

VOLUME 69, NO.10

EDITOR Martin Carr (202) 595 0724

You’ve probably heard that the Biden Administration and Treasury have pub lished final regulations pertaining to the so-called “family glitch” aspect of the ACA. You published my article on this topic in the October issue of ABS and, at the time, the final regulations were not known. Well… now they are. On October 13, the IRS published the final rule that changes the afford ability calculation to include the cost of family coverage for employees seek ing employee plus dependent(s) coverage, beginning in 2023. Here’s the update: Under the final rule, an employer-sponsored plan is affordable for family members if the portion of the annual premium the employee must pay for the lowest-cost health insurance plan option offered for family coverage does not exceed 9.12% in 2023 (adjusted annually) of household income. An employee’s required contribution for family coverage is the portion of the annual premium the employee must pay for coverage of the employee and all other eligible indi viduals included in the employee’s family. Currently, the affordability calcula tion is based only on the “lowest cost, self-only coverage option.” Importantly, employers whose portion of the cost of family coverage to the employee fails the revised affordability test will NOT be subject to an employer shared responsibility penalty. The change (or fix) is strictly to allow more people to gain access to coverage on the individual market. The final rule also adds a minimum-value rule for family members based on the benefits provided to the family members.

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The opinions expressed in this magazine are not necessarily endorsed by NAHU nor does the magazine assume responsibility for statements made in advertisements or published articles. Send editorial submissions to: America’s Benefit Specialist Editor, 999 E Street NW,

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Suite 400, Washington DC 20004. America’s Benefit Specialist (ISSN 2475-5826, publication no. 238660), 2022, volume 69, number 10 Published 10 times per year (January/February, March, April, May, June, July, August/September, October, November and December) by the National Association of Health Underwriters, 999 E Street NW, Suite 400, Washington DC 20004. $25 annual subscription price is included in NAHU member dues. Periodical postage paid at Washington DC and additional mailing offices. POSTMASTER: Please send address changes to America’s Benefit Specialist, 999 E Street NW, Suite 400, Washington DC 20004.

NAHU’S LEGISLATIVE SUCCESSES

Anatomy of a Bill Medicare Matters Value-Based Care

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Continued from page 3

percent), quickly addressing a new acute or urgent medical problem (seven percent vs. five percent), getting a referral to a specialist (six percent vs. four percent), addressing urgent issues or flare-ups associated with chronic conditions (six percent vs. three percent) and managing chronic conditions (five percent vs. two percent). As digital communications dominate everyday interactions and business trans actions, there is an opportunity for provid ers to increase adoption of technology to address a gap with consumer use of digital communications in healthcare. Around two in five (41%) Americans who have a primary healthcare provider wish digital forms of communication, such as text messages or emails, were used more. Despite mixed familiarity surrounding virtual primary care, Americans appear eager to embark on this new path in health care. More than half who have a primary care physician (52%) say they would use virtual primary care in addition to the care they receive from their current primary healthcare provider within the next year, while most are likely to do so within the next two to five years (59%) and beyond the next five years (62%). Most Americans who have used virtual primary care (84%) say it has been very useful during the pandemic and plan to continue using it as pandemic con ditions improve. Many people are interest ed in using virtual primary care for services such as prescription refills (76%), referrals to specialists (72%), and address ing both non-urgent (67%) and/or urgent issues (58%). Overall, Americans believe the healthcare system is changing for the better with the inclusion of virtual primary care (71%). Similarly, a majority of Americans (83%) believe it is a great way to increase access to healthcare for people who may otherwise be unable to visit a provider in person.

surance, so they feel it may cost more (21%). Fortunately, some health plans include virtual primary care as a plan benefit. Virtual primary care can help address many conditions and help individuals manage their chronic conditions, such as diabetes, high blood pressure and asthma. Virtual primary care also provides people access to urgent care services for minor health issues, including allergies, cold, skin rashes and more. While a majority of Americans (82%) feel their health is excellent or good, more than three in five Americans (63%), are currently living with or managing a chronic health condition. Nearly two-thirds (62%) of those living with a chronic condition believe vir tual primary care may help them take charge of their health. Americans see the benefits of virtual primary care, no matter if they are living with or managing a chronic health con dition. Many feel it can be a great way to increase access to healthcare for people who may otherwise be unable to visit a provider in-person (83%). However, the motiva tions to use it may differ, with those living with/managing chronic conditions being intrigued by the array of services easily available to them. Those without a chronic health condition who have a primary care physician are more likely than their coun terparts to wish their primary healthcare provider used more digital forms of com munication (47% vs. 39%) Americans with a chronic health con dition are more likely than those without a chronic health condition to be familiar with virtual primary care (52% vs. 42%). This group is also more likely to have ever used virtual primary care (36% vs. 25%), specifically for each of the follow ing (chronic health condition vs. without chronic condition): prescriptions (19% vs. 12%), general wellness/treatment plans (10% vs. seven percent), addressing a non-urgent medical problem (eight percent vs. five

To learn more about the virtual primary care study, visit www.elevancehealth.com/ research/physical-health/what-consum ers-want-from-virtual-primary-care-findings. FAMILY PREMIUMS FOR EMPLOYER COVERAGE AVERAGE $22,463 THIS YEAR, WITH WORKERS CONTRIBUTING AN AVERAGE OF $6,106 Annual family premiums for employ er-sponsored health insurance average $22,463 this year, similar to last year ($22,221), the 2022 benchmark KFF Em ployer Health Benefits Survey finds. On average, workers this year are contributing $6,106 toward the cost of family premium, with employers paying the rest. Among workers who face an annual deductible for single coverage, the average this year stands at $1,763, similar to last year ($1,669) but up 61% since 2012 ($1,097). “Employers are already concerned about what they pay for health premiums, but this could be the calm before the storm, as recent inflation suggests that larger increases are imminent,” KFF President and CEO Drew Altman said. “Given the tight labor market and rising wages, it will be tough for employers to shift costs onto workers when costs spike.” The report reveals ongoing disparities in the burden of healthcare costs on workers at smaller and large employers. Workers at firms with less than 200 workers on average pay $7,556 out of their paychecks annually for family coverage—nearly $2,000 more than workers at larger firms ($5,580). For single coverage, workers at small and large firms contribute similar amounts toward their coverage, though small-firm workers face much larger deductibles on average ($2,543 vs. $1,493). Viewed another way, nearly half (49%) of workers at small firms face an average deductible of at least $2,000, while just a quarter (25%) of workers at large firms do.

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health services (55%) and serving enrollees in remote areas (54%). Smaller but still significant shares say telemedicine will be “very important” in providing primary care (35%) and specialty care (24%). Other findings include: Offer rate. Nearly all (99%) large employ ers offer health benefits to at least some of their workers, though smaller firms are in creasingly less likely to offer health benefits as they get smaller. For example, two thirds (67%) of firms with 10 to 199 employers offer health benefits to at least some of their workers, while just 39% of firms with three to nine workers do so. Spousal coverage restrictions. While most employers allow a worker’s spouse to enroll in coverage even if they are offered other coverage, 16% do not allow spouses to enroll in such circumstances, and another 14% place restrictions on the spouses’ enrollment. Some (five percent) charge spouses more for cover age if they have access to other coverage. Helping employees buy non-group coverage. The survey finds 11% of firms that offer health benefits to at least some workers and seven percent of those who don’t offer funds for some employers to purchase non-group coverage, such as that offered on the Affordable Care Act marketplaces. Such assistance can be provided in a tax-preferred way though Individual Coverage Health Reimbursement Arrangements. Coverage for insulin and statins. Most covered workers are in plans that cover the cost of at least some insulin products (70%) and statins for treating high cholesterol (71%) before they meet their general annual deductible. This follows a 2019 change in policies that allowed plans eligible for use with a Health Savings Account plans to cov er these expenses as preventive services. The Kaiser Family Foundation conducted the annual employer survey between Feb ruary and July. It included 2,188 randomly selected, non-federal public and private firms with three or more employees that responded to the full survey. An additional

The modest change in premiums this year is unusual in that it is less than the increase in inflation (eight percent) or workers’ wages (6.7%) during the same period. Even with this year’s minimal change, average premiums for family coverage have risen 43% since 2012, more than the shift in inflation (25%) and a little more than wages (38%) over the same period. Employer costs for this year were largely set last year, before inflation became a major economic concern and after the pandemic led to a temporary slowdown in utilization of healthcare services. Following the pandemic, which brought new attention to mental health needs, the survey finds that almost half (48%) of large employers report an increase in the share of workers using mental health care services, and more than a quarter (29%) say more workers are asking for family leave due to mental health issues. A smaller share of large employers say they have seen an increase in the share of workers using substance-use services (14%), while more than four in 10 (43%) say that they are at least somewhat concerned about the growth of substance-use conditions among their workers. The survey finds that more than a quarter (27%) of large employers this year added mental health providers—either in physical offices or virtually through telehealth—to their plan’s networks to expand access. Even with those additions, three in 10 (30%) large employers say their networks do not have enough behavioral health providers to ensure their workers have timely access to care. Nearly half (47%) of large firms say tele medicine matters “a great deal” in providing access to mental health services. Almost all large firms (96%) now cover some form of telemedicine services, either directly through their health plan (46%), through a specialized telemedicine provider (32%), or both (20%). More than half expect telemedicine to be “very important” in providing behavioral

2,917 firms responded to a single question about offering coverage. UNCERTAINTY OF HEALTHCARE COSTS DETERS 35% OF AMERICANS FROM SEEKING CARE AKASA, a developer of AI for healthcare operations, released findings from a new survey conducted on its behalf by YouGov, which highlights how limited price trans parency in healthcare can influence patient decisions on whether to seek necessary care and how the lack of awareness about finan cial resources offered by health systems puts patients at a disadvantage when managing medical bills. More than 2,000 Americans were asked: “If you were unaware of the price ahead of the care or service, would you be deterred from seeking out care or services for any of the following individuals?” When answering for themselves: • 40% said they wouldn’t be deterred from seeking out care from themselves based on lack of healthcare pricing information • 35% said they would be deterred from seeking out care for themselves if they were unaware of pricing for necessary care or services • 25% said they didn’t know if lack of healthcare pricing information would or would not deter them from seeking care for themselves When answering for their dependents: • 51.2% said they wouldn’t be deterred from seeking care for dependents if pricing information wasn’t provided on necessary care or services needed • 18.3% said they would be deterred from seeking care for dependents if they were unaware of healthcare pricing information • 30.3% said they didn’t know if lack of pric ing information would or would not deter them from seeking care for dependents When answering for their parents/ guardians:

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• 50% said they wouldn’t be deterred from seeking care for parents or guardians if pricing information wasn’t provided on necessary care or services needed • 20% of Americans said they would be deterred from seeking care for parents or guardians if they were unaware of healthcare pricing information • 30% said they didn’t know if lack of pricing information would or would not deter them from seeking care for parents or guardians While many people may be more willing to invest in the care of loved ones, this trend is troubling as limited knowledge around pricing may discourage individuals from seeking care they need themselves. Delaying care can lead to more severe conditions that are often more complicated and costly to treat. Respondents were also asked: “Do you know if payment plans or financial assistance are offered by your physician or hospital?” Sixty-four percent said they didn’t know if their physicians or hospitals offer payment plans or financial assistance for medical bills—highlighting how a key measure to prevent financial hardship is underutilized. When delving into the data, a shocking 80% of uninsured Americans said they didn’t know about financial resources like payment plans or financial assistance offered by their providers. The YouGov survey, commissioned by AKASA, fielded responses from 2,026 Americans between March 9 and 14. IN THE WAKE OF THE GREAT RESIGNATION, 84% OF HR PROFESSIONALS ARE INCREASING BENEFITS OFFERINGS Lively Inc. recently released its inaugu ral Employee Benefits Pulse Check that captures HR leaders’ efforts to keep up with shifting marketplace and employee demands. The study, conducted by CITE Research on behalf of Lively, reveals that 84% of HR professionals are increasing ben-

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ing remote work or flexible work arrange ments is the most impactful action they can take to retain or attract employees. Employees are financially stressed and looking to benefits to help. As inflation re mains high and organizations content with a looming recession, financial benefits are more important than ever when it comes to attracting and retaining employees. With 62% of HR decision makers reporting their employees’ financial stress levels have risen in the past year, 80% of HR leaders feel that offering competitive financial benefits, such as 401(k) matching, is more import ant for attracting and retaining employees than it was a year ago. Some HR decision makers (36%) report that employees ask for increased financial benefits. While employees are more routinely asking for benefits such as family leave, re productive healthcare, and family planning, many HR leaders need to become better educated about what is covered by health in surance, HSAs and FSAs. Almost all (94%) say parental leave benefits are the most important to attract and retain employees. In the wake of the policies affecting women and LGBTQIA+ folks this year, 66% support coverage of hormone-replacement therapy and 60% say funding and leave for abortion is important to their employees. Fifty-eight

ny. In response to growing demand, 84% of companies increased benefits to attract and retain employees. A majority of companies have also increased base salaries (72%) and flexible work arrangements (72%). Healthcare coverage is critical to retaining employees. Healthcare is one of the most im portant workplace benefits an employer can offer, according to both employees and HR leaders. When it comes to attracting and re taining employees, 60% of HR leaders rated healthcare as a top-three benefit they offer, along with base salary. More than half (58%) of organizations have improved healthcare coverage. A little over a third (36%) of HR decision makers reported that employees asked for better health coverage. Base salary and workplace flexibility have the highest impact on employee recruiting and retention. A majority of HR leaders took action to retain or attract employees by increasing base salaries in order to aid in attracting top talent. Some HR decision makers (20%) believe increasing base salary is the most impactful action they can take to retain or attract employees. Most HR leaders (63%) reported that employees ask for an in creased base pay, followed by 39% reporting that employees asked for bonuses. Most HR leaders (71%) improved their remote work or flexible work arrangements, and some HR decision makers (26%) believe improv

efits, over half (58%) of organizations have improved healthcare coverage, and almost all (94%) believe parental leave benefits are the most important to attract and retain employees. The survey found that an increased base salary, flexible work arrangements and better healthcare coverage are the most impactful actions employers can take to attract talent. High inflation has increased the importance of offering competitive financial benefits, and most HR leaders (80%) feel that offering competitive financial benefits is currently more important for attracting and retaining employees than it was a year ago. The report also includes key steps HR leaders and benefits brokers can take to ensure they are meeting their employees’ needs in the wake of a volatile economy and an ever-changing healthcare and legislative landscape. The data revealed the importance of family planning and reproductive health benefits has increased, along with the overall need for benefits education to keep up with today’s policy. Key findings: Employees have newfound power, which has an effect on the benefits landscape. Employee turnover is at an average of 20% and employees are asking for higher salaries, better benefits and increased flexibility as a condition for joining or staying at a compa

INDUSTRY EVENTS

FEBRUARY 5-8 YOU POWERED SYMPOSIUM Miami, FL www.epoweredbenefits.com/2023 you-symposium/ FEBRUARY 6-8 ICMG ANNUAL CONFERENCE Scottsdale, AZ https://icmg.org/conference

JUNE 11-14 SHRM23 ANNUAL CONFERENCE & EXPO

OCTOBER 22-24 LIMRA ANNUAL CONFERENCE National Harbor, MD www.limra.com

Las Vegas, NV www.shrm.org

JUNE 16-18 WOMEN OF INSURANCE ANNIVERSARY CONFERENCE Nashville, TN www.womenofinsurance.org

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half now say they plan to add a new benefit, either employer-paid, partially-employer paid or voluntary.” Other findings in the report: Two-thirds of employers now offer at least one voluntary benefit to their employ ees. This represents an increase from 60% two years ago and is driven primarily by the higher percentage of smaller employers offering voluntary coverage. Nontraditional voluntary benefits con tinue to increase in popularity. Legal plans lead the list, followed by auto/homeowners, identity theft protection and pet insurance. Online benefits administration services are very important to employers of all sizes. The top three online services employers want include the ability to adjust and pay a bill, the ability for employees to file claims, and the ability for employees to check their claim status. More information is available at www. eastbridge.com.

percent support travel for medical purposes if a procedure is not available in state. Despite the support of a majority of HR decision makers for reproductive and family health benefits, only about a quarter are aware that certain expenses, such as egg-storage fees and baby formula, are cov ered by FSAs or HSAs. REPORT REVEALS INCREASING An increasing number of employers plan to make changes to their benefits programs in the next 12 to 18 months, according to East bridge’s new MarketVision—The Employer Viewpoint report. The report shows nearly two-thirds (62%) of employers plan to add or change an employee benefit—significant ly more than the 44% reporting such plans just two years ago. The MarketVision—The Employer View point report explores employer attitudes and PACE OF CHANGE FOR EMPLOYEE BENEFITS

opinions about voluntary benefits based on survey data from more than 1,000 employers in firms of all sizes, from 10 to more than 10,000 employees. The findings update more than two decades of Eastbridge data on a wide range of topics including types of benefits employers offer, which benefits they offer as voluntary and why, changes they’ve made recently or plan to make in the future, com munication and enrollment methods they use, benefits administration systems and more. The report is designed to help benefits carriers better understand the needs, wants and expectations of employers to develop effective marketing plans and business strategies. “Our research shows a past trend of em ployers cutting back on employee benefits to control costs has changed,” said Nick Rock well, Eastbridge president. “Only a handful of employers—six percent—say they plan to drop one or more benefits completely, less than half the number in our 2020 survey. In fact, just the opposite is true: more than

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INDUSTRY ISSUES TO WATCH IN 2023

By Misty Baker Director of Compliance and Government affairs BenefitMall Leander, Texas misty.baker@benefitmall.com

As we close the book on 2022, it’s time to look ahead at what is in store for 2023. While the impact of election results and potential inflation are still unknown, there are a number of healthcare industry issues to keep an eye on in 2023. RATE INCREASES CONTINUING This first trend isn’t going to be popular: Rate increases will continue. Across the board, rates are expected to increase by around 10% for employers and employees, continuing an uphill trend. While rates, in general, are increasing, it doesn’t help that labor costs and prescription fees are rising as well. Add in global supply-chain issues and overall 2023 healthcare spend is expect ed to increase exponentially.

facilitate these services is the issue employ ees are facing. For many employees and their families, available services may be out-of-network, out of their city limits, or even out of their price range with this surge of awareness. FAMILY GLITCH FIX Let’s travel back to 2012 when regulations used self-only employee coverage as the de

MENTAL HEALTH STILL THE FOCUS

Following COVID, mental health service usage has skyrocketed—a trend that can be attributed to increased offerings by employ ers as well as a newfound overall awareness of the importance of mental health. With recent legislation being passed tightening regulations and impacting benefits offer ings, finding mental health practitioners to

WHILE WE’VE SEEN NEW MODELS COME TO FRUITION FOR MANAGING COSTS, THERE IS STILL ROOM FOR NEWER, MORE EFFICIENT OFFERINGS TO BREAK THROUGH.

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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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RECENT MERGERS AND ACQUISITIONS

solutions at the workplace,” said Heather Lavallee, president and CEO-elect, Voya Financial Inc. Benefitfocus will operate as a distinct business under Voya’s ownership, with con tinuity in the existing Benefitfocus manage ment team and a reaffirmed commitment to Benefitfocus’ broker, advisor and carrier relationships. AMERILIFE TO ACQUIRE TRUCHOICE FINANCIAL GROUP AmeriLife Group LLC has entered into an agreement to acquire TruChoice Financial Group and its affiliate Inforce Solutions LLC from Allianz Life Insurance Company of North America. Headquartered in Minneapolis, TruChoice is one of the largest field market ing organizations in the financial services industry. The company partners with life and annuities agencies to provide them with marketing, business support and financial solutions in an ever-changing industry. In force, an affiliate of TruChoice, is a national brokerage general agency focused on the life insurance market. The addition of TruChoice provides significant opportunity for AmeriLife to expand its annuities production, as well as increase its reach in the fast-growing life insurance market and forge a closer rela tionship with Allianz Life. Under the AmeriLife umbrella, TruChoice and Inforce will gain access to resources, new products and solutions to expand opportunities for their more than 4,000 financial professionals. TruChoice will continue to maintain its strong relationship with Allianz Life as a non-affiliated FMO, as the latter moves to consolidate its focus around its core business of creating innova

synergistic and complementary offerings, we can now leverage those strengths to offer even more robust benefits for our partner firms, their distribution sources and insur ance company partners.” Insurance Designers of America will merge into the LIBRA brand, adding as many as 50 agency partnerships to the LI BRA Insurance Partners community. IDA’s team, distribution network, technology of ferings and extensive advisor resources will be available to all LIBRA-affiliated partners post-integration. Collins will continue in a leadership position as executive vice presi dent and chief relations officer, overseeing carrier partnerships and agency services. VOYA FINANCIAL TO ACQUIRE BENEFITFOCUS Voya Financial Inc. and Benefitfocus Inc. recently announced that the companies have entered into a definitive agreement for Voya to acquire Benefitfocus. Under the terms of the agreement, Voya will acquire all outstanding shares of Benefitfocus common stock for $10.50 per share in an all-cash transaction valued at approximately $570 million, inclusive of Benefitfocus debt consulting firms in the health and benefits industry and, through its employer and health plan customers, touches more than 25 million lives on its platform. Combined with its own existing workplace customers, Voya will serve approximately 38 million individuals, or roughly one in 10 Americans following completion of the acquisition. “Our acquisition of Benefitfocus is an exciting opportunity to accelerate our workplace-centered strategy and increase our capacity to meet the growing demand for comprehensive benefits and savings and outstanding preferred shares. Benefitfocus serves brokerage and

LTC GLOBAL ACQUIRES PITTSBURGH BROKERAGE SERVICES

LTC Global Inc. (Fort Myers, Florida) has acquired Pittsburgh Brokerage Services Inc., a Capitas Financial Inc. partner headquar tered in Pittsburgh. PBS Founder Thomas Hall will continue to manage the business. Pittsburgh Brokerage Services operates a life and health insurance brokerage that has served brokers and clients throughout Pennsylvania, West Virginia and Eastern Ohio for over 35 years. LIBRA INSURANCE PARTNERS AND INSURANCE DESIGNERS OF AMERICA MERGE LIBRA Insurance Partners and Insurance Designers of America LLC have announced the merger of the two organizations. The combined company will operate under the LIBRA Insurance Partners (LIBRA) brand. Bill Shelow, CEO and president of LIBRA Insurance Partners, and J. Craig Collins, president and executive director of Insurance Designers of America, along with the respective Board of Directors and more than 110 combined affiliated partner agencies, have approved entering a merger agreement. The merger will take effect on January 1, 2023, upon completing the tran sition process. “We recognize that during a time of mass BGA transactions and industry-wide consol idations, only those with the ability to scale, innovate and evolve will remain relevant and thrive throughout consistently-changing market conditions,” said Shelow. “We’ve worked alongside LIBRA for many years. I have tremendous respect for the leadership team and its agency part ners,” said Collins. “Our firms are aligned in values and commitment, and with many

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agencies and the 48th transaction since its founding in 2020. Founded in 1979, the agency takes great pride in being an integral part of the com munities it serves and was named the 2022 Minnesota State “Agency of the Year” by Keystone Insurers Group. Its agency leader ship participates in many community boards, committees and service organizations. “Cartier Agency has built a reputation of trust and integrity over our 40-plus years serving communities throughout the state,” said Matt Cartier, co-owner at Cartier Agency. “Our team of professionals repre sent many years of experience in personal, commercial, life and health insurance.” INTEGRITY ACQUIRES FIRMS Integrity Marketing Group LLC has an nounced several acquisitions. It has entered into an agreement to acquire The Milner Agency, a brokerage general agency (BGA) located in Athens, Georgia. As part of the acquisition, The Milner Agency’s Chairman of the Board, Seixas “Chip” Milner Jr., and Executive Vice President Whitner Milner will become partners in Integrity. The Mil ner Agency spans four generations of family leadership, beginning in 1958 with founder Willis J. Milner Jr. Today, The Milner Agency is a national, full-service brokerage agency that offers life insurance, annuities, long-term care and disability insurance products, securing more than $170 million in annual paid premium. Integrity has also entered into an agree ment to acquire Mason Insurance, an in dependent agency based out of Colleyville, Texas. Dale Mason, president of Mason Insurance, will become a managing partner in Integrity. A former professional bull rider, Mason recognized the need for better health insurance information in rural areas

and founded Mason Insurance in 1998. The company provides health insurance products, including Medicare, ACA and group health plans to clients across Texas and Oklahoma. Finally, Integrity has entered into an agreement to acquire Elevation Sales Coach ing, based in Wake Forest, North Carolina. Jordan Smith, president of Elevation Sales Coaching, will become a managing partner in Integrity. Elevation provides expert education and accessible information that empower agents to improve their sales pro cesses and maximize revenue. The company specializes in coaching agents who serve the senior market with final expense, life insurance, annuities or Medicare products. Smith will add his sales coaching expertise to Integrity’s partner network, a group that shares best practices and collaborates on solutions that better protect the life, health Carolina-based Allegacy Benefit Solutions, expanding the company’s presence in the Southeast and broadening its expertise in the employee benefits arena. The acquisition took effect October 1. Based in Winston-Salem, Allegacy Benefit Solutions designs custom em ployee benefits programs and is commit ted to meeting client needs by building packages that help attract and retain top talent, promote engagement and reduce absenteeism, and maintain a healthier and more financially secure workforce. Sharon Yarborough, Chad Huff and their team of insurance professionals will join Hilb Group’s Southeast regional operations. and wealth of all Americans. HILB GROUP EXPANDS SOUTHEAST EMPLOYEE BENEFITS PRESENCE The Hilb Group has acquired North

tive products that help clients manage their risk in retirement. ALLIANT INSURANCE SERVICES ACQUIRES FUTURESENSE Alliant Insurance Services has acquired Fu tureSense, a national provider of people-fo cused HR, compensation and organization al-development services. The move expands Alliant’s consulting capabilities across a breadth of geographies and industry catego ries within its Employee Benefits Group. Founded in 1995, FutureSense has emerged as an innovative force in HR, compensation and organizational develop ment consulting through the deployment of multifaceted strategies that focus on helping companies grow and seeing people succeed. The firm has a national reach and is active across a broad cross-section of industries with a large presence in the healthcare and high-tech sectors. Additionally, FutureSense has been a virtual company since its found ing, giving its team insight into the virtual workplace as more organizations embrace remote work. FutureSense and its national team of consultants will join the Alliant family of companies and will continue operating under its current name and brand. KEYSTONE AGENCY PARTNERS FORMS STRATEGIC PARTNERSHIP WITH CARTIER AGENCY Keystone Agency Partners (Harrisburg, Pennsylvania) has announced a strategic partnership with Cartier Agency, an inde pendent insurance agency serving the per sonal, commercial, life and health insurance needs of customers in Minnesota. Cartier Agency marks the 16th Platform Partner in KAP’s growing network of independent

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the business and decided to focus primarily on the benefits side of the business, as it had been extremely successful and there was a lot of potential. Randy and Cyndy, as well as the rest of the team at Pierson & Associates, are very involved in their community, volunteer ing and being part of multiple clubs and organizations, both independently and as an agency. As part of the acquisition, Inszone Insurance will retain Pierson & Associates employees, as well as the current location in Salinas, that will continue to operate under the leadership of Randy and Cyndy Pierson. EPIC EXPANDS NORTHERN CALIFORNIA PRESENCE EPIC Insurance Brokers and Consultants has acquired SLCO LLC, headquartered in Lafayette, California. The acquisition expands EPIC’s presence in Northern Cal ifornia and adds to its client offerings both regionally and nationally.

SLCO is a leader in employee benefits, property & casualty, and personal lines. SLCO will continue to serve clients from its offices in Lafayette, Santa Rosa and Novato, California, under the leadership of Matthew Sitzmann, SLCO practice leader. GALLAGHER ACQUIRES CASON, HUFF & SCHLUETER INSURANCE Arthur J. Gallagher & Co. has announced the acquisition of Quincy, Illinois-based Ca son, Huff & Schlueter Insurance. Founded in 1923, Cason, Huff & Schlueter is a retail insurance agency specializing in personal and commercial insurance as well as life, health and disability insurance to clients in Illinois and Missouri. Mike McCaughey, Patty McCaughey, Bryan Feldner, Eric Frese, Mary Kinscherf and their associ ates will remain in their current location under the direction of Ryan Isaacs, head of Gallagher’s Midwest region retail property/ casualty brokerage operations.

INSZONE INSURANCE SERVICES ACQUIRES PIERSON & ASSOCIATES INSURANCE SERVICES

Inszone Insurance Services has announced today the acquisition of Pierson & Associ ates Insurance. In 1948, Bud Pierson started his insurance agency in Salinas, California. Specializing in pensions, 403(b) plans and life insurance, with a focus on healthcare and agricultural businesses, Bud was a con stant production leader with Mutual of New York and was recognized as Man of the Year in 1963. Randy Pierson joined his father’s agency in 1981 and began brokering with other highly rated companies. After a couple years of experience in the industry, he added a health benefits line to the agency. In 1996 Cyndy Pierson, Randy’s wife, joined the agency and began to grow the employee benefits side of the agency. After 2004, when Bud retired, Randy and Cyndy took over

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ICHRAs SEE TRIPLE-DIGIT GROWTH

The HRA Council Leander, Texas www.hracouncil.org

The HRA Council has released its inaugural HRA Report (www.hracouncil.org/report), an industry-wide snapshot of the uptake of newer models of Health Reimbursement Arrangements like the Qualified Small Employer HRA (QSEHRA), established in 2017, and the Individual Coverage HRA (ICHRA), established in 2020. The HRA Report highlights the phenomenal growth of these defined-contribution models and emphasizes their critical role in bolstering the health of the ACA marketplace, broad

ening access to quality care, and delivering more flexible benefits options for historical ly underserved and under-resourced small and midsize businesses. “Health Reimbursement Arrangements are a popular bipartisan policy solution to cover more Americans with affordable, quality health insurance,” said Robin Paoli, executive director of the HRA Council. “Employees are empowered to choose the coverage they want from respected region al and national insurers, and employers are

empowered to offer predictable, cost-ef fective benefits with fewer administrative burdens.” Not since the explosion of the 401K has there been an opportunity to transform employee benefits like ICHRA. Access to affordable health coverage is critical to attract and retain employees but, just as we don’t expect our boss to pick our grocery store or choose what kind of house we live in, we shouldn’t settle for a one-size-fits-all approach to employer-sponsored health care. This data shows that more employers are realizing the benefits of a predictable budget that helps their employees pick the robust benefits they need. HRAs are doubling on average among all states, with significant growth across all industries, types of employers and employee groups. Ninety-two percent of adoption is

ICHRAs, IN PARTICULAR, ARE EXTENDING BENEFITS TO TRADITIONALLY DIFFICULT-TO-INSURE GROUPS.

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