America's Benefit Specialist March 2023
NABIP’S LEGISLATIVE PRIORITIES M&A CONSIDERATIONS
NEW REPORTING REQUIREMENTS
Life Is Not Without Risk .
An infant with a 60-day NICU stay could exceed $1 million in costs. *
Amy didn’t think she’d spend her maternity leave with her baby in the NICU. Neither did her self-funded employer.
Catastrophic claims can arise unexpectedly. If the plan has the right Stop Loss protection in place, focus can remain on achieving business goals and welcoming Amy back when it’s time. When you work with the experts at HM Insurance Group, you can have confidence that the claims will be paid. Find more on hmig.com .
SECURE FINANCIAL PROTECTION WITH OUR INSURANCE AND REINSURANCE OPTIONS: Employer Stop Loss: Traditional Protection • Small Group Solutions • Coverage Over Reference-Based Pricing Managed Care Reinsurance: Provider Excess Loss • Health Plan Reinsurance
* Cost estimate based on HM Insurance Group historical Stop Loss data and additional industry observations, May 2022.
In all states except New York, coverage may be underwritten by HM Life Insurance Company, Pittsburgh, PA, or Highmark Casualty Insurance Company, Pittsburgh, PA. In New York, coverage is underwritten by HM Life Insurance Company of New York, New York, NY. The coverage or service requested may not be available in all states and is subject to individual state approval.
YOUR INDUSTRY 3 Employee Benefit
YOUR SALES 39 Travel Insurance in the Pre- and Post-COVID Worlds By Bradley Niederman YOUR ASSOCIATION 41 Gordon Award Nominations
Considerations during Mergers and Acquisitions By Stacy Barrow
5 Recent Mergers and Acquisitions 6 NABIP’s Legislative Priorities
42 Welcome to NABIP
43 CPC Quiz
13 Product News
45 Congratulations, Registered Employee Benefits Consultants!
18 Is It Just the Acronyms or Is It All Confusing to Employers? Part 2 By Dorothy Cociu 24 Insurance Websites Gone Wrong—10 Crucial Mistakes By Heather Sloan
46 NABIP’s Board of Trustees
47 Your NABIP Staff
48 Association Events
27 People on the Move
32 Industry Events
33 Medicare Matters
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VOLUME 70, NO.2
EDITOR Martin Carr (202) 595 0724
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The Rise of Telehealth Examining the Insurance Workforce Strategies for Reducing Prescription Costs
BENEFIT TRENDS FOR 2021
All About ICHRAs The Medicare Advantage OEP POP Documents
BENEFIT SPECIALIST L ST AM E R I C A’S Th e O f f i c i a l P u b l i c a t i o n o f t h e Na t i o n a l A s s o c i a t i o n o f H e a l t h Un d e r w r i t e r s i o r
CONVERT THE LOW-HANGING FRUIT IN YOUR BOOK OF BUSINESS
Solving Compliance Problems Managing Remote Employees NAHU Award Winners
NAHU’S LEGISLATIVE SUCCESSES
Anatomy of a Bill Medicare Matters Value-Based Care
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NABIP 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, Suite 400, Washington DC 20004. America’s Benefit Specialist (ISSN 2475-5826, publication no. 238660), 2022, volume 70, number 2 Published 10 times per year (January/February, March, April, May, June, July, August/ September, October, November and December) by the National Association of Benefits and Insurance Professionals, 999 E Street NW, Suite 400, Washington DC 20004. $25 annual subscription price is included in NABIP 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.
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EMPLOYEE BENEFIT CONSIDERATIONS DURING MERGERS AND ACQUISITIONS
By Stacy Barrow Partner, Barrow Weatherhead Lent LLP Boston, Massachusetts email@example.com
stock or ownership interest in another) or a merger (where two existing businesses merge). An important aspect of employee benefits compliance is determining whether the parties involved in a transac tion have sufficient common ownership so as to constitute members of a “controlled group” as described in Section 414 of the Internal Revenue Code. While a fulsome discussion of controlled-group rules exceeds the scope of this article, un der ERISA, a group health plan that covers employees of two or more unrelated employers is a multiple employer welfare arrangement (MEWA), which is heavily regulated under state and federal law. Therefore, counsel on both sides of a deal will typically advise against forming even a temporary MEWA as part of a transaction. In determining whether two or more employers exist, the Department of Labor does not recognize the IRS “affiliated service group” rules (unlike in the case of qualified retirement plans). This can catch some employers unaware and result in a so-called “accidental MEWA” if seller’s group health plan continues to cover its employees who transition to the buyer
Brokers and consultants are often asked to advise on employ ee benefits considerations for their clients who are involved in mergers and acquisitions. Employee benefits are heavily implicated in this space, and it is important to encourage employers to consult directly with their counsel for the deal to ensure all compliance touchpoints are considered. Generally, an M&A transaction will consist of an asset pur chase (where a party purchases some or all of the assets of another), a stock purchase (where a party purchases all of the PERHAPS THE MOST SIGNIFICANT ACA CONSIDERATION IN M&A TRANSACTIONS IS THE EMPLOYER SHARED RESPONSIBILITY PROVISION.
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EMPLOYEE BENEFIT CONSIDERATIONS
(unless COBRA applies). This is because, in some cases, a retire ment plan covering multiple entities may be treated as a single employer plan under the affiliated service group rules, whereas a group health plan covering the same group of employees would be a MEWA under DOL rules unless the requisite level of common ownership is met (generally at least 80%). A number of other employee benefit laws and regulations are also implicated as part of deals, including the ACA, CO BRA and nondiscrimination testing for self-insured medical plans, cafeteria plans and FSAs. AFFORDABLE CARE ACT Perhaps the most significant ACA consideration in M&A transactions is the employer shared responsibility provision (ESRP), which applies to employers with an average of 50 or more full-time-equivalent (FTE) employees in the prior calendar year. If there are two or more entities in a controlled group, then the 50 FTE count applies across the controlled group. Thus, it is important to have controlled-group status determined post-deal. For example, an M&A deal could con vert two non-ALEs into an ALE as of the start of the following year. Moreover, a deal between a non-ALE and an ALE can in stantly transition a non-ALE to an “ALE member” at the time of closing. In that scenario, the new ALE member must offer health coverage to avoid potential penalties. Note that while ACA reporting is performed at the EIN level, employers must identify all controlled-group members on Form 1094-C. It is also critical for buyers to review seller’s ACA reporting as part of the diligence process. If the selling entity is (or was) an ALE, buyer should request copies of Forms 1094-C and 1095-C filed with the IRS for all prior tax years (and confirm that forms were timely furnished to participants), any letters the employer may have received from the IRS related to their filings, and the current cost of coverage information so that an affordability analysis can be completed. This will give the buyer critical potential liability information to consider in the deal process. COBRA Federal COBRA rules require that health plans sponsored by employers with 20 or more employees allow employees to extend their benefits if they experience a loss of coverage after a qualifying event, such as termination of employment or reduction in hours. As with the ACA, COBRA obligations apply on a controlled-group basis. Further, COBRA generally applies to seller’s current CO BRA participants and its employees who experience a quali fying event as a result of the deal. As a general rule, if seller’s plan terminates due to the sale, then the buyer assumes the seller’s COBRA obligations for both current COBRA enrollees and seller’s employees who experience a qualifying event as a result of the deal. If the seller’s plan continues after the deal for a short period of time or longer, then the parties may
negotiate who assumes the COBRA obligation. For an asset deal, the default is that the seller is obligated to offer COBRA, so long as the selling group maintains a plan after the sale. This is the case even for employees hired by the buyer. FLEXIBLE SPENDING ACCOUNTS M&A transactions occurring during the seller’s plan year may result in complications for the seller’s health FSA. An M&A transaction mid-year will generally cut short the 12-month plan year of the seller’s FSA. When this happens, there are several options for the parties to consider: 1) Seller’s plan terminates early and employees make new elections under buyer’s plan. Unused amounts are forfeit ed upon termination. 2) Seller’s plan terminates early but, if the plan years are the same, seller’s plan may transfer FSA balances to buyer’s plan as described in Rev. Rul. 2002-32. (This treatment is available in both asset and stock deals.) 3) Seller’s plan completes its plan year and employees remain eligible. This approach is typically available in the stock deal context. There are pros and cons to all the above options, therefore, it is important for the buyer and seller to coordinate with counsel to determine the best approach. CONCLUSION These are some of the more common employee benefit plan issues to consider in M&A transactions. Other considerations include Form 5500 filing requirements and implications to retirement plans. Thus, it is important for employers to work with counsel knowledgeable on employee benefits issues when working through a business transaction.
Stacy Barrow is a partner at Barrow Weatherhead Lent LLP, a boutique employee benefits, executive compensation and employment law firm located in Boston. Stacy has been licensed to practice law for over 20 years and has been practicing law in private practice for 15 years. Stacy has extensive technical knowledge and experi
ence designing and implementing health and welfare plans that meet the numerous and intricate requirements of state and federal law. For the first five years of his career, Stacy served as in-house counsel to a prominent employee benefits and group health insurance brokerage and consult ing firm. He was an associate lawyer with K&L Gates and Proskauer Rose prior to co-founding Barrow Weatherhead Lent in 2015. Stacy holds a B.A. in Psychology from Brandeis University and a J.D. from Hofstra University School of Law and is licensed to practice in the Commonwealth of Massachusetts.
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RECENT MERGERS AND ACQUISITIONS
expands the agency’s presence in the Midwest Region of the United States. Clients of Brinch Agency will continue to be serviced by the team in the Roseville office, now working under Inszone Insurance brand. Founded in 2002 and headquartered in Sacramento, California, Inszone continues to grow organically, as well as through acquisitions. With 37 locations across California, Arizona, Nevada, Utah, Colorado, Michigan, Missouri, Tex as and Illinois, the company is looking to further expand throughout the United States. INTEGRITY ADDS DELONG SALES GROUP Integrity Marketing Group LLC has acquired DeLong Sales Group, an independent marketing organization based in LaGrange, Georgia. As part of the acquisition, Scott DeLong, president of DeLong Sales Group, will become a managing partner in Integrity. Financial terms of the acquisition were not disclosed. “Young, visionary leaders like Scott are the future of this industry,” shared Bryan W. Adams, co-founder and CEO of Integrity. “He has built a remarkable business by focusing on great service to his agents, who then provide exception al service to their clients. It’s an honor for Integrity to come alongside agencies like DeLong Sales Group and support them in reaching their highest potential.” DeLong Sales Group helps families achieve peace of mind as they prepare for the future by offering life insurance products coupled with expert guidance. Scott DeLong began his career in the industry as an individual producer com mitted to helping Americans feel secure by helping them understand the best products for their needs. In 2015, he established DeLong Sales Group with a foundational system of training and product expertise that positions agents for long-term success. For more information about DeLong Sales Group’s deci sion to partner with Integrity, view a video at www.integrity marketing.com/DeLong.
HUB INTERNATIONAL ACQUIRES GRACE & PORTA BENEFITS IN MICHIGAN Hub International Limited has acquired the assets of Grace & Porta Benefits Inc. Located in Brighton, Michigan, Grace & Porta Benefits is an independent agency specializing in em ployee benefits consultation. Jon Porta, president/CEO, Travis Porta, vice president/CMO, Josh Porta, treasurer/CFO, Dave Porta, secretary/CIO, and the Grace & Porta Benefits team will join Hub Midwest East. Grace & Porta Benefits was represented by Marsh Berry for the transaction. The transaction closed in 2022, and terms were not disclosed. INSZONE INSURANCE SERVICES CONTINUES GROWTH Inszone Insurance Services, a national provider of benefits, personal and commercial lines insurance, recently an nounced the acquisition of Mattis Insurance Agency. Found ed in 1998 by Derrick and Dalia Mattis, and located in Hous ton, Texas, Mattis Insurance Agency has provided protection for individuals, families and businesses throughout the state. The Mattis Insurance team will merge and continue to operate out of Inszone Insurance’s Houston location. Mattis Insurance customers can expect the same service they are accustomed to, now under the Inszone Insurance brand. “Texas continues to be an important geography for our agency, we are very happy to be strengthening our presence in the Houston area,” said Chris Walters, CEO of Inszone Insurance Services. Inszone also announced the acquisition of Brinch Agency Insurance. Brinch Agency Insurance was founded in 2001 by Chris and Kathy Brinch after managing a family-owned agency in Eastpointe for over two decades. Formed and located in Roseville, Michigan, Brinch Agency provides per sonal, commercial and health insurance to Macomb County and the surrounding areas. The acquisition of Brinch Agency provides Inszone In surance with its first location in the State of Michigan and
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LEGISLATIVE PRIORITIES NABIP’S T he National Association of Benefits and Insurance Professionals advocates on behalf of benefits and insurance professionals. The health insurance and benefits landscape has evolved, and so has NABIP’s role in supporting our members and their clients. Over the years, our membership has grown to encompass professionals who sell traditional health insurance products and those who offer non-traditional coverage options. The association has expanded its capabilities to respond to new marketplace dynamics, offering its members a growing selection of professional educational opportunities, network-building conferences and business-development tools. While our name has changed, our mission and vision remain the same: We believe that all Americans should be empowered to make wise healthcare and benefits decisions and have access to high-quality, affordable healthcare and related services. Here are NABIP’s legislative priorities for 2023 and beyond.
One of the single most important things Congress could do is ensure that the cost of a service does not vary based on where it is delivered. The price of the same X-ray, MRI or phy sician’s visit should not differ if it is delivered in a free-stand ing facility vs. an outpatient hospital setting. NABIP supports building on site-neutral rules to deter location-based gaming of coverage. Surprise medical bills—which have financially impover ished millions of Americans—have been addressed prelimi narily by enactment of the No Surprises Act. With constant legal challenges to the final rules, consumers are left in limbo as to how the law will be enforced, which is leading to increasingly large requests for arbitration and a backlog in the system to resolve surprise bills. NABIP supports action that would stabilize the enforce ment of the No Surprises Act so that the process can be more predictable. The present and growing cost of pharmaceutical and biological therapies is as much a threat to both private and
ADDRESS THE COST OF CARE Rising healthcare costs are the greatest challenge in health care coverage today. Rising costs mean higher health-plan costs. Small-business owners have cited this as a leading challenge for more than 30 years. Medical care from doc tors, hospitals and other medical providers has grown more expensive, as have prescription drugs and biologics. One of the most significant items contributing to high er costs today is consolidation of providers, whether it is merging hospital systems or hospital systems’ purchase of physician practices and other ancillary services providers. Numerous studies have shown that when these mergers occur, prices go up. This drives up costs in all markets, includ ing Medicare, leading to an increase in federal spending for covering these higher-cost services. NABIP strongly supports greater Congressional over sight of the Federal Trade Commission review of hospital and physician practice consolidation.
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NABIP’s LEGISLATIVE PRIORITIES
Under fully insured coverage, employers purchase a plan that meets federal Affordable Care Act requirements as well as other state regulations. These plans still offer the benefits of employer-sponsored coverage and the natural pooling it creates, but employers do not bear the full financial risk of claims. Regardless of funding arrangement, employers still hold a fiduciary interest in the cost and quality of coverage under ERISA. Employer-sponsored coverage—whether self-insured or fully insured—holds a distinct advantage over coverage sold in the individual market. Workplace-based coverage groups together employees without regard to their health status. These pools tend to be more stable over time and more predictable, leading to lower premium trends than other pooling arrangements. Controlled entry and exit from the plan, employer contributions and the ability of younger, healthier employees to offset the cost of older or less-healthy employees helps keep coverage more affordable across the entire workforce. This natural pooling of employees in the private sector is more affordable and effective than pools in which less-healthy individuals have a greater incentive to join than do healthier ones. UPHOLD THE TAX TREATMENT OF EMPLOYER SPONSORED COVERAGE For decades, employees and employers have benefited from the preferences in the Tax Code that exclude the employer’s contribution toward employment-based health coverage from being considered compensation for tax purposes, allow NABIP OPPOSES LEGISLATION THAT WOULD ONLY CAP OUT-OF-POCKET COSTS FOR EMPLOYEES WITHOUT ADDRESSING THE COST OF THE DRUG ITSELF.
public coverage as it is essential to modern healthcare. Phar maceutical manufacturers, pharmacy benefit managers and others are often wrapped up in a convoluted and mutually dependent web that adds needless complexity to coverage. Greater transparency and innovative solutions are needed to ensure that these life-saving drugs can continue to be avail able when they are needed. NABIP supports additional steps to improve transpar ency and greater oversight and regulation of the pharma ceutical supply chain and the current patent-approval pro cess, and the ability to extend patent exclusivity through incremental changes. Prices for insulin are unsustainable, particularly when compared to the cost of manufacturing insulin. While the federal government has the ability to negotiate high-cost drugs, allowing a cap on copays for Medicare beneficiaries to be feasible, such an approach in the private-plan market, including employer-sponsored plans, shifts the high cost of insulin to the plan but does nothing to address the cost of insulin overall. We strongly encourage Congress to employ additional oversight and other means of addressing this problem comprehensively rather than merely capping the out-of-pocket cost in private plans. NABIP opposes legislation that would only cap out-of pocket costs for employees without addressing the cost of the drug itself. PRESERVE AND STRENGTHEN EMPLOYER SPONSORED HEALTH COVERAGE Employer-sponsored coverage has been the backbone of our nation’s health system for more than 80 years. Businesses of all sizes contribute vast financial, administrative and other re sources to employees and their families through the employ er-sponsored system and have a vested interest in healthcare quality, value and system viability. Benefit offerings and cov erage plans in the employer-sponsored system are as diverse as employers and employees themselves. Employers may choose to self-insure or purchase one or more fully insured plan options for their employees. With self-insured coverage under ERISA, employers tailor coverage to meet their workforce’s specific needs regardless of their work or home location. Many employers operate in multiple states with employee populations in each. Self-insured cov erage allows a common benefit plan for all of these employ ees. These employers pay all healthcare claims and bear the financial risk of claims made by covered employees under the plan. Employers often utilize a third-party administrator for plan management and, in most cases, rent provider and pharmaceutical networks, secure stop-loss coverage, and secure other vendors to ensure quality plan operation. Most important, employers maintain a fiduciary interest under ERISA in the cost and quality of coverage for their employees.
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for the pre-tax payment of an employee’s premiums for em ployment-based health coverage, and enable employers to deduct the cost of health coverage as a business expense. The direct benefits and federal spending offsets of employer- provided coverage result in an annual net social impact of $1.5 trillion, driven by increased labor participation, business formation, increased health coverage and reduced federal health subsidies. Each dollar of federal expenditure—the tax revenue foregone for employer-provided coverage—yields approximately $5.34 in benefits for covered employees and their families, according to the National Bureau of Economic Research. Capping or eliminating the tax exclusion of employer-spon sored coverage for individuals has been seen by some as a way to raise federal revenue and/or offset the cost of other federal reforms or programs. A cap on the exclusion does not address rising medical costs or limit utilization of medical ser vices and will stifle private-sector innovation of benefits and delivery designs. To tamper with the current tax treatment of employer-sponsored coverage would be especially devastat ing to businesses and American workers, which could lead to the highest increase in taxes to middle-class Americans in decades. NABIP strongly opposes capping or modifying the in dividual tax exclusion of employment-based coverage as that would be a direct tax increase on working Americans and their families. PROVIDE EMPLOYERS WITH COMPLIANCE RELIEF FROM BURDENSOME REGULATIONS The ability to offer coverage to employees and the capacity to operate a business for its core purpose are not mutually exclu sive functions. An employer’s offer of coverage is not merely a transaction in which an employee fills out paperwork, enrolls in coverage and receives an insurance card. It is a multifacet ed fiscal and operational commitment at the core of any busi ness. As employers are making the decision to offer coverage and determine which type of coverage to offer their employ ees, the administrative compliance costs and complexities associated with coverage is critical to their consideration. The compliance requirements under the ACA have always been complex and administratively burdensome on employ ers. The workforce changes wrought by COVID-19 continue to further challenge employers. NABIP has long advocated bipartisan legislation to provide a more streamlined approach to the IRS employer infor mation-reporting requirements, the employer mandate definitions of full-time and seasonal employment, and the large-business threshold. The ACA tax policy rules fundamen tally altered business operations and continue to be costly and burdensome. Following the 2022 regulatory actions by HHS, IRS and the DOL to fix the “family glitch,” it is more important than ever
Our Legislative and Regulatory Successes during the 117 th Congress Legislative 4 NABIP supported key provisions in the American Res cue Plan Act that: • extended the employer retention credit previously established by the CARES Act, allowing employers to keep employees on their payrolls and enrolled in employer-sponsored coverage. • extended ACA subsidies to higher-income indi viduals and increased the amount of available subsidies to lower-income individuals, allowing an increase in access to coverage. • temporarily eliminated the ACA “subsidy cliff” and extended tax credits to those with incomes above 400 percent of the federal poverty level for 2021 and 2022. • eliminated the Medicaid drug rebate cap that could have had unintended consequences of increasing drug costs. 4 Following NABIP’s advocacy during our 2022 Capitol Conference, Congress extended the special provision put in place during the pandemic to allow the use of HSA funds for telehealth services from March 2022 to January 1, 2023. • Congress later acted with our support in the 2022 end-of-year omnibus bill to extend this provision through January 1, 2025. This will extend access to care, specifically mental health care. 4 NABIP advocated for the 2020 passage of the 988 system to build on the National Suicide Prevention Lifeline that went live in 2022. Congress designated the hotline, which will build on the National Suicide Prevention Lifeline, an existing network of over 200 crisis centers nationwide staffed by counselors who answer millions of calls each year. 4 NABIP actively negotiated aspects of the Inflation Reduction Act to include: • extension of ACA subsidies previously approved by ARPA • capping Part D out-of-pocket expenses at $2,000 • allowing the HHS secretary to negotiate drug costs for Medicare • capping Medicare insulin costs at $35 4 NABIP actively negotiated aspects of the Inflation Reduction Act to exclude: • lowering the Medicare eligibility age to 60, effec tively creating a public option
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for Congress to pass the Commonsense Reporting Act to en sure that only those individuals who do not have an “afford able” offer of coverage from an employer receive a tax credit. Currently, HHS, IRS and DOL rely on employer data reported after the plan year to reconcile whether an individual appro priately received a subsidy. The IRS then seeks to recoup any excess in subsidy that was distributed through an increase in taxes to the individual. This is a long, burdensome and con fusing process for consumers and could be avoided with the Commonsense Reporting Act if employers were to report at the beginning of the plan year what they are offering to em ployees, their spouses and dependents so that the IRS would know before distributing a subsidy whether the individual has an affordable offer of coverage from an employer. This would be a huge benefit to consumers in both the individual and employer market while streamlining the system for the federal government to ensure compliance with the employer mandate and confirming eligibility for individual subsidies in the marketplace. Reforming the reporting requirements with the Com monsense Reporting Act would provide a more consum er-friendly process for individuals and a less burdensome and costly compliance process for employers, the federally facilitated and state-based exchange systems, and the IRS. PROMOTE INNOVATION AND DIVERSITY OF PLAN DESIGNS AND OFFERINGS FOR EMPLOYEES Employers have led the way in benefit design and innova tion for decades and will continue to do so for many years to come. There is no one-size-fits-all employer health plan, nor should the federal government enact or implement laws to undercut ERISA and stifle an employer’s ability to develop benefit offerings that meet the specific workforce’s needs, regardless of where that workforce is located. A recent example is the onset of the pandemic, which presented immense challenges to the workforce. During that time, many employers expanded the ways through which en rollees could get mental-health or substance-abuse services, and others developed new resources, such as employee- assistance programs.. All levels of government should work constructively with private-sector employers to ensure that they have the tools and flexibility to foster benefits design and innovations that provide employees with benefits that are crucial to their wellbeing. We urge Congress to remove barriers for employers to participate in innovative payment initiatives, such as direct contracting, centers of excellence and high- performance networks. NABIP appreciates the policies adopted during the pan demic to help employees and employers, including expand ing telemedicine availability to employees, enabling employ ees to roll over unused Flexible Spending Account funds,
• lowering the employer affordability calculation to 8.5%, which would have increased the cost of employer-sponsored coverage • civil monetary penalties on employers for noncompliance with network adequacy for mental health parity 4 NABIP worked hand in hand with Senator Mike Rounds (R-SD) to introduce legislation that would explicitly ex clude independent agents and brokers from the current Medicare recording requirement. The bill is expected to be introduced in the 118th Congress. 4 NABIP supported provisions in the 2022 Omnibus Bill: • allowing individuals to be able to pay up to $2,500 each year for long-term care insurance with their 401(k)s, 403(b)s and IRAs without a 10% early- withdrawal penalty tax. • extending HSA telehealth flexibilities through January 1, 2025. 4 NABIP fought tirelessly to exclude from any large legislative packages provisions that would limit the use of Medicare as a secondary payer for end stage renal disease and instead shift the cost to employers. Regulatory 4 Following the 116th Congress’s passage of the No Sur prises Act, NABIP successfully impacted regulations for the implementation of the Act to use the qualified payment amount (QPA) during the independent dispute resolution process, which NABIP believes will drive down the costs negotiated for these surprise bills. 4 The No Surprises Act also included provisions requiring agents and brokers earning over $1,000 in commissions in the individual and employer markets to disclose their earnings to clients prior to enrollment. The language of the Act left many unanswered questions about im plementation, and upon request from NABIP, the DOL released a set of FAQs and a good-faith standard of enforcement for the employer market. 4 Days after being sworn in, President Biden released an executive order allowing for a special enrollment period during the national health emergency for the federal marketplace. NABIP had been advocating for this since the pandemic began in 2020. 4 After opposing the previous administration’s drug-re bating rule because of unintended consequences that could lead to higher costs in the prescription drug market, the Biden Administration rescinded the final rule.
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allowing for first-dollar coverage of COVID-19 testing and treatment under a high-deductible health plan, and treat ing health expenses as an employment expense under the employee retention tax credit. These provisions have begun a path toward lowering the cost of healthcare that this Con gress should build upon to provide employers with the ability to enhance employee coverage permanently. NABIP also urges action on bipartisan legislation to increase affordable options for patients and employers. Be cause the cost of care has increased, health-plan deductibles have also increased in an effort to keep the cost of coverage affordable. Many of the most creative plan designs allow access to primary care before the deductible has been met to ensure that covered individuals can get the coverage they need early before their condition becomes more severe. Un fortunately, these innovative plan designs don’t qualify to be paired with a Health Savings Account, which would be a very cost-effective way for covered individuals to pay for out-of pocket expenses. HSAs were created nearly 20 years ago, but regulations that define a qualified high-deductible health plan that can be used with an HSA have not kept pace in today’s changing benefits landscape. Modernize the definition of an HSA-qualified high- deductible health plan to allow primary care visits before application of the plan deductible. PROTECT MEDICARE BENEFICIARIES FROM PREDATORY MARKETING New Medicare marketing regulations, which officially went into effect on October 1, made significant changes to existing marketing requirements for both Medicare Advantage and Part D plan-marketing requirements that NABIP believes will be ineffective and place consumers in the hands of those entities CMS is trying to protect them from. The regulation seeks to account for unscrupulous marketing behaviors by requiring third party marketing organizations (TPMOs) to record all enrollment conversations. The final rule’s definition of TPMO, however, is overly broad and includes independent Medicare agents and brokers, needlessly impacting agents who are acting responsibly. NABIP supports legislation to explicitly exclude indepen dent agents and brokers from the current requirement to record calls with beneficiaries, in addition to any future regulations that relate to recording calls with beneficia ries. NABIP recognizes the increase in unscrupulous actors in the Medicare market; however, the CMS regulations re leased last year do not adequately address these entities and inappropriately target licensed and certified agents and brokers committed to acting in the best interest of Medicare beneficiaries. For more information about our legislative priorities, visit www.nabip.org/advocacy.
4 There is a delay in the Consolidated Appropriations Act (CAA) Transparency in Coverage (TiC) require ments that machine-readable files be released by plan sponsors to indicate in- and out-of-network costs of care. NABIP advocated for a delay because plan spon sors would not have been able to comply with the law without further guidance beyond what was included in the CAA. • NABIP subsequently requested and received TiC guidance on allowing carriers to post ma chine-readable files for plan sponsors with specific rules for fully funded versus self-funded plans. This lifted a huge burden from some plan sponsors that were struggling with compliance without the assis tance of a carrier. 4 NABIP was successful in receiving a delay in the CAA’s prescription drug-reporting requirements accompanied by specific reporting standards and definitions, including identifying prescription drugs regardless of the dosage strength, package size or mode of delivery. Additionally, the guidance clarified the role of the PBM, requiring PBMs to provide any information they have on the top 25 drugs generating the highest rebate amounts. 4 NABIP won a long-fought victory when CMS released a new FAQ document that clarified that a health insur ance issuer cannot treat commissions on individual en rollments during a special enrollment period differently than commissions on enrollments during the open- enrollment period. 4 Since the inception of the ACA, NABIP has advocated for a fix of the “family glitch.” The Biden administration released a final rule to do just that, but also responded adding a section that directly addressed NABIP’s con cerns about a potential conflict between the affordability rules and the cafeteria plan rules by issuing guidance in IRS Notice 2022-41, which permits employers to amend their Section 125 plans to allow eligible dependents to drop their group coverage midyear in favor of subsidized individual exchange coverage. 4 NABIP continues to advocate for changes to the CMS Medicare Marketing Rule. NABIP was successful in re questing CMS to provide official written clarification on several questions that NABIP and our members have posed to the agency since the rule became final. 4 With NABIP’s support, CMS altered the timeline for Medicare coverage eligibility. Under the final rule, Medicare coverage would become effective the month after enrollment for individuals enrolling in the last three months of their initial enrollment period, thereby reducing any potential gaps in coverage.
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Nonstop Administration and Insurance Services, Inc. (Nonstop) offers an employer sponsored health insurance solution that enables brokers to help their clients get more out of their health insurance investment. Built with the mission to reduce the cost of healthcare for employees without sacrificing health benefit quality, we help contain costs for the employers and help our broker partners bring a competitive option to their clients. Similar to an HRA, Nonstop administers a section 105 Medical Expense Reimbursement Plan (MERP). We pair an ACA compliant HDHP with a level-funded MERP and a back-end warranty, and integrate a financial dashboard for employers, employees and brokers. The results are that we’re able to upgrade health benefit plans with first-dollar coverage for the employees and known financial outcomes for the employer.
Bring a competitive advantage to your business. • Better benefits for less means your clients can promote their health benefits as a key part of their compensation package and improve recruitment and retention. • Eliminated or reduced out-of-pocket costs make for happier, healthier, and more financially solvent employees. • Nonstop broker support can help with a number of tasks, from co-presenting, to open enrollment meetings and member education.
Nonstop Administration and Insurance Services, Inc. 1800 Sutter St., Suite 730 Concord, Ca 94520 1.877.626.6057 nonstophealth.com
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BLUE SHIELD OF CALIFORNIA LAUNCHES VIRTUAL BENEFIT PLAN
MUTUAL OF OMAHA OFFERS DENTAL INSURANCE CUSTOMERS EXPANDED RESOURCES THROUGH GO2DENTAL
Blue Shield of California recently unveiled its Virtual Blue health benefits plan offering members easy-to-access care through a team of “virtual-first” primary, behavioral and spe cialist healthcare professionals. In addition to virtual care, members can access Blue Shield of California’s statewide PPO network for in-person care, plus national BlueCard and global GeoBlue coverage when care is needed outside of California. The plan, effective April 1, 2023, is now available to be selected by Blue Shield’s employer customers as a benefits offering for employees. Key features of Virtual Blue include $0 out-of-pocket cost (no copay, nor deductible charges) for the following virtual care services: • primary care, including pediatrics, family medicine and internal medicine • specialty care that includes 20 specialties • integrated mental health care for members ages four and older, including access to psychologists, psychiatrists, licensed clinical social workers (LCSW), and marriage and family therapists (MFT) • 24/7 urgent care The benefit plan offers simple online booking for virtual appointments. Copays and deductibles will apply when using an in-person provider or a virtual provider outside of Virtual Blue’s platform. In Accolade’s Advanced Primary Care model, physicians work with a team of certified health coaches, care coordi nators, and nurses who help members pursue health and wellness goals, manage chronic conditions and coordinate specialty and in-person care. Virtual Blue members can choose an Accolade primary care physician based on criteria such as gender, race, years of experience and language. All virtual care, including mental health and specialty care, is available on a single platform. Accolade’s virtual primary care physicians have achieved a 90% patient satisfaction score. Virtual Blue also offers 20 types of virtual specialists through California-based TeleMed2U. Members preferring in-person provider visits can still access Blue Shield’s Tandem PPO Network of nearly 40,000 physicians across California. While virtual care accessed through the Virtual Blue platform comes at no out-of-pocket cost to the member, copay and deductible costs will apply for in-person care and virtual care outside of the platform. To learn more, go to www.blueshieldca.com/virtualblue.
Mutual of Omaha is now offering dental insurance custom ers an enhanced all-in-one online resource center through go2dental. Customers who have Mutual of Omaha dental coverage through their employer can now access the Dental Wellness Center through Mutualofomaha.com/dental. These tools will empower members to make more informed decisions related to their dental health care and before they receive treatment. Features include: Find a Dentist—Search the extensive directory to find a dentist in your dental plan network. Dental Insurance Basics—Learn more about dental insur ance and how it works. Risk Assessments—Take a quiz to see if you are at a higher risk for certain oral conditions. Ask a Dentist—Email a dentist your dental-related ques tions. It’s free and a dentist will respond within 48 hours. Dental Care Resources—Access a dental library with videos of procedures, a terms glossary and other information to help you prepare for your visit or consultation and better understand your dental health. Dental Health News—View the latest dental health related articles. “Dental insurance is an important part of the formula for employer-provided coverage, so we are extremely excited to expand our services for this product,” said Scott Ault, execu tive vice president, workplace solutions at Mutual of Omaha. For more information, visit www.mutualofomaha.com. HIGHMARK BLUE SHIELD TO OFFER SUITE OF HEALTH INSURANCE SOLUTIONS IN SOUTHEASTERN PENNSYLVANIA Highmark Blue Shield (Pittsburgh) plans to strengthen its statewide presence and community-focused service by offer ing a wide range of health insurance solutions in Southeast ern Pennsylvania starting in 2024. Highmark Blue Shield plans to offer customers located in Southeastern Pennsylvania a full suite of health insurance products and solutions including Medicare Advantage, Medicaid dual-eligible, Individual Affordable Care Act, small-
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group ACA, large-group fully insured and large group self-in sured across 2024 and 2025, subject to regulatory filings. For more information, visit www.highmark.com.
PIVOT LAUNCHES DIGITAL SOLUTION FOR MENTAL WELL-BEING Pivot, a behavioral change digital health company, has announced the launch of Pivot Flex, a digital health solution employers and health plans can offer their employees and members to help themmanage everyday stress and build resilience to improve their mental well-being. A natural evolution of Pivot’s offerings, Pivot Flex is based on the successful behavioral change model established with its flagship solution, Pivot Breathe, for tobacco cessation. Stress is the number-one reason people smoke, and the com pany realized that skills, lessons, and support offered through Pivot Breathe could be applied to a much larger population impacted by the health crisis of stress and burnout. Pivot Flex is a mobile app and set of tools built on sever al proven tenets to address everyday stress. The platform provides board-certified health coaches, connection to a supportive community of fellow users, and challenges, tools and resources, such as the Flex Assessment, to help users track progress, develop strategies and become more resilient to the daily stressors we all face. Pivot Flex also supports employers and health insurers with insights into measurable data and outcomes they can tie into their strategic goals. “Did you know more than 70% of us are reporting insur mountable stress, leading to burnout and feeling out of con trol?” said David Utley, M.D., Pivot’s founder and CEO. “Having a dedicated coach to advise and guide you, a community around you, so you know where to turn and don’t feel alone, and ample ways to learn, challenge and practice to build new skills—that’s what Pivot Flex offers. We want to support hu man beings struggling with the challenges of everyday stress.” Employers and health insurers benefit too. Resilient indi viduals are likely to take fewer sick days, experience fewer stress-related healthcare claims, be more productive, and report greater job satisfaction. For more information, visit https://pivot.co/mental-well-being.
BENEFITMALL EXPANDS KAISER PERMANENTE RELATIONSHIP TO CALIFORNIA BenefitMall announced an expansion of its relationship with Kaiser Permanente to serve as a general agency in California beginning February 1. Kaiser Permanente members benefit from doctors, hospitals, digital tools and specialty services that are all connected to deliver patient-centered care. BenefitMall has served as a general agency for Kaiser Permanente in Colo rado, Georgia and the Mid-Atlantic for more than 10 years. “BenefitMall is proud to become a general agency for Kaiser Permanente in the California market, adding to our strong portfolio of products,” said Tiffany Stiller, BenefitMall vice president for carrier relations. “The opportunity it pres ents to elevate our service to our broker and carrier partners.” For more information, visit www.benefitmall.com. LIVELY GROWS NATIONWIDE BENEFIT SOLUTIONS NETWORK TO HELP BROKERS AND CONSULTANTS Lively Inc., a benefit solutions provider known for creating the modern HSA, recently announced the expansion of its na tionwide benefits network for employee benefits brokers and consultants. The network will give its members access to dis counted products, 360-degree service, and in-person events to help augment their benefits offerings and bottom line. In 2022, businesses went from needing to load up on perks and compensation to attract talent (84% of HR leaders in creased benefits to attract and retain employees, according to Lively’s Employee Benefits Pulse Check) to having to ensure they meet their employees’ needs in the wake of a volatile labor market, inflation pressures and rising healthcare costs. In 2023, benefits brokers and consultants are well-positioned to take a proactive, consultative approach to their client relationships and offer benefits options that give their clients, and their employees, opportunities for greater flexibility and savings. Lively’s network is a tool to help them do that. Lively’s products now cover a broad range of health and wellness categories, both pre- and post-tax, that will help em ployers offer timely and easy-to-use benefits to their employ ees without breaking the bank: HSAs, FSAs, COBRA, HRAs, Lifestyle Spending Accounts and Medical Travel Accounts. To learn more, visit www.livelyme.com.
CVS HEALTH LAUNCHES VIRTUAL PRIMARY CARE OFFERING, EXPANDS ACCESS TO MENTAL HEALTH SUPPORT The increasing need for digital innovation and better access to healthcare post-pandemic has led to a massive shift in how care is delivered. People now have more options in how they access their care, whether it be virtually, in-person or a combination of both. According to a recent CVS Health Care
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of nurse practitioners and licensed clinical social workers. In addition, members seeking mental health services will have the ability to consult with psychiatrists. Members can easily access their health information, includ ing lab results and medications, on the CVS Health Dashboard and they can share their clinical data with other clinicians. The dashboard will also enable the care team to have a compre hensive view of care activity across different sites of care.
Insights Study, 59% of consumers feel it is important to their health that they have access to virtual and telehealth ser vices. Over 71% think a virtual visit for mental health services would be more convenient. CVS Health Virtual Primary Care is a new virtual care of fering that provides primary care, 24/7 on-demand care and scheduled mental health services. If in-person follow-up care is needed, a patient can seek care at any in-network provider, including MinuteClinic. This program is now available to Aetna commercial mem bers nationwide enrolled in eligible fully insured and self-in sured health plans. Members can schedule a primary care visit within days with a provider they select and access 24/7 quick care for common illnesses and infections. Through this launch, CVS Health is also expanding its virtu al mental health services. Members ages 18 and up enrolled in CVS Health Virtual Primary Care will now have access to virtual mental health support nationwide, seven days a week, from clinicians, including licensed therapists and psychiatrists. CVS Health Virtual Primary Care has a dedicated practice of board-certified physicians and nurse practitioners who help deliver primary care services through physician-led care teams. These physician-led care teams can consult with CVS pharmacists to better support patients. To deliver on-de mand and mental health services, this dedicated practice is supplemented by our MinuteClinic providers consisting
ALLIANZ PARTNERS NOW OFFERS “CANCEL ANYTIME” COVERAGE UPGRADE ON ITS MOST POPULAR TRAVEL INSURANCE PLANS Allianz Partners USA is now offering more flexibility to its customers with the addition of an optional Cancel Any time upgrade to its most popular plans, OneTrip Prime and OneTrip Premier, allowing customers to cancel their trip for almost any unforeseeable reason. OneTrip Prime and OneTrip Premier are among the travel-protection products available on AllianzTravelInsurance.com. Many standard travel-insurance policies often include trip-cancellation benefits, which may reimburse up to 100% of prepaid, non-refundable expenses if the trip is cancelled
WHO IS THE BROKERAGE, INC.? The Brokerage, Inc., National Insurance Marketing Organization specializing in life, health and accident products, was founded in 1976. We are proud to partner with carriers that offer Ancillary, Annuity, Health, Life, and Accident products and marketing services to over 20,000 actively appointed Independent agents nationwide effectively across the country. Agency contracts are also available.
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6200 Stone Hill Farms Parkway | Flower Mound, Texas 75028 Phone: 800-442-4915 | Fax: 469-635-6001 | firstname.lastname@example.org
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