GPAHU Pulse – Dec 2019

GPAHU - Monthly State and Legislative Updates

Many people are working a second unpaid job providing care to a loved one, and it’s having a significant impact on their health, so employers need to take notice.  According to a recent study by the National Business Group on Health, one out of every four traditional employees is also a caregiver.  Of these people, 88% believe their health is affected by the strain of caregiving responsibilities. Data bears that out.  Caregivers are twice as likely to suffer from mental health conditions and chronic physical conditions personally. Being a caregiver puts a strain on people’s finances and impacts their workplace productivity too.  Brokers can show value by encouraging clients to be forward-thinking about the needs of caregivers, including support through innovative employee benefits strategies.



The Pennsylvania Health Insurance Exchange Authority Selects A Technology Vendor

The Pennsylvania Health Insurance Exchange Authority Board recently approved a seven-year contract with GetInsured. GetInsured will power the new state-based exchange’s technological, enrollment, and customer service platform.

GetInsured provides a technology platform for the state exchanges in California, Idaho, Minnesota, Nevada, and Washington.  Beginning with the 2021 plan year, they will serve the Pennsylvania state exchange too.  The cost of this contract is significantly less than what Pennsylvanians currently pay the federal government for participation in healthcare.gov. 

Finalizing this contract will help ensure that the Pennsylvania exchange will be fully operational for the 2021 plan year.  It will also allow the Exchange Authority Board to “better support insurance brokers and carriers, and also provide a more consumer-friendly shopping experience to help residents select the best health coverage available for their needs and budget.”

For the 2020 plan year, including the open enrollment season that began on Friday, November 1, and runs through Sunday, December 15, 2019, Pennsylvania will continue to operate as a State-Based Exchange on the Federal HealthCare.gov platform. 

PAHU representatives will be meeting directly with the Exchange  Executive Director, Zachary Sherman, on December 18, 2019. We will discuss the critical role health insurance agents and brokers will play with the state-based exchange once it is fully operational.  If you would like to be involved, contact GPAHU legislative chair Vicky Cagliola or PAHU legislative chair Jessica Waltman.

Pennsylvania Insurance Department Releases ACA Section 1332 Waiver Application for Public Comment

Pennsylvania is applying for a federal Affordable Care Act (ACA) Section 1332 waiver to create a statewide reinsurance pool to backstop high individual market claims.  As part of the federal waiver process, the Commonwealth is seeking public comment on its draft waiver application. 

The Pennsylvania Insurance Department believes a pool will positively impact individual market premium rates beginning with the 2021 plan year.  Lower health coverage costs will be particularly significant for people who do not qualify for federal premium tax credit subsidies. The program would work by using federal waiver funds and new exchange user-fee revenue to offset high individual market claims. By providing claims cost stability, the existence of the pool should allow carriers to lower individual market rates for all consumers. Comments are due on the draft application by Saturday, December 14, 2019. If you would like to help contribute to PAHU’s comment letter, reach out to GPAHU legislative chair Vicky Cagliola or PAHU legislative chair Jessica Waltman

Trump Administration Extends Employer Reporting Deadline and Releases New Transparency Rules

The Trump Administration released new regulatory guidance that will impact many employers that offer health benefits.  The Internal Revenue Service (IRS) extended a critical employer reporting deadline, and there are also new rules on healthcare price transparency.

According to Notice 2019-63, applicable large employers (ALEs) and self-funded health plans now have an extra 31 days to distribute Forms 1095 B & C to employees. The original January 31, 2020 deadline is now March 2, 2020.  The IRS also will provide good-faith compliance relief for specific employer reporting penalties for the 2019 period. However, the deadline to submit Forms 1094 B & C to the IRS remains unchanged.  Paper copies of Forms 1094 are due by February 28, 2020, and electronic submissions must be completed by March 31, 2020. 

The Administration also proposed new price transparency regulations that will impact almost every type of health insurance coverage offered nationwide. This proposal creates significant new compliance responsibility for all non-grandfathered health plans and employers that provide group health coverage, particularly most self-funded employer plans. Health plans, including self-funded plans, would need to develop a comprehensive online transparency tool for consumers.  They would also have to provide paper copies of consumer-specific price and cost-sharing information within two business days of receipt of a request.  Finally, plan sponsors would be required to make public machine-readable data files containing negotiated in-network rate information and historical data on out-of-network provider payments.

Employers with fully-insured coverage can transfer compliance responsibility to their carrier through a contractual agreement. However, self-funded plans retain compliance liability, even if they hire their claims-paying entity or another vendor to help them. NAHU will be providing formal comments to the Administration on the proposed rule by January 15, 2020.  If you would like to provide input, please contact GPAHU legislative chair Vicky Cagliola or PAHU legislative chair Jessica Waltman

Check This Out!

If you want to expand your health policy knowledge beyond this newsletter, here is a resource to check out!

Did you know that the Department of Labor’s Employee Benefits Security Administration has a wide range of free health plan tools available for your use?  Check out this comprehensive compliance checklist.


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