GPAHU Pulse – March 2023

GPAHU - Monthly State and Legislative Updates

Here’s something to talk about when discussing plan design options and employer contribution strategy with group clients in the New Year.

According to findings of the Employee Benefit Research Institute (EBRI)/Greenwald Research Consumer Engagement in Health Care Survey, 19 percent of respondents reported being enrolled in a health savings account (HSA)-qualified high deductible health plan (HDHP) in 2022. Enrollment in health plans with high deductibles not eligible to be paired with an HSA was 12 percent in 2022, according to the survey. Other findings include:

  • Younger people are more likely to enroll in traditional health coverage, while older people are more likely to be in an HDHP or another high deductible plan.
  • Men are more likely to enroll in an HDHP or other high deductible plan, while women are more likely to be in traditional health coverage.
  • People in lower-income households are more likely to enroll in traditional health coverage, while those in higher-income households are likely to be in an HDHP or another high deductible plan.
  • College-educated individuals are more likely than individuals without a college degree to be in an HDHP or another high deductible plan.
  • Married individuals are more likely than individuals who were never married to be in an HDHP or another high deductible plan.

Source: EBRI Fast Facts, March 9, 2023

The Big Three

Each month GPAHU identifies three top public policy or legal developments that could impact our members and clients.  Here are this month’s big three!

PA Legislature Begins To Act on Insurance-Related Matters

The Pennsylvania legislature is finally getting down to the business of governing. The Housed of Representatives is fully organized under the slimmest of Democratic majorities, and Representative Kevin Boyle (D-172) will serve as the Chair of the House Insurance Committee. Representative Tina Pickett (R-110) will serve as the Republican Chair.

In the Senate, John DiSanto (R-15) is the Chair of the Banking and Insurance Committee, and Senator Sharif Street (D-3) is the Minority Chair. The Committee has already approve S.B. 8, a measure to eliminate cost-sharing for genetic testing for breast and ovarian cancer in fully insured health policies and for supplemental screenings for women with a high risk of breast cancer. In addition, the Banking and Insurance Committee is considering association health plan legislation in S.B. 504. It is expected that other measures the legislature may consider this year will include cybersecurity requirements for the insurance industry, telehealth legislation, and a measure to allow mid-sized employer groups to access de-identified health claims data. In addition, the Medicaid redetermination process, which could impact the coverage status of hundreds of thousands of Pennsylvanians will be a focus. GPAHU and PAHU will be watching all of these measures closely.

New Gag Clause Compliance Obligation for Group Health Plans

“Gag clauses,” which restrict disclosures of provider-specific cost or quality information, or electronic access to deidentified claims data, have been prohibited in healthcare provider contracts with group health insurance plans and their service providers since the Consolidated Appropriations Act, 2021 became law on December 27, 2020. However, it was only recently that federal FAQ guidance made it clear group health plan sponsors will need to file annual attestations with the federal government noting that none of their contracts include such clauses. The first attestations will be due by December 31, 2023. However, it is very important to note that employers who sponsor group health plans may delegate this task to either their health insurance carrier or third-party claims administrator (TPA).

While the legal obligation to file the attestation does ultimately rest with each employer sponsor of group health coverage, health insurance carriers may satisfy the attestation requirement on the behalf of fully insured group clients. Businesses offering self-funded and level-funded coverage may contract with a health insurance issuer offering administrative services to their plan, or their TPA, to complete the annual attestation. GPAHU members can show value to their group clients by helping them get written confirmation that their carrier or TPA will not include gag clauses in any of their contracts with providers, and that they will file attestations on behalf of group clients.

IRS Sets 2024 Employer Plan Penalty Amounts

The Internal Revenue Service just released employer mandate penalty amounts for the 2024 calendar year.  The “no coverage” penalty, which is assessed when an applicable large employer (ALE) does not offer 95% of its full-time employees and their dependent children minimum essential coverage, will be $2,970 per full-time employee minus the first 30 employees, in calendar year 2024. The fine for an ALE not offering full-time employees’ coverage that meets federal affordability and minimum value standards will be: (1) $4,460 for each full-time employee without access to group affordable and/or minimum value coverage receiving a federal subsidy for exchange-based individual coverage, or (2) $2,970 per full-time employee minus the first 30, whichever is less. The trigger for employer mandate penalties is if at least one full-time employee obtains subsidized exchange-based coverage instead.  These two base penalty amounts were originally set at $2,000 and $3,000 when the Affordable Care Act became law in 2010, but have been adjusted for inflation every year since 2015, when employer-mandate enforcement began.

Check This Out!

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

The Center for Connected Health Policy is the federally designated national telehealth policy resource center. Click here to find out how Pennsylvania’s telehealth laws and regulations work with federal requirements.

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