GPAHU Pulse – November 2023

GPAHU - Monthly State and Legislative Updates

Here is something to mention when discussing cost and benefit trends with clients in the month ahead.

The average annual premium for employer-sponsored health insurance in 2023 is $8,435 for single coverage and $23,968 for family coverage. The average annual single premium and the average annual family premium each increased by 7% over the last year. Comparatively, there was an increase of 5.2% in workers’ wages and inflation of 5.8%2. The average single and family premiums increased faster this year than last year (2% vs. 7% and 1% vs. 7% respectively).
Source: Kaiser Family Foundation, “2023 Employer Health Benefits Survey,” October 18, 2023. Available online at: https://www.kff.org/report-section/ehbs-2023-section-1-cost-of-health-insurance/

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!

The Pennsylvania Department of Insurance (PID) released Bulletin 2023-16, on November 4, 2023

The Pennsylvania Department of Insurance (PID) released Bulletin 2023-16, on November 4, 2023, which establishes that in order to meet mental health parity requirements, all commercial health insurers in the Commonwealth offering fully-insured major medical coverage that includes any autism service benefits must provide complete coverage for autism spectrum disorders no later than January 1, 2024.

The new directive from Governor Shapiro and the PID makes it clear that autism services are mental health services with full parity protections. It requires insurers to handle claims for autism services in a manner that complies with the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) and Pennsylvania’s mental health parity requirements. 

Most of the major health insurers offering comprehensive health insurance in Pennsylvania already treat autism as a mental health condition, subject to parity requirements. However, some classify it as a medical condition that does not qualify for parity protections. PID’s Notice directs the remaining insurers to adjust their insurance policy form language and claims handling processes to provide Pennsylvanians with autism the protections afforded by the mental health parity provisions.

When announcing Bulletin 2023-16, Insurance Commissioner Mike Humphreys also announced his intention to diligently monitor the compliance efforts of insurers in the state regarding coverage of autism services. “We share this message with the entire autism community,” Humphries said. “If you are getting denials for services or running up against unfair coverage limitations, we encourage you to reach out to us. The Shapiro Administration wants to support you and work with you and your insurer to avoid mental health parity violations and to help you live healthy and productive lives.” 

Open enrollment season has begun for Pennie, Pennsylvania’s health insurance marketplace.

Pennie’s Open Enrollment Period began on November 1, 2023, and the deadline to enroll in coverage that will start New Year’s Day is December 15.

According to Pennie Executive Director Devon Trolley, “the Philadelphia region has more people without coverage than any other part of Pennsylvania. This means that more people are missing out on important medical care to prevent and manage serious illnesses, and more people are at financial risk if they get hurt. Having health coverage means protecting your health and your wallet. We encourage any Pennsylvanian without health insurance to start the new year with the peace of mind that comes with having coverage.”

Currently, ninety percent of Pennie enrollees qualify for individual coverage premium tax credits and save over $500 a month on average. Pennie is also a potential option for individuals who are no longer eligible for Medicaid coverage. Their options through Pennie can be found at:

pennie.com/learn/loss-of-medical-assistance-coverage/.

New Federal Limits, Rates, and Fine Levels Released for 2024

Each Fall, the federal government releases many new rates, limits, and fine amounts that will impact health insurance plans and employers who offer group health insurance coverage in the year ahead.  Here is a round-up of recent federal decisions that will impact you and your clients in 2024:

2024 Account Contribution Limits for Flexible Spending Arrangements (FSAs)

Plan/Limit Type2023 Level2024 Level
Health FSA Account Pre-Tax Contribution Limit$3,050$3,200
Health FSA Carry-Over Limit$610$640
Dependent Care Account (DCAP) Contribution Limit$5000$5000

2024 Limits for Transportation Benefits, QSEHRAs, and Archer MSAs

Applicable Benefit2024 Limits
Qualified Transportation Benefit (for either transportation in a commuter highway vehicle or any transit pass)$315
Qualified Small Employer Health Reimbursement Arrangement (QSEHRA) Payment and Reimbursement Limits$6,150 individual /$12,450 family
Archer Medical Savings Account (MSA) High-Deductible Health Plan (HDHP) LimitsMinimum: $2,800 individual/$5,550 family  Maximum: $4,150 individual/$8,350 family 
Archer MSA HDHP Maximum Out-of-Pocket LimitsNo more than $5,550 individual/$10,200 family

Electronic Filing Threshold for ACA Reporting

The IRS also recently issued updated instructions for preparing and submitting ACA health insurance coverage and employer reporting Forms 1094 and 1095 B and 1094 and 1095 C which lower the mandatory electronic filing threshold as follows:

Reporting for Calendar Years Before 2023Reporting for Calendar Years 2023 on Forward
250 or more forms10 or more Forms

PCORI Fee Rates

Another IRS notice issued recently sets the 2023 plan year Patient-Centered Outcomes Research Institute (PCORI) fee, which must be paid by group health insurance plan sponsors and health insurance issuers by July 31, 2024.  Carriers will pay the fee on behalf of fully insured clients, but self-funded and level-funded plans, and employers who offer health reimbursement arrangements, must pay the fee themselves using IRS Form 720. The fee rate for plan years ending in 2023 are as follows:

Plan Year Dates2023 Fee Rate
Plan years ending between January 1, 2023 and September 30, 2023$3.00 per covered life.  
Plan years ending between October 1, 2023 and December 31, 2023 $3.22 per covered life.  

HIPAA Privacy and Data Security Rule Violation Fine Levels

According to a new rule from the federal Department of Health and Human Services (HHS), group health plans, health insurance issuers, and other entities that are covered entities according to HIPAA, or business associates of covered entities will now face higher penalty levels for fines that are assessed on or after October 6, 2023.  The new penalty levels are as follows:

Type of ViolationMinimum Penalty Levels (Per Violation)Maximum Penalty Levels (Per Violation)Calendar-Year Penalty Cap (announced in 2019 using enforcement discretion and still in force)
Entity Had No Knowledge of the Violation$137$68,928$25,000
Entity Had Reasonable Cause to Know of the Violation$1,379$68,928$100,000
Violation Caused by Willful Neglect but Corrected $13,785$68,928$250,000
Violation Caused by Willful Neglect and Not Corrected$68,928$2,067,813$1,500,000

Affordable Care Act Violation Fine Levels

The ACA includes numerous requirements for group health insurance plan sponsors and health insurance issuers. The HHS civil penalties rule sets maximum penalties for the following requirements will increase for 2024 as follows:

RequirementMaximum Penalty
Failure by a Group Plan Sponsor or Issuer to provide a Summary of Benefits and Coverage $1,362 per failure
Failure by a health insurance issuer to comply with Medical Loss Ratio (MLR) reporting and rebate regulations$136 per failure

Medicare Secondary Payer Rule Violation Fine Levels

If an employer with 20 or more employees offers group health insurance coverage, than that health coverage is primary to Medicare if a Medicare beneficiary is enrolled in the group plan.  Federal rules prohibit group health plan sponsors from trying to convince people who are both eligible for the group plan and Medicare to decline group coverage in favor of Medicare. For 2024, federal Centers for Medicare and Medicaid Services (CMS) rules establish that the maximum penalties associated with such actions will be:

RequirementMaximum Penalty
Prohibition on group health plan sponsors offering Medicare-eligible individuals financial or other incentives to not enroll in a group health plan that would be primary coverage over Medicare$11,162 per eligible individual who was incented not to enroll
Failure of a health insurance issuer, third-party administrator or self-funded group plan sponsor to inform Medicare about situations where the group plan would be primary to Medicare$1,428 per day without proper notification

Check This Out!

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

NABIP has completely revamped its web page for state health policy resources.  The charts, toolkits, and state legislation tracker are all available here!

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