Viewing posts from: April 2019

AP Benefit Advisors’ Webinar – HRCI & SHRM Pre-Approved | J-Codes: Your Healthcare Plan’s Biggest Enemy

Posted April 17, 2019 by Megan DiMartino

In case you missed it…

“J-Codes” and “medical specialty pharmacy” claims are going to be one of the top two procedure categories in terms of cost within your health plan. Knowing the amount of waste and abuse can give you insight into how you can develop strategies to drive more cost-effective utilization of the plan, and even enhance the benefits to the plan members for that efficient behavior. By identifying these specific issues within your plan and implementing targeted, value-based strategies to address them, you could eliminate tremendous costs without any adverse effects to your population.

Join us for this HRCI* and SHRM** pre-approved, complimentary, one-hour webinar as our Senior Healthcare Data Analyst, Virak Nhek, talks about the financial perils and pitfalls of “J-Codes” within an employer-sponsored health plan, and how the power of data can unlock the secrets to managing its spend.

Topics include:

  • What J-Codes are, how they differ from pharmacy claims and how plans bill for them
  • How providers negotiate reimbursements through the medical benefit and how it differs from the pharmacy benefit
  • The role of channel management, site of care, manufacturer assistance programs and others

Webinar details:

  • Thursday, April 25, 2019
  • 2:00pm – 3:00 pm EDT
  • No cost to attend
  • This webinar is open to all HR and Finance Professionals – but not to brokers, agents, TPAs and PEOs

Register Now


*The use of this seal confirms that this activity has met HR Certification Institute’s® (HRCI®) criteria for recertification credit pre-approval.

**AP Benefit Advisors, LLC is recognized by SHRM to offer Professional Development Credits (PDCs) for SHRM-CP or SHRM-SCP. This program is valid for 1 PDC for the SHRM-CP or SHRM-SCP. For more information about certification or recertification, please visit shrmcertification.org.


For more information, contact info@apbenefitadvisors.com. The information contained in this post, and any attachments, is not intended and should not be misconstrued as legal advice. You should contact your employment, benefits or ERISA attorney for legal direction.

AP Benefit Advisors’ webinar and website resources are designed for U.S.-based organizations. Our privacy and GDPR policy should be reviewed here. Please opt-out if you do not agree to these terms and conditions.

Maryland Minimum Wage to Increase to $15 an Hour

Posted April 15, 2019 by Megan DiMartino

On March 28, 2019, Maryland’s legislature overrode Republican Governor Larry Hogan’s veto to raise the state’s minimum wage limit to $15.00 per hour from the current minimum wage of $10.10 per hour. This now makes them the sixth state to increase their minimum wage. The other states include California, Illinois, Massachusetts, New Jersey and New York.

The new minimum wage will not take effect immediately, but rather on a yearly increase schedule. Large employers, with at least 15 employees, will start their increases on January 1, 2020, to reach the end goal of $15.00 by January 1, 2025. And for small employers, with fewer than 15 employees, will have an extra year to reach the new minimum wage.

Large employer increased minimum wage schedule:

Date Minimum Wage
January 1, 2020 $11.00
January 1, 2021 $11.75
January 1, 2022 $12.50
January 1, 2023 $13.25
January 1, 2024 $14.00
January 1, 2025 $15.00

Small employer increased minimum wage schedule:

Date Minimum Wage
January 1, 2020 $11.00
January 1, 2021 $11.60
January 1, 2022 $12.20
January 1, 2023 $12.80
January 1, 2024 $13.40
January 1, 2025 $14.00
January 1, 2026 $14.60
July 1, 2026 $15.00

For businesses with employees under the age of 18 may pay them a minimum wage equal to 85% of the state’s minimum wage.

Tipped Employees

Also under the new legislation, Commissioner of the Maryland Division of Labor and Industry (DLI) will adopt regulations requiring restaurant employers to provide wage statements to employees per pay period. These wage statements must show the employees’ hourly tip rate (derived from employer-paid cash wages) plus all reported tips (for tip credit hours) worked each workweek.

Source: Jackson Lewis | Maryland Approves Minimum Wage Increase to $15 an Hour


For more information, contact info@apbenefitadvisors.com. The information contained in this post, and any attachments, is not intended and should not be misconstrued as legal advice. You should contact your employment, benefits or ERISA attorney for legal direction.

AP Benefit Advisors’ webinar and website resources are designed for U.S.-based organizations. Our privacy and GDPR policy should be reviewed here. Please opt-out if you do not agree to these terms and conditions.

Judge Strikes Down Association Health Plan Rule

Posted April 1, 2019 by Megan DiMartino

By now you have probably seen or heard the news that the new rules governing association health plans (AHPs) have been struck down. Although true, this is not yet in effect. The judge in this case has remanded the final rule back to the DOL to consider whether two specific provisions of the rule can be severed from the rest of the regulations. The remainder of the rule is still valid.

Background

The final rule governing AHPs was created by the Department of Labor (DOL) to comply with an executive order issued by President Trump in October 2017. As directed by the executive order, the DOL was tasked with issuing regulations that would permit more employers (as well as sole proprietors) to form AHPs, thus expanding access to more affordable, high-quality health coverage. The DOL was specifically instructed to consider expanding the conditions that must be satisfied to form an AHP that is treated as a single plan under the Employee Retirement Income Security Act (ERISA).

The final rule allows AHPs to offer coverage to some or all employers in a state, city, county or multi-state metro area, or to businesses in a common trade, industry, line of business or profession in any area, including nationwide. In addition, the final rule allows working owners without other employees, such as sole proprietors and other self-employed individuals, to join AHPs.

So, What Happened?

On Thursday, March 28, U.S. District Judge John Bates struck down the Trump administration’s new regulations governing AHPs stating they are “clearly an end-run around the ACA.” Specifically, the court struck down two parts of the final rule:

  • The provision allowing any association of disparate employers to be considered a “bona fide group,” and
  • The provision allowing working owners, without employees, to become members of an association.

The lawsuit against the DOL was brought by eleven states and the District of Columbia, which contend the final rule was intended to “end run” the requirements of the ACA, and that the bona fide association and working owner provisions of the rule are “unreasonable interpretations of ERISA.”

What Does This Mean?

This ruling does not impact associations comprised of related employers, those in the same industry, as they will continue to be considered a “bona fide group” for AHP purposes. However, unrelated employers and business owners, without employees, that have already joined an AHP or are considering it, should review how they may be affected if this ruling stands.

AssuredPartners will be closely monitoring all developments related to this ruling and will communicate any new information as soon as it is known.

Should you have any questions or concerns, please contact your AP Benefit Advisors’ Account Executive or Account Manager.

Links:
State of New York v. U.S. Department of Labor


For more information, contact info@apbenefitadvisors.com. The information contained in this post, and any attachments, is not intended and should not be misconstrued as legal advice. You should contact your employment, benefits or ERISA attorney for legal direction.

AP Benefit Advisors’ webinar and website resources are designed for U.S.-based organizations. Our privacy and GDPR policy should be reviewed here. Please opt-out if you do not agree to these terms and conditions.

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