CVS-Aetna Merger Finalized

Posted September 13, 2019 by Megan DiMartino

We expect to see the ongoing consolidation of our industry stakeholders. The CVS/Aetna plays with the recent CIGNA/ESI deal that also aligns in the integrated medical/Rx delivery model with UHC/Optum. With this alignment between CVS and Aetna and the continued move towards an integrated care model, it is more imperative than ever for employers to carve out their Pharmacy benefit to have maximum disclosure and savings for their drug spend.

– Howard Mazzafro, VP Business Development at Keenan Pharmacy (An AssuredPartners Company)

Dive Brief:

  1. District Court Judge Richard Leon has approved the settlement agreement CVS and Aetna reached with the U.S. Department of Justice to allay antitrust concerns
  2. Leon gave his blessing grudgingly. He had been highly critical of the settlement that called for Aetna to divest its Medicare Part D business to WellCare, noting the agreement addressed just a sliver of the nearly $70 billion deal. His order, however, imposes no further conditions.
  3. The American Medical Association, which argued in court the agreement did not go far enough to address market concentration concerns, spoke out against Wednesday’s ruling.

Dive Insight:

The review by Leon was unprecedented, spanning nearly a year as he decided whether the agreement was in the public interest.

Under federal law, judges have the power to review DOJ settlement agreements and the risk was whether Leon would send the DOJ and CVS-Aetna back to the negotiating table.

“Indeed, if the Tunney Act is to mean anything, it surely must mean that no court should rubberstamp a consent decree approving the merger of ‘one of the largest companies in the United States’ and ‘the nation’s third largest health-insurance company,’ simply because the Government requests it!” Leon wrote in an accompanying opinion.

Leon even held a hearing, letting others besides CVS-Aetna and the DOJ testify on the merits of the merger and the potential harm to competition.

“Obviously we’re disappointed, but I think we’ve established a precedent for the future for the enforcement of the Tunney Act in antitrust cases,” David Balto, a lawyer who testified at the evidentiary hearings on behalf of U.S. PIRG and Consumer Action, told Healthcare Dive. “I think the judge demonstrated why the Tunney Act is important in the oversight of antitrust actions.”

The American Medical Association has been critical of the deal and also had their own experts testify during the hearing.

“Nothing in the deal guarantees reductions on insurance premiums or prescription drug costs. As for promised efficiency savings, that money will likely go straight to CVS’ bottom line. CVS made no commitment to pass much-hyped savings onto consumers through lower premiums or drug costs,” the AMA said in a statement.

CVS, which previously closed on its deal with Aetna, said – “CVS Health and Aetna have been one company since November 2018, and today’s action by the district court makes that 100 percent clear.”

Source: Healthcare Dive | Judge finally blesses CVS-Aetna merger settlement


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.

Rx Plans May Exclude Value of Drug Manufacturers’ Coupons Until Further Notice

Posted September 4, 2019 by Patrick Haynes

The DOL, HHS, and IRS have jointly issued an FAQ addressing whether health plans must count drug manufacturers’ coupons toward the annual cost-sharing limits under the Affordable Care Act (ACA). (Note:  these limits apply to non-grandfathered group health plans, including self-insured and insured small and large group market health plans.) Regulations that announced the 2020 benefit and payment parameters (including the maximum annual cost-sharing limits) provided that, for plan years beginning on or after January 1, 2020, plans and insurers need not count the value of drug manufacturers’ coupons toward the annual cost-sharing limits when a medically appropriate generic equivalent is available.  Please see our May 9, 2019 post about the 2020 limits here.

After the regulations were released, stakeholders pointed out that this provision implies that, in any other circumstances, plans and insurers must count such coupon amounts toward the annual cost-sharing limits, and that such a requirement could create a conflict with certain rules for high deductible health plans (HDHPs) that are intended to allow eligible individuals to establish HSAs.

Explaining that, for purposes of determining whether the HDHP minimum deductible has been satisfied, HDHPs must disregard drug discounts and other manufacturers’ and providers’ discounts and may only take into account amounts actually paid by the individual, the FAQ acknowledges that HDHP insurers or sponsors may be unable to comply with both rules simultaneously. The agencies intend to address this conflict in the regulations that announce the 2021 benefit and payment parameters. Until such regulations are effective, the agencies will not initiate an enforcement action if an insurer or plan excludes the value of drug manufacturers’ coupons from the annual cost-sharing limits, including when no medically appropriate generic equivalent is available.

The rule announced in the 2020 benefit and payment parameters was intended to discourage providers and patients from choosing expensive brand-name drugs when a less expensive and equally effective alternative is available. HHS also proposed other rules designed to encourage the use of generic drugs but did not include them in the final parameters, noting their complexity and administrative burden. It will be interesting to see what direction the agencies take when the 2021 benefit and payment parameters are proposed, including how they reconcile any conflicting rules such as the one addressed in this FAQ.

Links:


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.

ACA Limits, Penalties and Fees – 2014 thru 2020

Posted August 26, 2019 by Patrick Haynes

Employer Shared Responsibility (Employer Mandate)

Plan Years 2020 2019 2018 2017 2016 2015 2014
Affordability Safe Harbor Percentage 9.78% 9.86% 9.56% 9.69% 9.66% 9.56% 9.50%

Employer Mandate Penalties – Calendar Year

Penalties 2020 2019 2018 2017 2016 2015 2014
Tier One: Failure to offer coverage or to offer to 95% of employees (70% for 2015) TBD $2,500 $2,320 $2,260 $2,160 $2,080 $2,000
Tier Two: Failure to offer coverage that is affordable and meets minimum value TBD $3,750 $3,480 $3,390 $3,240 $3,120 $3,000

Market Rules

Account Limits 2020 2019 2018 2017 2016 2015 2014
Health Care Flexible Spending Account (FSA) TBD $2,700 $2,650 $2,600 $2,550 $2,550 $2,500
Dependent Care Flexible Spending Account (FSA) TBD $5,000 $5,000 $5,000 $5,000 $5,000 $5,000
Health Spending Accounts (HSA)
High Deductible Health Plan Annual Deductible Minimums (Self-Only/Family) $1,400
$2,800
$1,350
$2,700
$1,350
$2,700
$1,300
$2,600
$1,300
$2,600
$1,300
$2,600
$1,250
$2,500
Annual Out-of-Pocket Maximums (Self-Only/Family) $6,900
$13,800
$6,750
$13,500
$6,650
$13,300
$6,550
$13,100
$6,550
$13,100
$6,450
$12,900
$6,350
$12,700
Maximum Contribution (Self-Only/Family) $3,550
$7,100
$3,500
$7,000
$3,450
$6,850/$6,900
$3,400
$6,750
$3,350
$6,750
$3,350
$6,650
$3,300
$6,550
Transportation
Parking (per month) $265 $265 $260 $255 $255 $250 $250
Mass Transit (per month) $265 $265 $260 $255 $255 $250 $130

Fees – Paid by Health Plan (per Covered Life)

Fees 2019 2018 2017 2016 2015 2014
Transitional Reinsurance Fee N/A N/A $0 $27.00 $44.00 $63.00
Patient-Centered Outcomes Research (PCORI)
Plan Years Ending 1/1 – 9/30 $2.45 $2.39 $2.26 $2.17 $2.08 $2.00
Plan Years Ending 10/1 – 12/31 N/A $2.45 $2.39 $2.26 $2.17 $2.08

 

2020 HSA Limits were made available on May 28, 2019.  Please see those details here:  https://www.apbenefitadvisors.com/2019/05/28/irs-releases-2020-limits-for-hsas/

Please contact your AssuredPartners’ Sales Executive or Account Manager for any further questions or assistance.


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.

HRCI & SHRM Pre-Approved Webinar | Voluntary Benefits: Life Insurance with Long-Term Care – The Overlooked Lifetime Benefit

Posted August 13, 2019 by Megan DiMartino

The life insurance market has changed dramatically in the last 20 years and that is nothing compared to what has happened in the long-term care (LTC) market. Almost every employee has some personal financial risk (many are great) with the potential costs of an extended long-term care situation.

Join us for this HRCI* and SHRM** pre-approved, complimentary, one-hour webinar as our Director of Voluntary Benefits, Stephen Ivey, discusses the changes in the markets, the new definitions and features of LTC, and how these new types of plans are becoming much more important as a benefit offer.

Webinar details:

  • Thursday, August 22, 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.

2019 2nd Quarter Compliance Update

Posted July 17, 2019 by Megan DiMartino

Topics include:

  • Expanded HRA Options
  • Form 5500 is Due by July 31
  • President Trump’s Latest Executive Order
  • HDHP/HSA Limits Increase for 2020
  • New EEOC Wellness Rules Expected by December
  • ACA Limits, Penalties and Fees
  • And more!

Read Now


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.

HRCI & SHRM Pre-Approved Webinar | 2019 Mid-Year Review – Your Compliance Checkup!

Posted June 19, 2019 by Megan DiMartino

Benefits WebinarsJoin us for this HRCI* and SHRM** pre-approved, complimentary, one-hour webinar as our General Counsel and VP of Compliance, Patrick Haynes, reviews the first-half of 2019 and provides a compliance checkup that you won’t want to miss.

Patrick will cover:

  • Changes to the Affordable Care Act (ACA)
  • ERISA/Section 125 Best Practices
  • Federal Government’s Approach to Health and Wellness Plans
  • “Working Wounded” – those employees and plan participants that no longer work the ACA-minimum required 30 hours per week, but are still on your plans

Webinar details:

  • Friday, June 28, 2019
  • 12:00pm – 1:00 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.

Individual Coverage and Extended Benefit HRAs Are in Play for 2020 Plan Start Dates

Posted June 14, 2019 by Patrick Haynes

On June 13, the U.S. Departments of Health and Human Services, Labor and Treasury issued a final rule that creates two new kinds of Health Reimbursement Arrangements (HRAs) – the Individual Coverage HRA (ICHRA) and the Extended Benefit HRA – effective for January 1, 2020 effective dates.

This final ruling is in response to the Trump administration’s October 2017 executive order on healthcare choice and competition.

Individual Coverage HRA

The ICHRA allows employers of all sizes that do not offer a group coverage plan to fund an HRA for employees to buy individual-market insurance, including insurance purchased on the public exchanges formed under the Affordable Care Act (ACA).

Currently, qualified small-employer HRAs (QSEHRAs) that were created by Congress in December 2016, allow small businesses with less than 50 full-time employees (FTEs) to use pre-tax dollars to reimburse employees who buy non-group health coverage. This ICHRA rule goes even further and doesn’t cap employer contributions. As a result, employers with less than 50 FTEs will have two choices – a QSEHRA or an ICHRA – with some regulatory differences between the two.

The departments posted an FAQ on the new rule that includes a model ICHRA employee notice and attestation form that complies with the new rule’s disclosure provision and aims to explain the type of HRA being offered and communicate that individuals may become ineligible for a premium or tax subsidy when participating in an ACA exchange-based plan.

If employers choose to offer this new ICHRA benefit in 2020, they will need to take action before then, including the required notice for eligible participants. Employees who want to take advantage of an ICHRA in the new year must enroll in an individual health plan during the open enrollment period (unless they have Medicare) that runs between November 1 and December 15, 2019.

Extended Benefit HRA

The Extended Benefit HRA will increase flexibility for employer-sponsored insurance. It can be offered in addition to a traditional group health plan to permit employers to finance up to $1,800 (pre-tax) of additional medical care (such as copays, deductibles, premiums for vision, dental, COBRA and short-term insurance coverage), even if the employee has declined enrollment in the traditional group health plan.

Anticipated Impact

These HRA rules will provide hundreds of thousands of businesses a better way to offer health insurance coverage so that millions of workers and their families can obtain the best coverage for their needs.

The ICHRA will help small employers compete for talent as they have typically faced unaffordable costs that prevent them from offering a traditional group health plan, and, in particular, the Extended Benefit HRA will benefit the growing number of employees who have opted out of their employer’s traditional group health plan because their share is too expensive.

The departments estimate that these HRA rules will help 800,000 employers insure more than 11 million employees and family members of which 800,000 were previously uninsured.

Should you have additional questions or comments, please contact your Sales Executive or Account Manager.  Thank you.

Links

ACA Limits, Penalties and Fees – 2014-2019

Posted June 14, 2019 by Megan DiMartino

Employer Shared Responsibility (Employer Mandate)

Plan Years 2019 2018 2017 2016 2015 2014
Affordability Safe Harbor Percentage 9.86% 9.56% 9.69% 9.66% 9.56% 9.50%

Employer Mandate Penalties – Calendar Year

Penalties 2019 2018 2017 2016 2015 2014
Tier One: Failure to offer coverage or to offer to 95% of employees (70% for 2015) $2,500 $2,320 $2,260 $2,160 $2,080 $2,000
Tier Two: Failure to offer coverage that is affordable and meets minimum value $3,750 $3,480 $3,390 $3,240 $3,120 $3,000

Market Rules

Account Limits 2019 2018 2017 2016 2015 2014
Health Care Flexible Spending Account (FSA) $2,700 $2,650 $2,600 $2,550 $2,550 $2,500
Dependent Care Flexible Spending Account (FSA) $5,000 $5,000 $5,000 $5,000 $5,000 $5,000
Health Spending Accounts (HSA)
High Deductible Health Plan Annual Deductible Minimums (Self-Only/Family) $1,350
$2,700
$1,350
$2,700
$1,300
$2,600
$1,300
$2,600
$1,300
$2,600
$1,250
$2,500
Annual Out-of-Pocket Maximums (Self-Only/Family) $6,750
$13,500
$6,650
$13,300
$6,550
$13,100
$6,550
$13,100
$6,450
$12,900
$6,350
$12,700
Maximum Contribution (Self-Only/Family) $3,500
$7,000
$3,450
$6,850/$6,900
$3,400
$6,750
$3,350
$6,750
$3,350
$6,650
$3,300
$6,550
Transportation
Parking (per month) $265 $260 $255 $255 $250 $250
Mass Transit (per month) $265 $260 $255 $255 $250 $130

Fees – Paid by Health Plan (per Covered Life)

Fees 2019 2018 2017 2016 2015 2014
Transitional Reinsurance Fee N/A N/A $0 $27.00 $44.00 $63.00
Patient-Centered Outcomes Research (PCORI)
Plan Years Ending 1/1 – 9/30 $2.45 $2.39 $2.26 $2.17 $2.08 $2.00
Plan Years Ending 10/1 – 12/31 N/A $2.45 $2.39 $2.26 $2.17 $2.08

 

2020 HSA Limits were made available on May 28, 2019.  Please see those details here:  https://www.apbenefitadvisors.com/2019/05/28/irs-releases-2020-limits-for-hsas/

Please contact your AssuredPartners’ Sales Executive or Account Manager for any further questions or assistance.


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.

IRS Releases 2020 Limits for HSAs

Posted May 28, 2019 by Patrick Haynes

On May 28, 2019, the IRS released Revenue Procedure 2019-25 It provides the 2020 inflation-adjusted amounts for HSA-qualified high deductible health plans (HDHPs).

The inflation-adjusted increases for 2020 are:

  • HSA-Qualified HDHP Self Coverage: Annual deductible must be $1,400 or more in 2020 (up $50 from 2019), and annual out-of-pocket expenses cannot exceed $6,900 (up $150 from 2019).
  • HSA Contribution Limit for Self Coverage: Increases to $3,550 in 2020, up $50 from 2019.
  • HSA-Qualified HDHP Family Coverage: Annual deductible must be $2,800 or more in 2020, up $100 from 2019, and annual out-of-pocket expenses cannot exceed $13,800 (up $300 from 2019).
  • HSA Contribution Limit for Family Coverage: Increases to $7,100 in 2020, up $100 from 2019.
  • No change to the Age-55+ HSA catch-up limit.  That value remains at $1,000 per year.

Please contact your Sales Executive or Account Manager for additional details about how this may affect your 2020 HDHP-HSA offerings.    And, don’t forget to review our 2020 non-HDHP plan limits here.

Contribution and Out-of-Pocket Limits
for Health Savings Accounts and High-Deductible Health Plans
2020 2019 Change
HSA contribution limit (Employer + Employee) Self-only: $3,550
Family: $7,100
Self-only: $3,500
Family: $7,000
Self-only: +$50
Family: +$100
HSA catch-up contributions (age 55 or older) $1,000 $1,000 No change
HDHP minimum deductibles Self-only: $1,400
Family: $2,800
Self-only: $1,350
Family: $2,700
Self-only: +$50
Family: +100
HDHP maximum out-of-pocket amounts (deductibles, co-payments and other amounts, but not premiums) Self-only: $6,900
Family: $13,800
Self-only: $6,750
Family: $13,500
Self-only: +$150
Family: +$300

Links: