The Affordable Care Act (ACA) Implementation FAQ Part 63, issued by the U.S. Departments of Labor, Health and Human Services, and the Treasury focuses on the Public Health Service Act, which mandates that non-grandfathered group health plans and health insurance issuers provide culturally and linguistically appropriate summaries of benefits and coverage (SBC) and claims and appeals notices.
The regulations stipulate accommodations for notices in counties where more than 10 percent of the population is literate only in a specific non-English language, as determined by American Community Survey (ACS) data. Plans and issuers must offer oral language services, provide notices in the relevant non-English language upon request, and include a statement in English notices indicating how to access language services (referred to as taglines).
Non-grandfathered group health plans and issuers must adhere to the guidance for plan or policy years beginning on or after January 1, 2025. This guidance ensures that the provision of SBC and claims and appeals notices aligns with cultural and linguistic competence standards.
Employer Considerations
Employers should be prepared to point out to applicable employees the tagline to access language services found in English language SBCs and notices.
REDUCED INSULIN PRICES FOR SOME
UnitedHealth’s pharmacy benefit manager unit, Optum Rx, announced the inclusion of eight insulin products in its reimbursement list, limiting out-of-pocket expenses to $35 or less for enrollees. These products, including short- and rapid-acting insulin from Eli Lilly, Novo Nordisk, and Sanofi will be moved to tier one, the preferred status with the lowest prices, effective January 1, 2024. The move is part of an effort by these major insulin manufacturers, who collectively control 90 percent of the U.S. insulin market, to reduce list prices by 70 to 78 percent this year or in 2024. The Biden administration and lawmakers have been urging insulin makers and pharmacy benefit managers to address the high prices of this crucial medication.
Employer Considerations
Employers should check their insurers’ Rx formulary as more carriers may follow suit to lower insulin prices. Self-funded plans may consider making this change to remain competitive with fully funded plans.
BLUECROSS BLUESHIELD MOVES INTO DIRECT CARE DELIVERY
In 2023, various BlueCross BlueShield (BCBS) plans underwent reorganization, engaging in corporate restructuring, mergers and acquisitions, or establishing subsidiaries focused on healthcare delivery to enhance competitiveness with larger insurers.
BCBS plans have been expanding their presence in healthcare delivery by opening medical clinics exclusively serving their members. In Washington, Premera Blue Cross collaborated with Kinwell Medical Group in 2022 to establish primary care clinics for its members. BCBS Arizona took a similar approach in 2023, launching Prosano Health Solutions, a new primary care subsidiary, with plans to address specific geographic areas in Arizona to improve access to care.
BCBS North Carolina recently announced its intention to acquire 55 North Carolina locations of FastMed, a national chain offering preventive, telehealth, occupational health, primary care, and urgent care services. This move is aimed at enhancing healthcare services, particularly in rural areas with limited access to resources.
Employer ConsiderationsEmployers covered by BCBS should ask their insurance broker whether the carrier provides a direct care option near them.
CALIFORNIA TAKES A STEP TOWARD SINGLE-PAYER SYSTEM
Governor Gavin Newsom signed Senate Bill 770, a significant step toward universal healthcare in California. The legislation directs the state’s Health and Human Services Agency to collaborate with the federal government to create a unified health financing system for all Californians. This move could pave the way for a single-payer system, covering every resident and funded by state and federal resources, including Medicaid and Medicare funds.
Senate Bill 770 aims to establish a uniform standard of healthcare accessible to all individuals, irrespective of factors such as age, income status, employment status, immigration status, and other variables. As California undergoes modifications in its Medi-Cal system, Michael Lighty, president of Healthy California Now, emphasizes that certain persisting issues can only be effectively addressed through comprehensive reforms across the entire healthcare system.
The law requires California’s health secretary to provide recommendations on crafting a federal waiver by June 1, 2024, potentially allowing the state to access federal financing for a universal healthcare system.
While the legislation faced opposition, including criticism from both the left and the right, it suggests an incremental approach to healthcare reform in California. The move aligns with Governor Newsom’s 2018 campaign promise of supporting a single-payer system. Despite the diverse opinions, the signing of SB 770 underscores California’s commitment to exploring avenues for achieving universal healthcare.
On November 9, 2023, Chicago replaced its existing paid sick leave ordinance with the Chicago Paid Leave and Paid Sick and Safe Leave ordinance, effective December 31, 2023. The new ordinance modifies the accrual system, allowing employees to earn one hour of paid sick leave plus one hour of paid leave for every 35 hours worked, with a yearly maximum of 40 hours of each. Employees can carry over 16 hours of accrued paid leave and 80 hours of accrued sick leave to the next benefit year. Alternatively, employers can front-load 40 hours of each at the start of each benefit year.
Unlike the prior ordinance, the new law mandates that accrued, unused leave be paid to employees upon termination or when no longer covered by the ordinance, subject to a phased approach based on employer size. Any excess leave beyond annual carryover limits is forfeited. New employees become eligible for paid sick leave after 30 days and paid leave after 90 days of employment. Paid leave can be used for any purpose, and employers cannot compel employees to disclose the reason.
Employer Considerations
Employers must comply with various notice and posting requirements, including providing written notice of the paid-time-off policy at the start of employment and before any changes. A 14-day notice of policy changes affecting final compensation must be given, and information about leave accrual and usage must be provided with each wage payment. Employers with Chicago-based employees should carefully review and adjust their sick leave and paid leave policies to align with the new ordinance, considering its differences from the previous paid sick leave ordinance and the upcoming statewide Paid Leave for All Workers Act.
QUESTION OF THE MONTH
Q: Can former employees who are on COBRA and paying monthly premiums to a TPA for COBRA deduct those premium amounts on their taxes? For example, if a person is on COBRA for three months in 2023, can they deduct COBRA premium payments from taxable income on their 2023 federal tax return?
A: Yes, COBRA premiums can be deducted on an individual’s federal income taxes provided they itemize their taxes and the person’s medical expenses (including COBRA premiums) exceed 7.5% of their adjusted gross income.
Answers to the Question of the Week are provided by Kutak Rock LLP. Kutak Rock provides general compliance guidance through the UBA Compliance Help Desk, which does not constitute legal advice or create an attorney-client relationship. Please consult your legal advisor for specific legal advice.
This information is general in nature and provided for educational purposes only. It is not intended to provide legal advice. You should not act on this information without consulting legal counsel or other knowledgeable advisors.
‘Tis the season for family, festivity, and food—lots of food. The holidays dish up a triple whammy of wintry weather, irresistible foods, and stress, which can cause even the strongest-willed person to reach for another festive goodie.
While the notion of enjoying “healthy holidays” has a nice ring to it, reaching that goal can be very challenging. Between the endless social gatherings and the to-do lists that seem longer than Santa’s list of names, balancing the season’s obligations often means that our diets take a backseat until the New Year.
If you’re trying to maintain a healthy lifestyle this holiday season, you may be wondering what foods you should prepare and how to stay on track with your goals.
Here are six tips for savoring a healthier holiday season:
Portions Matter – Eat slowly and mindfully and opt for smaller portions. Also, avoid going back for seconds; your body needs time to feel full so give yourself 20 minutes before you reach for more.
Fit in Favorites – No food is on the naughty list. Deprivation leads to backlash – it’s better to have a plan and do it on purpose. In advance, plan for the indulgences that matter most to you so you can be sure to savor a small serving of Aunt Carol’s pie!
Make Movement Merry – Be active after a big meal; not only does activity help you burn off some calories but you may also feel more energized. Exercise is the secret to holding the (waist)line when holidays indulgences call. Choose fun activities like ice skating or sledding with friends and family or take a walk with family after a holiday meal.
Include Some Healthy Options – A platter of raw veggies or fruit with a low-fat dip can be a colorful and healthier alternative to a tray of sliced cheese, deli meats and crackers. Or replace the cheese dip with a bowl of cold large shrimp with cocktail sauce.
Try a New Tradition – You may not be the only person at the gathering trying to maintain healthy eating goals. Why not try a healthier recipe that may become a new tradition?
Get Your Zzz’s – Going out more and staying out later means cutting back on your sleep. Sleep loss can make it harder to manage your blood sugar, and when you’re sleep deprived, you’ll tend to eat more and prefer high-fat, high-sugar food. Aim for 7 to 8 hours per night to guard against mindless eating.
Set an example for your children. By incorporating some of these ideas, you can create healthy traditions for your kids. As these traditions are passed down from one generation to the next, your family will learn that it’s possible to make positive lifestyle choices while still enjoying the holiday season.
Remember, a healthy holiday makeover doesn’t require drastic changes to have a significant impact. Modifying a few choices and behaviors can lead to health benefits that can last a lifetime of happy, healthy holidays.
If you have a health plan through a job, you can use a Flexible Spending Account (FSA) to pay for health care costs, like deductibles, copayments, coinsurance, and some drugs. They can lower your taxes.
How Flexible Spending Accounts work
A Flexible Spending Account (FSA, also called a “flexible spending arrangement”) is a special account you put money into that you use to pay for certain out-of-pocket health care costs.
You don’t pay taxes on this money. This means you’ll save an amount equal to the taxes you would have paid on the money you set aside.
Employers may make contributions to your FSA, but they aren’t required to.
With an FSA, you submit a claim to the FSA (through your employer) with proof of the medical expense and a statement that it hasn’t been covered by your plan. Then, you’ll get reimbursed for your costs. Ask your employer about how to use your specific FSA.
To learn more about FSAs:
Contact your employer for details about your company’s FSA, including how to sign up.
They are limited to $3,050 per year per employer. If you’re married, your spouse can put up to $3,050 in an FSA with their employer too.
You can use funds in your FSA to pay for certain medical and dental expenses for you, your spouse if you’re married, and your dependents.
You can spend FSA funds to pay deductibles and copayments, but not for insurance premiums.
You can spend FSA funds on prescription medications, as well as over-the-counter medicines with a doctor’s prescription. Reimbursements for insulin are allowed without a prescription.
FSAs may also be used to cover costs of medical equipment like crutches, supplies like bandages, and diagnostic devices like blood sugar test kits.
You generally must use the money in an FSA within the plan year. But your employer may offer one of 2 options:
It can provide a “grace period” of up to 2 ½ extra months to use the money in your FSA.
It can allow you to carry over up to $610 per year to use in the following year.
Your employer doesn’t have to offer these options. If it does, it can be either one of these options, but not both.
Plan ahead At the end of the year or grace period, you lose any money left over in your FSA. Don’t put more money in your FSA than you think you’ll spend within a year on things like copayments, coinsurance, drugs, and other allowed health care costs.
You may have heard the saying attitude of gratitude. It’s a great little rhyme to remind us to live a life of gratitude – and practice it! When we practice being thankful on a regular basis, it not only impacts our mental and physical health, but those around you as well.
The Definition of Gratitude
The emotion of gratitude is defined as “the quality of being thankful; readiness to show appreciation for and to return kindness.” We are familiar with the act of “thank you” to represent gratitude, but it also includes thinking on positive things that have happened during the day or your life, meditating on positive thoughts, and feeling grateful.
The Health of Gratitude
Beyond making someone feel appreciated, gratitude also has other benefits. In fact, there are physical health benefits associated with the act of gratitude. The Greater Good Science Center produced a list of benefits to gratitude.
For the individual:
increased happiness and optimism for the future
improved mental wellbeing
greater satisfaction with life
increased self-esteem
better physical health
better sleep
less fatigue
lower levels of cellular inflammation
encourages the development of patience, humility, and wisdom
Research has shown that consciously practicing gratitude can reduce feelings of stress and anxiety. In fact, studies have found that a single act of thoughtful gratitude produces an immediate 10% increase in happiness and a 35% reduction in depressive symptoms. These effects disappeared within 3-6 months, which reminds us to practice gratitude over and over.
In addition to these above benefits, psychologically, the act of gratitude has been shown to reduce toxic emotions like envy, frustration, resentment, and regret. Those who focus on gratitude have even been reported to visit the doctor less!
The Act of Gratitude
So, how do you practice gratitude in your everyday life? Here are some easy-to-do exercises to strengthen your gratitude muscles:
Say thank you
Keep a gratitude journal or gratitude jar
Write handwritten thank-you notes
Think/meditate on positive thoughts
Create gratitude rituals
Put sticky notes around your home and workspace to remind you to be grateful
Our daily lives are fill of distractions and stress, and we often let our small achievements go unnoticed, even internally. Think about the past few days – what have you accomplished that went unnoticed? Did you cook a delicious meal, start a new book or chat with a loved one? Take a moment to celebrate that, to express gratitude for life’s everyday joys. Perhaps you might even write it down in a journal. This simple act that we’ve all been taught since we were born (Moms always remind you to say “thank you!”), has far-reaching benefits so start flexing your muscles of gratitude today.
Accidents happen. Whether you fall off a ladder, slip and break an arm, or get injured just living everyday life, an accident can happen. Anytime. Anywhere.
What Is Accident Insurance?
Accident insurance helps provide support when life’s most unexpected moments happen. It makes an accident less painful financially because it helps to pay the bills that your medical insurance doesn’t completely cover. It is important to understand that accident insurance is not intended to be a substitute for medical coverage. Instead, it is used as additional coverage and financial assistance.
Accident insurance may be offered by your employer as a voluntary benefit. Medical insurance doesn’t cover all of the expenses that result from an injury – you will likely owe a deductible and co-pays – and accident insurance helps fill in the gaps.
Examples of What Accident Insurance Covers:
Emergency treatment and medical exams
Hospital stays and surgical care
Diagnostic tests such as X-rays and CAT scans
Physical therapy and rehabilitation
Family lodging and travel needs related to follow-up care
Examples of What Accident Insurance Does Not Cover:
Injury due to extreme sports like bungee jumping or skydiving
Self-inflicted wounds or suicide attempts
Injury that occurs while doing criminal activities
Injury that occurs while under the influence of drugs or alcohol
How Does Accident Insurance Work?
You pay a premium every month for coverage which is often automatically paid through payroll deductions. If you get injured, you submit a claim as well as any required verification for the accident. Then, once approved, the insurance payment will be sent directly to you – often in a one-time lump sum. Some plans pay out according to your expenses up to a maximum specified in the policy while others pay out a predetermined amount based on the injury.
One of the biggest advantages of accident insurance is that the payouts come in cash, which can relieve the financial burden after an injury. Additionally, there isn’t a waiting period, so you get the money immediately. This money is given to you in addition to what your health insurance pays. When you receive your payout, you can use the money to pay for any of your expenses – rent or mortgage payment, groceries, childcare, medical expenses, or other needs. How you use the payment after your injury is up to you as you recover.
No one wants to think accidents can happen, but they do. So, while life may dose out the accidents, remember there is insurance that can help.
