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On June 19, 2018, the U.S. Department of Labor released its Final Rule regarding Association Health Plans (AHPs). AHPs are not new, but they have not been widely available in the past and, in some cases, they have not been successful. The Final Rule is designed to make AHPs available to a greater number of small businesses as an alternative to standard ACA-compliant small group insurance policies.
This article answers common questions about AHPs under the current rules (which groups can continue to use) and the new rules.
Yes and no. Federal law imposes certain basic requirements on all group medical plans, regardless of the employer’s size. For instance, plans cannot exclude pre-existing conditions nor impose annual or lifetime dollar limits on basic benefits. If the plan is insured, it also is subject to the insurance laws of the state in which the policy is issued.
Small group policies, which are sold to employers with up to 50 or 100 employees, depending on the state, are subject to additional requirements. These policies must cover 10 categories of essential health benefits (EHBs), including hospitalization, maternity care, mental health and substance abuse treatment, and prescription drugs. (Some states allow certain grandfathered or grandmothered policy exceptions.) For most small employers, their options for group medical insurance are limited to small group policies that comply with the full scope of ACA requirements. On the other hand, the policies are subject to guaranteed issue and adjusted community rating rules, so carriers cannot refuse to insure a small employer nor use any past claims experience in setting rates.
Large group policies, which can only be sold to groups with at least 50 or 100 employees, depending on the state, are not required to cover all EHBs. Carriers have more flexibility in designing coverage options and developing premium rates in the large group market. This means larger employers have more options to choose from and may be able to purchase coverage at a lower cost than would apply to a small group policy. Note, however, that there is no guaranteed issue protection, so carriers can accept or reject each employer’s application or use the employer’s past claims experience in setting rates.
Lastly, self-funded plans are subject to the ACA and other federal laws, but generally are exempt from state laws. They typically are not feasible for small employers, however, due to the financial risk of uninsured programs.
Group insurance covers the employees of an employer (or an employee organization such as a labor union). An AHP, as the name implies, covers the members of an association. Unrelated employers can obtain coverage for their employees through an AHP provided the employers form a bona fide association. Traditionally, this has meant that the employers had to have a “commonality of interest” and their primary interest had to be something other than an interest in providing benefits. For this reason, AHPs generally have been limited to associations formed by employers in the same trade, industry, or profession.
The Final Rule makes AHPs available to a wider range of businesses by expanding the meaning of “commonality of interest.” Once the Final Rule takes effect, an association may be formed by employers that are:
Under the new rules, the employer’s primary interest in associating may be benefits coverage, although they still will need to have at least one other substantial business purpose other than benefits. This is a key difference from the current rules.
The Final Rule expanding the definition of an association for purposes of an AHP will take effect on staggered dates:
As noted, the new rules do not replace existing rules. Employers and associations may continue to follow the existing rules (which generally limit AHPs to employers in the same trade, industry, or profession). The new rules merely expand the opportunities for AHPs, such as making them available to employers in the same state or metropolitan area even if they are in different industries.
Currently, sole proprietors, such as mom-and-pop shops without any W-2 employees, purchase medical insurance in the individual market. Individual policies often cost more than group policies or AHPs. The new rules will expand the availability of AHPs to include sole proprietors who work a minimum number of hours (so-called working owners).
Insurance products, including AHPs, are regulated by state law. Under both the existing and new rules, AHPs are multiple employer welfare arrangements (MEWAs). State laws on MEWAs are quite complicated. In some states, MEWAs are prohibited. In others, insured MEWAs are allowed but self-funded plans are prohibited. The laws vary from state to state, so different carriers will make different decisions about whether they want to design and market AHPs in various jurisdictions around the country.
A number of states are very concerned about AHPs and may prohibit them in their states or impose strict requirements to ensure they will provide reliable and effective coverage. Other states will view AHPs as cost-effective alternatives to ACA-compliant policies for small employers and look to encourage their expansion.
There is no clear answer to what’s next. Over the coming months, carriers across the country likely will review the reasons they have or have not offered AHPs in the past, and whether they want to consider new approaches in the future. Along with economic and market issues to consider, carriers also must consider the state insurance laws in different jurisdictions. At the same time, many state legislatures and insurance commissioners will be reviewing their existing rules and whether they want to promote or expand the availability of AHPs in their area.
Oh … and the lawsuits. Yes, that also is what’s next. As of this writing, attorneys general in different states are planning to join together in challenging the federal government’s Final Rule on AHPs. Their stated concern is that effective regulation is required to ensure that plans provide adequate coverage.
ThinkHR will continue to monitor developments in this area.
by Kathleen A. Berger
Originally posted on thinkhr.com
New technologies are poised to fundamentally change the HR industry as we know it. Just as the smartphone revolutionized the way we communicate, artificial intelligence will reshape all areas of HR, from employee onboarding to learning management to developing top talent. And, similar to smartphones, these changes will take place at lightning speed.
But what exactly is artificial intelligence? And what implications might this evolving tech have on the future of health care? Buckle up, because we’re going to take a glimpse into the current AI projects, as well as what the future of health care could look like with AI advancements.
In its most basic form, artificial intelligence uses computer programming to develop systems that are able to perform tasks that would normally require human intelligence. These tasks could include speech recognition, decision-making, language translation, and much more.
Have you ever wondered how ridesharing apps like Uber and Lyft are able to predict ETAs for rides? Artificial intelligence. Or, how email platforms know how to filter out spam and nicely categorize your emails into categories? Yep, artificial intelligence. Or, how your banking app is able to process a check deposit via a simple image? You guessed it, artificial intelligence.
Artificial intelligence has become an integral part of many of the technologies and services that we use in our everyday life without us even knowing or really thinking about it.
In addition to its many convenient applications, AI also offers a promising and impactful future in the field of health care.
The use of artificial intelligence is completely altering the front door of health care as we know it. From specific programs that aid in medical diagnostics to intelligent apps that triage remote patients, AI is making health care more efficient and accessible than ever.
One of the primary areas in which AI shines versus manual human processes in the field of data analysis. Not only can artificial intelligence process complex sets of data at lightning speed, it can also provide meaningful and actionable insight and recommendations based on data sets. DeepMind(acquired by Google in 2014) is an AI-based technology that works to expedite the process in which patients are moved from ‘test’ to ‘treatment’. IBM’s Watsonproduct provides solutions for interpreting, organizing, and easily accessing clinical and patient data, in addition to providing technology for recognizing patient similarity and medical insights. According to IBM, medical data is expected to double every 73 days by 2020. And, each person will generate enough health-related data in their lifetime to fill 300 million physical books. Utilizing AI will not only expedite the process in which health care providers access patient info but also better-organize and analyze data available and even provide predictions on future health concerns and recommendations for treatment plans.
The FDA recently approved the use of artificial intelligence powered software for the use of medical diagnostics, marking the first use of AI in this application. The program is designed to detect signs of diabetic retinopathy, a condition that can cause long-term vision loss and that impacts more than 30 million people in the United States alone. The technology uses an AI algorithm to scan and analyze multiple images of an eye and then delivers a positive or negative test result. This is the first FDA approved solution that does not require a doctor to interpret test results, and more AI-based diagnostic solutions are expected to get the green light in the next several years.
It’s no secret that testing pharmaceuticals through clinical trials is an expensive and time-consuming process. The full development, testing, and approval process can literally take decades and cost billions. Though pharmaceutical players of all sizes are currently experimenting with AI applications in the drug discovery and development process, GSK is considered a leader in the space. GSK has fully embraced AI research and applications with their dedicated in-house team, ‘In silico Drug Discovery Unit’. The ultimate goal of the GSK project is to leverage artificial intelligence to shorten the drug research, testing, and launch window to under a year, a bold vision. Making the pharmaceutical process more efficient could drastically reduce the cost of medical treatments and the cost of health care in general.
China is facing one of the most alarming doctor shortagesin history, with only 1.5 doctors for every 1,000 residents (compared to 2.5 doctors per person in the United States). The need is dire, and the government is calling for action and loosening restrictions on the use of data and new technology. Currently, more than 100 companies are working to develop AI solutions to address urgent health care needs. A recent reportpredicted that China’s market for AI-powered health care services will reach almost $6B yuan ($930 Million) by 2022. Current projects include diagnostic tools to assist with CT scans, x-rays, ultrasound scans and prosthetic design and manufacturing.
Which would you prefer – an hour-long wait in a doctor’s office plus the time to actually see the doctor, or a quick 15-minute consultation and diagnosis via your smartphone? Though many assume telemedicine is a modern iteration of health care, this practice has actually been around since the 1950’s. Now, telemedicine is a common alternative to traditional doctor’s visits for simple diagnostics and treatment. A new app, 98point6, is taking this remote-experience to the next level with artificial intelligence. The technology interacts with subscribers to help better understand medical needs and then channels requests to the appropriate doctor for evaluation. The AI-bot essentially serves as a personalized triage service, saving manual time and labor.
The adoption and utilization of artificial intelligence in the health care space will make health care more accessible, efficient, and affordable for everyone.
by Meisha Bochicchio, Content Marketing Manager at PlanSource
Originally posted on blog.ubabenefits.com
NLRB: Guidance on Handbook Rules Post-BoeingOn June 8, 2018, National Labor Relations Board (NLRB) General Counsel, Peter B. Robb, released a memorandum (GC 18-04) providing guidance to regional offices under the NLRB’s decision in Boeing. Per Boeing, the NLRB evaluates facially neutral handbook policies and work rules by a balancing test of impact versus justification. Specifically, the potential impact of an employer’s (workplace and handbook) policies and work rules on employees NLRA-protected rights versus the employer’s legitimate justifications for maintaining the policy or rule.
This balancing test was broken down into the following three categories:
In the memo, the general counsel provided in-depth guidance, along with application, of the three categories of rules for regional offices to use when investigating and processing cases. For example, regional offices were directed as follows:
Basically, the guidance provides insight as to how the holding in Boeing will be applied to workplace policies, rules, and company handbooks going forward.
Originally Published By ThinkHR.com
No one foresees needing disability benefits. But, should a problem arise, the educated and informed employee can plan for the future by purchasing disability insurance to help cover expenses when needed. Watch this short video to learn more!
