In this episode, Suzanne Spradley and Chase Cannon dig in to a trending topic, particularly for self-insured plans: reference-based pricing (RBP). Suzanne begins with a description of RPB, including an example to help illustrate how it works. Next, Suzanne explains the process and the pros and cons of RBP, which leads to a discussion on pricing and billing, including balance billing to unsuspecting plan participants. Suzanne outlines employer considerations when implementing an RBP design, including several issues with respect to the ACA and out-of-pocket maximums, and lessons learned from litigation relating to RBP strategies (including one case that made it to court with over $300K in claims at stake). The two close by discussing related ERISA fiduciary issues and administrative practicalities for employers to consider when adopting an RBP design.
Every other week, NFP's legal experts make the subject of compliance personal for a wide audience. By breaking down the daunting details of emerging policies and bridging the gap between legislation and what it means for the listener, Chase Cannon and Suzanne Spradley make compliance issues relatable and relevant. Visit our Soundcloud page every two weeks for the most up-to-date episode.
NFP's Benefits Compliance team is hosting its next webinar on October 16, 2019, from 2:00 to 3:00 p.m. CT (3:00 to 4:00 p.m. ET). The topic is "Cyber Threats Facing Fiduciaries Today."
Can't make a live webinar? A recording of each session will be posted to the NFP Client Learning Portal within 48 hours of the live webinar. Those listening to a recorded webinar aren't eligible for recertification credit.
The moderator will answer as many questions as possible during the webinar. If your question isn't answered by the end of the webinar, reach out to your advisor for assistance.
Cyber Threats Facing Fiduciaries Today
October 16, 2019
Register Now »
All programs are pending approval for 1.0 (general) recertification credit hour toward PHR, SPHR and GPHR recertification through the HR Certification Institute. For more information about certification or recertification, visit the HR Certification Institute website at www.hrci.org.
Employers must notify individuals who are eligible to participate in their medical plan of whether the plan’s prescription drug coverage is "creditable" or "non-creditable" as compared to Medicare Part D coverage.
As a reminder, the Medicare Part D notice of creditable coverage should be distributed to employees by October 14, 2019. This notice serves to inform Medicare-eligible individuals of whether or not their employer group coverage is creditable. That information is necessary to help such individuals avoid paying higher premiums (also known as late enrollment penalties) for Medicare Part D coverage.
Employers should consult with their service providers to determine whether their coverage is creditable using either the simplified determination method or an actuarial analysis. Also keep in mind that CMS provides a model notice for employers.