I think Washington is starting to get it; employers and insurers are feeling the pain. An FAQ was released by the U.S. Department of Labor on May 2 that is actually helpful to employers, and also to advisers who have been stuck trying to sift through the health landscape in an effort to effectively inform and guide employers.
The FAQ provides an interesting plan design opportunity for large-group market coverage and self-insured plans. The FAQ says the plans can define essential health benefits to include only generic drugs (mandatory generic), while providing a separate option not as part of essential health benefits of electing a brand-name drug at a higher cost-sharing amount. The additional employee cost-sharing for brand-name drugs is not required to be counted toward the annual out-of-pocket maximum.
See related: New law signals spring thaw
The FAQ also says that until guidance is issued and effective, a plan using reference-based pricing will be considered in compliance as long as the plan uses a reasonable method to ensure that it provides adequate access to quality providers.
And, the FAQ indicates that Internal Revenue Service emphasis will be on compliance assistance and not the imposition of penalties under ACA.
A revised optional COBRA model notice was released, which advises eligible recipients that the individual exchanges might provide better options than the employer plan. It is well documented that COBRA experience runs as much as 200% of active employees, so this should be a win for employers. Since there is a new special enrollment period through July 31, 2014, employers should act quickly to let their current COBRA participants know of this new window.
A new CHIPRA notice was also released steering children of low-wage employees to public assistance.
Do I sense change in the air or is it just the midterm election? Who cares? The pendulum seems to be swinging back in favor of employers, insurers and advisers.
Hasday is chief operating officer of Frenkel Benefits, LLC, one of the largest privately held independent employee benefits brokers in the United States. Reach him at firstname.lastname@example.org or (212) 488-0200, and read more from Hasday at frenkelyspeaking.com.
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