The CAA of 2021 is now in effect and for employers, this means that they have a fiduciary responsibility and expands ERISA into employer-sponsored health plans. In short, employers must now ensure their health plans pay “reasonable fees” for necessary services. Employers who rely on TPAs, brokers, carriers, and other vendors must now take on the responsibility of monitoring and documenting the decision-making process to show they are acting in the participant’s best interest. TPAs and other professionals should take time to help their employers create a fiduciary committee to assist with compliance with these new regulations.
As employers start to create health plans for 2023, it’s important they include the kinds of benefits people are now looking for. Affordable health care is at the top of the list. While more than two-fifths of large employers offer low or no deductible plans, 11% are now considering it. Currently, 11% of employers offer free employee-only coverage for at least one offered medical plan and another 11% are considering it.
Other expanded options in health care include more telehealth, more mental and behavioral health, and reproductive health including benefits for high-risk pregnancies, lactation, pregnancy loss, and menopause. Non-medical specific benefits candidates are searching for include remote work, flexible schedules, and expanded family leave including maternity and paternity leave.
Source: Healthcare Finance News
Sun Life released its report on the annual high-cost claims for 2021. Stop-loss reimbursements for Sun Life’s top 10 conditions amounted to $3.50 billion. Below are the top 10 costliest claims:
10. Gastrointestinal/abdominal issues
8. Covid-19 (this is expected to rise over the next four years)
5. Newborn/infant care
2. Leukemia, Lymphoma, Multiple myeloma
1. Malignant neoplasm (cancerous tumors)
Sun Life expects Covid claims to increase over the next four years, despite the cost of treatment going down. Mental health costs because of Covid have also increased significantly including depressive disorders, sleep/wake issues, and alcohol-related and opioid-related disorders.
Shark Tank star and entrepreneur Mark Cuban’s recently co-founded a company called Cost Plus Drug which eliminates the pharmacy benefit managers which he believes is one of the reasons drug costs are so high. By eliminating the middleman, Cost Plus sells drugs at cost plus 15% and charges pharmacies a flat $3 labor fee. Cuban is building a manufacturing facility in Dallas and currently offers 110 drugs through Cost Plus.