July 17th, 2019
On June 24, 2019, President Trump issued an Executive Order (“EO”) directing the relevant federal agencies to issue regulations or other guidance to make available more meaningful information related to the price and quality of healthcare.
This summary highlights aspects of the EO that may be relevant to employer-sponsored group health plans and their covered participants.
- By October 22, 2019, the Treasury shall issue guidance to expand the ability of patients to select a qualified high deductible health plan (“QHDHP”) that can be used alongside a health savings account (“HSA”), and that cover low-cost preventive care, before the deductible, for medical care that helps maintain health status for individuals with chronic conditions. This may provide first dollar coverage of more items and services for individuals with a QHDHP, particularly as it relates to individuals with chronic conditions (e.g., diabetes). [...]
February 26th, 2019
Whether you’re a Blue Shield member or insured with another carrier, this recommendation is based on clinical guidelines from the Centers for Disease Control and Prevention (CDC). The CDC is a federal office in charge of health promotion and disease prevention in the US.
“We have included guidelines for routine exams, screenings, and immunizations. These are based on clinical guidelines from the Centers for Disease Control and Prevention (CDC). The CDC is a federal office in charge of health promotion and disease prevention in the United States.
“We recommend that you take these guidelines with you to your next doctor’s appointment. You can ask for your doctor’s view on which exams and screenings you or your loved ones may need this year.”
February 13th, 2019
Last week, the Department of Health and Human Services (“HHS”) released a proposed rule to lower prescription drug prices and out-of-pocket costs by encouraging manufacturers to pass discounts directly to patients and bring new transparency to prescription drug markets.
- Nothing has changed. This is a proposed rule.
- Even if finalized in its current form, the proposed rule does not impact employer-sponsored plans unless Pharmacy Benefit Managers (“PBMs”) and pharmaceutical manufacturers adopt a new safe harbor (discussed below), which may provide additional transparency.
Under the federal Anti-Kickback Statute (“AKS”), the federal government may impose criminal and civil penalties on whoever “knowingly and willfully offers, pays, solicits or receives remuneration to induce or reward the referral of business reimbursable under any of the federal health care programs” (e.g., Medicare, Medicaid). Generally, employer-sponsored health plans are not “federal health [...]
February 1st, 2019
The Occupational Safety and Health Administration (OSHA) mandates that all employers who are required to maintain the OSHA 300 Log of Work-Related Injuries and Illnesses post a summary of the previous year’s log between February 1st and April 30th each year, even if no incidents occurred in the preceding calendar year. The summary (OSHA Form 300A) must be certified by a company executive and posted in a conspicuous location where notices to employees are customarily posted.
All employers who had more than ten employees at any point during the last calendar year are covered by this requirement unless they qualify as part of an exempt low-risk industry. A full list of the industries exempt from OSHA routine recordkeeping requirements (including posting Form 300A) can be found in the Guides section of the HR Support Center by searching “partially exempt industries.” [...]
January 30th, 2019
Employers must comply with numerous reporting and disclosure requirements throughout the year in connection with their group health plans. This Compliance Overview explains key 2019 compliance deadlines for employer-sponsored group health plans. It also outlines group health plan notices that employers must provide annually. Often, employers furnish these notices with the plan’s enrollment materials during its annual open enrollment period.
January 18th, 2019
The current partial government shutdown — which has been in effect since Dec. 22, 2018 — is the longest shutdown in U.S. history. Unlike past shutdowns, the government is not completely closed. However, due to the prolonged nature of the shutdown, employers are starting to feel its effects. This article provides an overview of how the shutdown is affecting private employers in the United States.
January 7th, 2019
The current federal minimum wage rate is $7.25 per hour. However, many states have adopted minimum wage rates higher than the federal rate. When the state rate and the federal rate are different, employers must pay their employees the higher rate.
The following states have adopted new minimum wage rates for 2019:
- New Jersey
- New York
- Rhode Island
- South Dakota
- Washington D.C
Affected employers should review their employees’ pay rates and update their minimum wage poster notices as necessary to ensure compliance with local wage and hour regulations.Important Dates
December 31, 2018
New minimum wage rate effective in New York.
January 1, 2019
New minimum wage rates [...]
November 14th, 2018
Date: November 9, 2018
Attn: Core and Premier Accounts
There are a number of wildfires underway in California. We are working hard to ensure the safety and care of all Blue Shield of California members.
Mandatory evacuations have been ordered for:
- The Hill Fire (Ventura County) is at ~10,000 acres in size. Mandatory evacuations are in zip codes, 93010, 93012, and 93066. New zip codes affected are 93041, 93033, and 91320.
- New Woolsey Fire (LA and Ventura County is at 8,000 acres in size. Mandatory evacuations are in 91361, 91362, 91301, 91302, 91367, 91377, 90265, 90263, 91307, 91360, and 93065.
- The Camp Fire (Butte County) is 20,000 acres in size. Mandatory evacuations are in zip codes 95969, 95965, 95967, 95928, and 95954. New zip code 95978.
Blue Shield’s response to fires:
- We are [...]
November 13th, 2018
FOR IMMEDIATE RELEASE
November 10, 2018
CONTACT: Eric Lail
Anthem Blue Cross
Anthem Blue Cross Supporting People Affected by Wildfires in Butte, Los Angeles and Ventura Counties
THOUSAND OAKS – Anthem Blue Cross (Anthem) is taking action to help people affected by the wildfires in Butte, Los Angeles and Ventura counties by revising medical and pharmacy guidelines that will help ensure members can access needed care and prescription medications. Anthem Blue Cross is also providing resources to access medical treatment or support via Anthem’s Employee Assistance Program (EAP) and Anthem’s LiveHealth Online telehealth service.
For impacted members, Anthem is:
- Relaxing time limits for prior authorization, pre-certification and referral requirements.
- Suspending early refill limits for prescriptions.
- Allowing replacement of medical equipment or supplies.
- Extending filing deadlines for claims.
These medical and pharmacy guidelines are effective from November [...]
October 25th, 2018
Anthem Blue Cross is updating pharmacy information on their ID cards to give their members a better experience at the drugstore. Your clients will receive a new ID card at renewal, starting in October 2018 and continuing through April 1, 2019. Groups scheduled to renew between May 2019 and October 1, 2019 will get a new ID card off renewal in the months of February and March 2019.Pharmacy changes
The new ID card will reflect new, Anthem-owned BIN and PCN numbers (used for processing prescription drug claims) and toll-free numbers for Pharmacy Member Services. These changes will help direct members and pharmacists to the right support, when they have questions about drug benefits.
Most members (about 85%) will get new cards during their plan’s regular renewal period, even if they don’t have any changes to their benefits at that [...]