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August 2022  Volume 20, Number 8        

This Just In ...

Portions of CAA Healthcare Price Transparency Requirements Already in Effect

Initially set to go into effect the beginning of 2022, enforcement was delayed. However, some rules have gone into effect as of July 1st, while others will become mandatory at the beginning of 2023 and 2024, respectively.

Employer-sponsored health plans now must reveal all the medical costs being paid. Some of the information to be made available to participants and beneficiaries includes:

  • In-depth explanations of benefits, including good-faith estimates of how much participants can expect to pay out of pocket for scheduled in-network medical services. This data is to be provided upon request.
  • An Online price comparison tool so beneficiaries can compare cost-sharing amounts from various providers for 500 goods and services starting at the beginning of 2023 and for all items and services starting in 2024. Upon request, individuals can receive this information on paper.
  • Data pertinent to plan pricing. This must be displayed on a website accessible to the public, and include in-network rates, allowable costs outside of the network, and the cost of prescription drugs based on the plan’s formulary.

In addition, detailed information on medication costs resulting from claims must be reported to federal regulatory authorities.

According to the Employee Retirement Income Security Act, employers that sponsor group health plans are ultimately responsible for ensuring their providers comply with the rules. This makes it incumbent on companies to ensure their vendors are up to speed and follow these new regulations.

Some experts advise employers to amend their service agreements to clearly affirm that insurers or third-party administrators are taking every action necessary to align with the new regulations.

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In this issue:

This Just In ... Portions of CAA Healthcare Price Transparency Requirements Already in Effect

Big Increases in Voluntary Benefits Participation

DOL Issues Mental Health Parity Act Enforcement Warning

How to Use Benefits to Improve Talent Acquisition and Retention

Zillennials Challenge Traditional Workplace Conventions



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