Lately, you may have heard about surprise medical billing in the local and national news.  I'm thrilled both Washington D.C. and Washington state are finally giving this issue the attention it deserves, because it is one of the most costly and troublesome issues I see for health insurance consumers.  For most of us, the only 'surprise' we want on our medical bill, is to hear either we don't owe anything after all or insurance decided to cover it.  But the reality is, surprise or 'balance' billing can happen when you're treated for an emergency, or have a scheduled procedure at an in-network hospital or surgery facility and are seen by an out-of-network provider.

A common concern we get at PNW Insurance Solutions, located in Mukilteo, WA is something along the lines of "I went to an in-network hospital, so why do I owe this HUGE amount still?" Well, this happens because some types of providers, including anesthesiologists, radiologists, pathologists, and labs may not be contracted with your insurance company even though they provide services at a hospital or facility that is in your health plan’s provider network. So, in addition to your expected out-of-pocket costs, you also get a bill for the difference between what your insurer has agreed to pay that provider and the amount the provider billed for their services.  This is commonly referred to as 'balance billing'.  

So, what is Washington state doing about this?  Quite a bit actually.  Beginning January 1, 2020, The new surprise billing law (www.leg.wa.gov) prevents people from getting a surprise medical bill when they receive emergency care from a hospital or get care at an in-network facility but are treated by an out-of-network provider. If an insurer and provider cannot agree on a price for the covered services, they can go to binding arbitration but they cannot bill the consumer for the amount in dispute. How great is that?!? 

This new law will provide transparency. Insurers, medical providers and facilities must give consumers a new notice detailing their rights and letting them know when they can and cannot be balance billed. Also, they must keep updated information about provider networks on their websites. At last, some long needed help!

This new law will provide dispute resolution. The amount an out-of-network provider will be paid by an insurer must be a 'commercially reasonable' amount, based on payments for the same or similar service in a similar geographic area. If an insurer and provider cannot reach an agreement, either one can request arbitration. Neither one can involve the consumer in the dispute. More protection for us!

There will be a new sheriff in town. If the commissioner's office sees that a provider is continuing to surprise bill consumers, it can refer the provider to the Department of Health for disciplinary action. Bam!

So what should you do before the law is enacted if this happens? If you get a surprise medical bill before the new law takes effect, you should contact the provider directly. Tell them you know the law is changing soon and ask them to reconsider the charges or request a reduced charge. Unfortunately, surprise billing could still occur in this time, but knowing your options could help you reduce your costs. Stand up for yourself!

If you have any questions, please contact Wendee Allen at PNW Insurance Solutions 425-314-0988.

As the weather heats up, the insurance carrier activity here in Washington state is heating up too.  The 2020 individual and small group requested rate increases were recently released.  There are decreases, increases, carriers exiting the state or certain counties, a few new players and more! 

Individual & Family Health Insurance

There are two new insurance companies entering the Washington market and many changes to county coverage with existing carriers.  Of note: 

• Bridgespan, Lifewise and Regence are adding King and Pierce counties
• Bridgespan also adding Clark county
• Lifewise adding 21 counties altogether
• Premera removing 7 counties including Snohomish & Pierce counties
• Coordinated Care adding Kitsap county
• Kaiser Permanente removing San Juan county
• Molina adding Snohomish county
• Two new carriers: PacificSource (3 counties) and Providence (6 counties)

Small Group Health Insurance

The requested small group rate increases for 2020 are in for several noteworty carriers:

• Aetna will continue to sell plans statewide and requested a 11.0% rate increase
• Kaiser Permanente requested a 4.4% increase and is pulling out of San Juan county 
• Premera Blue Cross requested a 5.6% increase and will offer plans statewide, except in Pierce county
• PacificSource is a new carrier to Washington offering plans statewide
• Regence Blue Shield - requested a 5.8% rate increase and will continue to sell plans in all current areas
• United Healthcare - will continue to sell plans statewide and requested a 9.0% rate increase
• Health Net has decided to discontinue selling small group plans altogether in Washington state

The requested changes from each insurance company have not been approved yet by Washington's Insurance Commissioner.  We did see changes happen last year and will provide updates as they become available. If you have any questions please contact Wendee Allen at (425) 314-0988. Have a great summer!

The IRS recently announced the dollar limits for the 2020 calendar year applicable to group plans and high deductible health plans (HDHPs)/health savings accounts (HSAs) .

2020 maximum out-of-pocket limits for group plans 
$8,150 for self-only coverage ($7,900 in 2019)
$16,300 for family coverage ($15,800 in 2019)

The out-of-pocket maximum includes copayments, deductibles and coinsurance amounts, and excludes premiums.  

2020 limits for HDHPs/HSAs
Minimum deductible 2020 
$1,400 for self-only coverage ($1,350 in 2019)
$2,800 for family coverage ($2,700 in 2019)
$2,800 for embedded individual deductible ($2,700 in 2019)

Out-of-pocket maximum 2020
$6,900 for self-only coverage (versus $6,750 in 2019)
$13,800 for family coverage  (versus $13,500 in 2019)

HSA contribution limits 2020
$3,550 for self-only coverage (versus $3,500 in 2019)
$7,100 for family coverage (versus $7,000 in 2019)
The annual “catch-up” contribution amount for individuals age 55 or older will remain $1,000.

Contact your PNW Insurance Solutions representative for more information by calling (425) 314-0988.

Is your Company's HSA Plan Compliant for 2019? 

You can easily make sure by reviewing these 2019 HSA Compliance Tips //j.b5z.net/i/u/10244843/f/Key_HSA_Features___2019_Compliance.pdf.

If you have questions, please contact Wendee Allen at PNW Insurance Solutions by calling (425) 314-0988.

New Limit Amount
In November 2018, the IRS increased the FSA contribution limit from $2,650 to $2,700 for taxable years beginning in 2019. This increase reflects the steady contribution limit increase from the past few years. 

Next Steps
Employers should ensure that their health FSA will not allow employees to make pre-tax contributions in excess of $2,700 for 2019, and they should communicate the 2019 limit to their employees as part of the open enrollment process.

A new proposed rule would permit all employers to offer health reimbursement arrangements (HRAs) to reimburse employees' individual health insurance policy premiums if certain conditions are met. Currently, many employers are prohibited from offering such HRAs. If finalized, the proposal would be effective for plan years beginning on or after January 1, 2020.

In general, the proposal would permit HRAs to reimburse premiums for individual health insurance policies only if:

• All individuals covered by the HRA verified that they are, or will be, enrolled in individual health insurance coverage;
• No class of employees is offered a choice between a traditional group health plan and the HRA;
• The HRA is offered on the same terms to all employees within a class;
• Participants can opt out of the HRA annually; and
• Employers provide eligible participants with a written notice describing certain features of the HRA.

Click here for more information on the proposal and contact Wendee Allen of PNW Insurance Solutions at (425) 314-0988 with questions.

Got Strategy?  

Do you own a small business in Washington state? You do huh? Then chances are your company's health plan is about to get it's annual medical plan renewal. Before rushing right into things, stop, breathe and review your employee benefits strategy first. These are some questions to consider prior to renewal:

Cost Management
What is your plan doing to manage benefits costs and achieve sustainable results so you can attract and retain the talent you need?
Compliance Consulting
Have you built a solid foundation for your overall compliance strategy and are you prepared for legislative and regulatory changes that impact your business?
HR Technology Solutions
Do you need to find the right solution that lightens your workload and enables you to achieve your objectives?
Health and Performance
What steps are you taking to enhance the health and productivity of your workforce?
Benefits Communication 
Where can you elevate year-round benefits communication so your employees understand and use their benefits?
Voluntary Benefits
What other benefit options are you offering that your employees will embrace?

Taking a strategic approach before renewal will save time and money.  If your strategy is old or non-existent, we can help.

PNW Insurance Solutions (425) 314-0988

www.pnwisol.com 

Workplace Bullying: More Common Than You'd Think

National Bullying Prevention Month is recognized every October. What many people don’t realize is that workplace bullying affects more than 35 percent of adult Americans.

What is Workplace Bullying?
Generally, workplace bullying is defined as the use of intimidation through power, influence, tone, or language to affect a person negatively. Often, bullying is intentional, but sometimes the bully is not aware of their hurtful actions or words. Workplace bullying affects safety, productivity, trust, and the workplace culture.

What are the Signs of Workplace Bullying?
Some common signs of workplace bullying include:

• Ignoring, isolating, or excluding an employee
• Reprimanding or humiliating an employee publicly
• Name-calling or insulting an employee

Take steps today using your HR Library for specific forms and warnings.  Don't have an HR Library? Contact Wendee Allen (425) 314-0988

Back in early 2017, President Trump signed an executive order intending to provide alternatives to the Affordable Care Act (ACA). One of the rules included in this executive order modifies how the government can regulate association health plans (AHPs). 

What are association health plans?
Association health plans allow small groups to band together and act as one large group. AHPs are actually not plans themselves, but rather an overarching term describing small business and sole proprietors coming together to negotiate better prices with health insurance companies.

Essentially, the larger a group, the less risk there is for an insurance company.  If the group is determined to be less risky, the price is lower. So, by allowing several small groups to act as one large one, the risk (potential cost for the insurance company) gets spread out amongst the large pool of enrollees, and when one person gets sick, there are more than enough monthly payments going to the insurance company to cover those costs.

This concept isn't really new, so what is changing about association health plans?
The big change with these plans is that they will now be regulated the same as large employer policies. Most importantly, this means that association health plans (AHPs) do not need to adhere to ACA rules, such as the requirement to offer plans with the ten essential benefits.

According to Labor Secretary Alexander Acosta, “AHPs are about more choice, more access, and more coverage.” These plans will probably benefit enrollees by having lower premiums, and might even mean the difference between offering coverage or not for some small employers who struggle to afford Obamacare prices. The devil will be in the details.

At what cost does access to more choice and cheaper premiums come at?
Although being part of a larger group does often come with price reduction due to a larger risk pool, there are more reasons why these plans will likely be a lot cheaper.

As stated before, these plans do not have to offer the ten essential benefits. If you’re a young woman looking for maternity benefits, or someone with a chronic illness, you might not be getting everything you need by getting coverage from an association health plan.

Also differing from ACA policy—gender, age, and industry could affect prices of individuals being covered under association health plans. Health status is not included in this list though, so just as with the ACA, pre-existing conditions will not affect prices for those covered under association health plans.

How does the new regulation on association health plans affect the ACA as a whole?
A major selling point of the ACA was that all people would be treated the same, and there was a baseline of benefits that had to be offered.

With the new rules regarding association health plans, this facet of the health insurance industry would no longer be true for small businesses participating in the AHPs.

AHPs could also make our Washington State Health Insurance exchange (Obamacare) more volatile. In theory, young healthy workers could all choose to be covered by the less comprehensive, but cheaper AHP plans. This could leave older and sicker Americans as the only enrollees in Obamacare plans, which could mean prices skyrocket, since the insurance companies are only covering sicker individuals. The death spiral.

We should all remain skeptical until more details and bonfide products are released.

Should you have any questions, please contact me.  Wendee Allen, PNW Insurance Solutions wendee@pnwisol.com.  

This is article is for general information and may not be updated after publication.

Effective for disability claims filed after April 1, 2018, employee benefit plans subject to the Employee Retirement Income Security Act (ERISA) must comply with new requirements.

Background
In 2016, the U.S. Department of Labor (DOL) released a final rule to strengthen the claims and appeals requirements for plans that provide disability benefits and are subject to ERISA. According to the DOL, the information it received during the delay period did not justify modifying or rescinding the final rule. Thus, the final rule will take effect without change.

Final Rule Applies to "Disability Benefits"
A benefit is considered a "disability benefit" if the claimant has to be disabled in order to obtain the benefit. It does not matter how the benefit is characterized or whether the plan as a whole is a retirement plan or a welfare plan. If the claims adjudicator must make a determination of disability in order to decide a claim, the claim must be treated as a disability claim for purposes of the DOL's claims procedures.

Specific Changes Made By The Final Rule
Specifically, the final rule requires that plans, plan fiduciaries and insurance providers comply with additional procedural protections when dealing with disability benefit. 
Employer Action Steps
The final rule applies to ERISA plans that include disability benefits. These plans must comply with the new procedural protections, effective for claims that are submitted after April 1, 2018. Entities that administer disability benefit claims, including issuers and third-party administrators, will need to revise their claims procedures to comply with the final rule. This includes sponsors of defined benefit pension plans, 401(k) plans, 403(b) plans covered by ERISA, and top hat plans, in addition to disability benefit plans.

Specific employer action items include the following:

Identify all ERISA covered plans that provide for a disability benefit. This includes most long-term disability plans and some short-term disability plans, as well as retirement plans that provide for a disability benefit;
Review current plan documents and summary plan descriptions, and update claims procedure descriptions to include the additional requirements of the final rule; and
If applicable, review any contractual agreements with third parties responsible for making disability determinations to confirm appropriate processes are in place on their end and they have responsibility for complying with the new requirements.

For additional information, please contact your PNW Insurance Solutions Benefits Consultant or Wendee Allen at 425-314-0988 or wendee@pnwisol.com.