The Internal Revenue Service (IRS) has announced that the 2018 annual limitation on health savings account (HSA) contributions by individuals with family coverage under a high deductible health plan (HDHP) is now $6,850. This limit was previously announced as $6,900, but has been revised downward due to an inflation adjustment provision in the Tax Cuts and Jobs Act. The 2018 annual limitation on HSA contributions by an individual with self-only coverage under a HDHP remains unchanged at $3,450.

Click here to read the IRS announcement and contact us with any questions.

PNW Insurance Solutions

(425) 314-0988

www.pnwisol.com

Hello,

I wanted to share with you a very informative webinar, Sexual Harassment Prevention Guidelines. I have included a copy of the slide presentation and a recording of the webinar below.

Download Webinar Slide Presentation
View the Webinar Recording

This webinar covers important topics, including:

• Recognizing Sexual Harassment
• Establishing a Sexual Harassment Policy
• Investigating Sexual Harassment Claims
• Taking Corrective Actions

I hope you find this webinar helpful.

Best,

Wendee Allen
PNW Insurance Solutions
(425) 314-0988

If you've got teenagers covered on either your individual or small group medical insurance plan, be prepared to pay higher rates for them because insurance companies must comply with new Member-Level Rating (MLR) requirements starting in 2018. This change is to help lessen future increases when a member turns age 21.  

Q: What is Member-Level Rating (MLR)? 
A:  Each member gets an assigned rate and these are then added together to determine the premiums charged to the subscriber and any dependents. 

Q:  What are the new regulations about age and rates? 
A:  The Final Rule directs all health plan issuers of small group and individual plan coverage (on and off the  Exchanges) to revise the member level rating age bands used for individuals 0–20 years of age from using 1 age band to now create 7 age bands. The first age band cover ages 0–14, then single year age bands cover 15, 16, 17, 18, 19, and 20. This change will align with utilization of  services while smoothing rate increases over time. 

Q: How does this impact rates? 
A:  Every year members get 1 year older and in most cases move to a new age band. The introduction of the new age bands changes how rates are calculated for members under 21. By 2019, having more age bands will allow a more gradual  increase as experienced today when turning age 21.  2018 is a transition year where all members age 0 to 20 will experience significant increases. 

Want to learn more about this change and how it will impact you? Call PNW Insurance Solutions at (425) 314-0988 and ask to speak with Wendee Allen
 

King County & Snohomish County Health Insurance Open Enrollment begins in 1 week! Are you ready? Need help? We're not called PNW Insurance Solutions for nothing. Contact us today. 
 

The Trump administration announced yesterday that it will no longer make cost-sharing reduction (CSR) payments to insurance companies under the Affordable Care Act (ACA). According to a statement issued by the U.S. Department of Health and Human Services (HHS), the agency's decision to discontinue these payments immediately follows a legal review by HHS, the Department of Treasury, the Office of Management and Budget, and an opinion from the U.S. Attorney General. 

Background
The ACA requires insurers to offer plans with reduced deductibles, copayments, and other means of cost sharing to eligible individuals who purchase plans through the Health Insurance Marketplace. In turn, insurers receive CSR payments arranged by the Secretary of HHS to cover the costs they incur because of this requirement. Whether CSR payments were properly appropriated by Congress has been the subject of litigation since 2014.
To read the HHS statement, click here. 

Call us today for more information about ACA requirements and changes to the Individual & Family marketplace. We're here to help. PNW Insurance Solutions - (425) 314-0988.  Ask for Wendee Allen

New Executive Order Calls for Expanding Access to Association Health Plans

President Trump has signed an executive order calling upon the U.S. Department of Labor (DOL) to consider, among other things, expanding access to Association Health Plans, which could potentially allow employers to form groups across state lines. Until further guidance is issued or legislation is signed, however, all current ACA requirements remain in effect, including penalties for noncompliance.

Key Highlights

The following are key highlights of the order:

Association Health Plans (AHPs): The executive order directs the DOL to consider adopting a broader interpretation of the Employee Retirement Income Security Act (ERISA), which could potentially allow employers in the same line of business anywhere in the country to join together to offer health insurance coverage to their employees.

Short-Term, Limited Duration Insurance (STLDI): The executive order directs federal agencies to consider ways of expanding coverage through low-cost STLDI, which is not subject to certain ACA rules.

Health Reimbursement Arrangements (HRAs): The executive order directs federal agencies to consider changes to the rules regulating HRAs so that employers can make better use of these arrangements for their employees.

Note: In general, executive orders must be implemented in a manner consistent with applicable law, including the Administrative Procedure Act, which requires extended review of and public comment on any federal rules which may be proposed as a result of an executive order. Going forward, we will promptly report changes made to any ACA requirements.

To access your HR library, please visit www.pnwisol.com/hr360. Call with questions (425) 314-0988.

Too often, mistakes happen during Open Enrollment that can expose an employer to significant penalties. Be sure to avoid these costly mistakes with PNW Insurance Solutions' new Five Most Common Open Enrollment Mistakes guide. Click here to download.

PNW Insurance Solutions was interviewed this week in the Mill Creek and Mukilteo Beacon. In the article, owner Wendee Allen discussed how "one size fits all" health insurance rarely ever meets the needs of employers or their employees. Wendee also outlined how healthier employees leads to increased productivity and profits. Download the article.

For small businesses with less than 5 employees in western Washington state, buying health insurance inside the more stable group insurance marketplace will be a challenge, but one which needs facing for 2018.

Back in the late eighties, for every dollar spent on medicine, roughly 12 cents went towards prescription drugs. Fast forward to the present, and you’ll find that number has increased to a whopping 38 cents, with pharmacy trend expected to continue rising at 15%-25% annually.

Consider this: there are 6 new Specialty maintenance drugs (not cures, maintenance drugs) slated for release before the end of 2016, each carrying a 6 figure price tag. How did Specialty Pharmacy become such a trend-inflating monster? Why is the use of these medication types skyrocketing? To find some of the answers, we need to look no further than our home TV.

We’ve all seen the Specialty medication commercials …you know, the ones that endlessly drone on between the nightly news segments. But, did you know only the U.S. and New Zealand allow DTC (Direct to Consumer) drug ads? It appears the FCC will continue to allow Big Pharma to use their sneaky commercials to solicit and entice us to run to our doctors and ask for these new, amazing medications by name. But these commercials and their drugs come at a price... a big one for group health plans! 

So what is feeding this pervasive Specialty drug trend? The top 3 specialty therapy classes include medications for multiple sclerosis, oncology and inflammatory conditions. Just these three 3 classes alone accounted for 56.3% of the entire specialty medication spend in 2015. Let’s take a look at the top 10 specialty therapy classes for 2015:

1. Sleep Disorders – average cost per script about $9,000 fueled by an 18.5% increase in cost and 5.5% increase in utilization. This category of medications remains one of the most challenging classes to stop taking, yet one of the easiest to get a prescription for!
2. Hemophilia – this medication went up in cost by 15.4% per unit.
3. Pulmonary Hypertension – these drugs incurred a 13.4% increase in utilization and 4.8% increase in unit cost.
4. Cystic Fibrosis – The trend for this class of medications reached 53.4% in 2015 with an average cost of $6,441.27 per prescription.
5. Growth Deficiency – Some of the highest trend in 2015 (+140.6%) was attributable to treating rare condition growth deficiencies.
6. HIV - 6 of the top drugs increasing in spend by double and triple digits in 2015 are from the HIV category, moving it up to fifth place in the most expensive specialty therapy class. Brand inflation and utilization will continue to drive the trend for HIV drugs.
7. Hepatitis C – At $1,200 per pill and a multi-million dollar marketing campaign, Harvoni which was approved in 2014, accounted for more than 57% of market share for hepatitis therapy. No end in sight here.
8. Oncology - The FDA approved 10 oncology therapies in 2015, which helped increase spend 23.7%, while the increase in utilization (9.3%) and unit cost (14.4%) helped drive the trend.
9. Multiple Sclerosis - MS is ranked at number 2 in total trend for medications at 9.7%.
10. Inflammatory Conditions – When ranked by per member per month spend, inflammatory conditions remained at the top of the specialty therapy classes for the 7th consecutive year in a row, trending at a whopping 25%. Yikes!

Source: American Journal of Pharmacy Benefits, Published online March 16, 2016. www.ajpb.com

Most large, self-insured employers (2,000+ employees) enjoy having the option to carve-out prescription drug costs away from their medical plan and contract directly with the PBM (Pharmacy Benefit Manager) itself, resulting in increased transparency and a potential for large cost savings. But, what if you are a smaller self-insured employer, say around 250 employees? I can’t help but wonder what price that health plan is currently paying for Specialty and other drugs. 

The truth is, the large PBMs won’t even pick up the phone and speak with a smaller employer, because the PBMs pricing and servicing bandwidth just isn’t cost favorable for this segment. That is until recently. 

At PNW Insurance Solutions, we approach pharmacy claims for smaller employers as something to be managed, as part of a multi-year strategy. If you are a smaller employer, you can have options too, you just need to know the right insurance advisor who can provide them. Faced with double-digit increases in health care costs and premiums, many driven by high cost specialty medications, smaller employers between 100-1,999 lives want and need solutions too! Fortunately, PNW Insurance Solutions has an established process to provide PBM carve out analysis to the underserved smaller, group employer segment.

You have options!

www.pnwisol.com