Why it May Help to Map Out Your Benefits Administration Process: Competitive Advantages Issue 48

I get it wrong sometimes. I put the cart before the horse and didn't have the right order of priorities for a group.

I jumped the gun and went to population health, risk financing like captives and stop-loss, and related topics with a group. It's what I wanted to talk about.

The issue is it's not what they wanted to talk about right now.

They're in the midst of a confusing web of benefits portals, worksheets, and more, none of which is making it easy for them to administer their benefits today. They're worrying about onboarding employees, downloading and reviewing spreadsheets, completing forms and tasks, and all other manner of responsibilities associated with managing their people and administering their benefits program.

We'll get to health plan strategy. But I had to reset and build out a strategic plan for benefits enrollment and communication to revamp what they're doing. This includes assessing and implementing:

• Benefits administration systems like Employee Navigator
• Employee communications systems like text-based platforms
• Setting up file feeds between their benefits admin system and carriers for direct information sharing
• We're also considering a payroll integration to automatically share payroll deductions from their benefits elections
• Enrollment microsite with learning resources and a live enrollment call center

Our intention with all these resources is to enhance the employee's experience with benefits and cut down on the headache and administrative load on HR. This will make their lives easier and their programs more effective.

Here's the enrollment flowchart I suggested to them, as a picture really helped us get on the same page:

All before we ever get to cutting healthcare costs, more effectively purchasing insurance, and improving employee health.

Walk before you run.

??Healthcare News

A questionable suggestion from Merriam-Webster:

Mental health parity update from my friend Solome Tibebu : Advocacy groups such as American Foundation for Suicide Prevention , American Psychological Association , American Psychiatric Association , NAMI, Eating Disorders Coalition for Research, Policy & Action (EDC) , and more are highlighting how new parity rules for mental health will spur behavioral health tech investments and innovation.

The U.S. Supreme Court will take up a case Tuesday that could impact how women get access to mifepristone: The Court will decide if the Food and Drug Administration (FDA) overlooked safety concerns in making mifepristone more accessible, including through mail-order pharmacies.?Legal briefs filed with the court describe the pill’s safety in vastly different terms: Medical professionals call it “among the safest medications” ever approved by the FDA, while the Christian conservative group suing the agency attributes “tens of thousands” of “emergency complications” to the drug. Pharmaceutical companies and former health officials worry that reversing the FDA’s decisions would upend and politicize otherwise routine regulatory review processes.

Measles are back in, unfortunately: There are now 64 measles cases in the US this year, more than the 58 in all of 2023. State required vaccinations in kindergartners have fallen from 95% a few years ago to 93% last year. Vaccine exemptions are on the rise, showing the public health challenge we're facing with vaccine hesitant parents.

??Compliance Updates

Federal Court Approves $1 Million Settlement in Class Action Involving Threatening and Misleading COBRA Notice: The former employees filed a class action lawsuit against the employer, claiming that in its COBRA notice, the employer attempted to intimidate them into not electing COBRA coverage by warning them that submitting incomplete information could result in civil and criminal penalties. The notice allegedly also referred to a $50 IRS penalty for each failure to provide a correct tax identification number for a covered individual. Read more here

A Rare Instance of Bipartisanship: Congress’ Unified Approach to PBM Reform: Core themes of these pieces of legislation are increasing transparency of PBM operations and prohibitions or limitations on the use of spread pricing, a technique where PBMs could profit from the margin between what health plans are charged and what is paid to pharmacies, potentially incentivizing formularies to favor more costly drugs. A deep dive into these significant bills will help us understand the potential landscape of PBM regulation and its far-reaching implications for the health care system. Read more here

Revised OCR Guidance Provides New Examples, but Raises More Questions, Regarding Use of Online Tracking Technologies by HIPAA Covered Entities and Business Associates: OCR has now opined that the information collected may not be PHI depending on the individual user's reason for visiting a Regulated Entity's unauthenticated pages on a website or mobile app. The updated guidance does not address how an individual's reason for visiting its website can be discerned at the point of collection through these automated electronic processes. Nor does the guidance expressly state that consideration of the reason for the individual's visit may be considered by OCR in its enforcement efforts. Read more here

Group Health Plan ACA Reporting – The 2024 Edition: Employers (or other plan sponsors) who missed the March 1 deadline should provide the individual returns as soon as possible. Corrections made within 30 days of the deadline will result in reduced penalty amounts, and corrections made after the 30 -day deadline but before August 1 are subject to increased penalty amounts that are still less than the presumptive penalty amounts that would otherwise apply. Read more here

The Cost Of Drugs: Johnson & Johnson Lawsuit Could Signal the Opening of a New Area of ERISA Class Action Litigation Against Health Plan Fiduciaries: Lewandowski reinforces how important it is for health plan fiduciaries to pay close attention to their plans' costs and fees. Retirement plan 'excessive fee' litigation has reshaped the entire retirement industry -- from the pricing of investments to compensation paid to service providers to insurance and legal costs. If Lewandowski gains any traction and paves a new path of ERISA fiduciary litigation, we could see the same seismic disruption in the health plan industry. Read more here

Another Class Action Alleging Discriminatory Coverage of Fertility Treatment Proceeds to Trial: The court concluded that the participant had adequately alleged that on its face, the plan imposed an unequal burden on same-sex couples by requiring them to incur out-of-pocket costs and provide verifiable proof of multiple cycles of donor insemination, while heterosexual couples could show infertility without cost or documentation. The court further concluded that the employer was not a necessary party to the litigation despite the administration company's argument that the employer had the final say on the benefits offered by the plan. Read more here