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Hot Topics Blog

Monday, July 11 2022

Each year, small group insurance carriers in Washington state must submit their requested rate increases to Washington’s Office of the Insurance Commissioner (OIC).  Small group insurance plans are for employers who had 50 or fewer employees on average during the calendar year prior to the effective (or renewal) date of the plan.  

Unfortunately, there are more two digit increases requested for 2023 than in 2022.  Why? The pandemic.  Many insurance companies are asking for higher rate increases on renewals due to lagging COVID-related claims, COVID test kits, a higher medical and prescription drug trend, and overall inflation.  Additional factors impacting small group rates include:

  • Some care deferred during the pandemic returned - Healthcare spending by employers in 2021 was lower than expected, in large part because of the deferral of care as a result of the pandemic. 
  • COVID costs are likely to persist - The costs of testing for COVID, treating patients and administering vaccinations for the disease likely will continue into 2023.
  • The mental health and substance use crises show no signs of waning - The pandemic substantially increased demand for mental health services. Increased substance use also likely will increase healthcare spending in 2023.
  • Population health worsened during the pandemic - Poor pandemic-era health behaviors such as lack of exercise, poor nutrition, increased substance use and smoking has led to an increase in healthcare spending and medical trend.  Medical trend is defined as the projected percentage increase in the cost to treat patients from one year to the next, assuming benefits remain the same.

There are two insurance companies who asked for double digit increases to their small group, age-banded rates:  Kaiser of WA (+10.2%) and Premera Blue Cross of WA (+11.5%).  These increase requests are based upon each carrier's gain or loss at the end of 2021.  Kaiser has a $10.3M deficit and Premera's was $1.6M.

It will take a few months for the OIC to review and approve the requested increases, but if you're with Kaiser of WA or Premera for small group, it may be time to shop around.  Need help? Contact us. We can help find alternative affordable plans.

Tuesday, February 01 2022

A quick update on the WA Cares LTC Act.  On 1/27/2022, Governor Jay Inslee signed into law two bills, House Bill 1732 and House Bill 1733, which became effective at signing. These new bills will delay and make significant changes to the Washington Cares Fund.

Employers should cease collecting premiums for the Washington Cares Fund immediately and refund any premiums that have been deducted in accordance with HB 1732 which requires refunds to be made within 120 days of the collection of the premiums.

Employers should continue to monitor the WA Cares Fund for further developments at the following link: https://wacaresfund.wa.gov/.  We will continue to provide updates on our website's blog located at https://pnwisol.com/hot-topics1.
 

Washington Cares Fund - LTC Tax Delayed
Wednesday, December 22 2021

On Friday, December 17, 2021, Governor Inslee, as well as Senate Majority Leader Andy Billig and House Speaker Laurie Jinkins, issued statements implementing a delay in the WA Cares program. Specifically: 

  • The statements “strongly encourage” employers not to withhold the premium, which would have otherwise gone into effect January 1, 2022.
  • The Washington Employment Security Department will not collect the employee premiums from employers before April 2022, at the earliest.
  • Washington State will not assess penalties or interest on employers who do not withhold the premium from employees’ wages.

Photo by Brett Jordan on Unsplash
 

Thursday, November 11 2021

FINALLY!

The Internal Revenue Service (IRS) finally announced the official 2022 Flexible Spending Account (FSA), commuter, and adoption limits. Here are the newly released contribution limits:

NEW CONTRIBUTION LIMITS

  • 2022 Healthcare FSA/Limited Purpose FSA: $2,850
  • 2022 FSA carryover: $570
  • 2022 Dependent Care FSA: $5,000 (family); $2,500 (married filing separately)
  • 2022 Commuter (parking and transit): $280 per month
  • 2022 Adoption limit: $14,890

YOUR FLEXIBLE SPENDING ACCOUNTS
The 2022 healthcare FSA contribution limit is an increase of $100 from the 2021 healthcare FSA contribution limit ($2,750). The carryover limit is an increase of $20 from the 2021 limit ($550).

The 2022 Dependent Care FSA contribution limits decreased from $10,500 in 2021 for families and $5,250 for married taxpayers filing separately. The 2021 Dependent Care FSA limits came in response to the COVID-19 pandemic as a temporary relief to working parents. Both healthcare FSAs and Dependent Care FSAs are versatile healthcare savings vehicles that allow individuals to receive tax benefits when they spend funds on eligible expenses.

Overall, there are four general types of FSAs to know about:

  1. Healthcare FSA: Can be used for eligible medical expenses, including deductibles, copays, and coinsurance.
  2. Post-deductible FSA: Can be used for certain eligible medical expenses once a minimum deductible has been met. Can be used in conjunction with a Health Savings Account (HSA).
  3. Limited-purpose FSA: Can be used to pay for eligible vision and dental expenses. Can be used in conjunction with an HSA.
  4. Dependent Care FSA: Can be used to pay for eligible expenses related to tax dependents, including day care, preschool, elderly care, and other types of dependent care. This type of FSA can only be used if the dependent care is necessary for you or your spouse to work, look for work, or to attend school full time.

 WHAT TO KNOW ABOUT ROLLOVER FUNDS 
In general, FSA funds are a use-it-or-lose-it account. However, employers may offer employees one of two options:

  1. Grace period: Allows for a maximum of an extra 2.5 months to use FSA funds for eligible expenses incurred in the following plan year.
  2. Carryover: Allows accountholders to carry over a certain amount (for 2022, the limit is $570) that can be used in the following year.

Employers can offer one of these options but not both, and neither option is required. To learn more contact us for more information.

DETAILS ON COMMUTER LIMITS
For 2022, the commuter contribution limits have increased $10 more per month than the 2021 contribution limit ($270).

If this plan is offered by the Employer, a commuter account allows you to set aside pre-tax funds to pay for your commute to work. For 2022, if you were to use both transit and parking, you could set aside up to $6,720 annually. Assuming a 30% effective tax rate that means you could potentially reduce your tax liability by more than $2,000. 


ADOPTION ASSISTANCE EXCLUSION AND ADOPTION CREDIT
The IRS also increased the Adoption Assistance Exclusion or Adoption Credit amounts to $14,890, an increase of $490 from 2021 ($14,400).
Parents who either adopted or tried to adopt a child may seek to claim the adoption credit on their individual tax returns. If a taxpayer’s employer helped with adoption expenses through a qualified adoption assistance program, the taxpayer may qualify to exclude that amount from their individual taxes.
 

401(k) Contribution Limit Increased to $20,500
Monday, November 08 2021

401(k) Contribution Limit Increased to $20,500

The Internal Revenue Service (IRS) has released Notice 2021-61, which contains cost-of-living adjustments for 2022 that affect amounts employees can contribute to 401(k) plans and individual retirement accounts (IRAs). The employee contribution limit for 401(k) plans in 2022 has increased to $20,500, up from $19,500 for 2021 and 2020.

Other key limit increases include the following:

The employee contribution limit for SIMPLE IRAs and SIMPLE 401(k) plans is increased to $14,000, up from $13,500.
The limits used to define a “highly compensated employee” and a “key employee” are increased to $135,000 (up from $130,000) and $200,000 (up from $185,000), respectively.

Key limits that remain unchanged include the employee contribution limit for IRAs (remaining at $6,000) and the catch-up contribution limit for employees aged 50 and over who participate in 401(k), 403(b), most 457 plans and the federal government’s Thrift Savings Plan (remaining at $6,500).

No more surprise or balance billings for emergency care
Monday, October 04 2021

Starting Jan. 1, 2022, Washington state law protects you from surprise or balance billing if you receive emergency care at any medical facility or when you're treated at an in-network hospital or outpatient surgical facility by an out-of-network provider. 

What is surprise or balance billing
Surprise billing happens because some types of medical providers, including anesthesiologists, radiologists, pathologists, and labs may not be contracted with your health insurer 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. 

The new Balance Billing Protection Act prevents people from getting a surprise medical bill when they receive emergency care from any hospital or if they have a scheduled procedure an in-network facility and receive care from an out-of-network provider. In this case, if an insurer and provider cannot agree on a price for the covered services, they go to arbitration and cannot bill the consumer for the amount in dispute.
 

What to do if you get a surprise bill
If you get a surprise medical bill for a service you had before Jan. 1, 2022, contact the provider or facility and tell them your concerns. See if you can get them to lower your bill. After Jan. 1, 2022, you cannot be surprise billed for certain services. If you get a surprise bill, contact the provider or facility and tell them you believe you've been wrongly billed. You can also file a complaint with the Washington Office of the Insurance Commisioner and they will investigate on your behalf. 
 

The law applies to most, but not all health plans 
The Balance Billing Protection Act applies to all state-regulated health plans and state and school employee benefit plans. Self-funded group health plans are not regulated by the state and must notify the WAOIC if they want to opt-in to the law and offer the protections to their enrollees.  

ACA Subsidy Expansion under ARPA
Wednesday, March 17 2021

There are a number of new laws coming out of the Biden Administration which may impact you.  Centers for Medicare & Medicaid Services (CMS) provided a fact sheet regarding new ACA subsidies, with a Q&A section to help individuals understand how to obtain the new subsidies. To delve further in by county, see the Assistant Secretary for Planning and Evaluation (ASPE) data sets which break down the uninsured numbers by household income, age, etc.  

Health and Human Services (HHS) provided a fact sheet regarding new ACA subsidies, along with a table which shows the number of uninsured who will now be eligible in each state.

For additional information, refer to HR360 .


 

HHS Finalizes ACA Section 1557 Rule
Wednesday, June 17 2020

Final Rule Removes Gender Identity, Termination of Pregnancy, and Notice and Tagline Provisions

On June 12, 2020, the U.S. Department of Health and Human Services (HHS) issued a final rule that revises the implementation of the Affordable Care Act’s Section 1557 nondiscrimination provisions on gender identity and language access. Specifically, the final rule:

  • Removes gender identity and termination of pregnancy from being included as sex discrimination; and
  • Eliminates the requirement that covered health programs and activities distribute nondiscrimination notices and tagline translation notices in at least 15 languages to patients and customers.

The final rule is scheduled to be published in the Federal Register on June 19, 2020, and will become effective 60 days after publishing. The final rule does not affect the substantive Section 1557 provisions related to nondiscrimination on the basis of disability, race, color, age, national origin or sex.

FFCRA Employer Notice, Fact Sheets, Q&As Available on DOL Webpage
Thursday, March 26 2020

Employer Notice, Fact Sheets, Q&As Available on DOL Webpage
Guidance materials on the new Families First Coronavirus Response Act (FFCRA) are now available for employers from the U.S. Department of Labor (DOL). Links to the materials, which explain how the law will be implemented and include required notices, can be found on a DOL webpage dedicated to COVID-19. Employers should monitor the webpage to stay apprised of the latest DOL guidance on the law, as the page is updated frequently.
 
The following resources are currently available on the DOL COVID-19 webpage:
 
Fact Sheets
Families First Coronavirus Response Act: Employee Paid Leave Rights (PDF)
 

Questions and Answers
Families First Coronavirus Response Act: Questions and Answers
COVID-19 and the Fair Labor Standards Act: Questions and Answers
COVID-19 and the Family and Medical Leave Act: Questions and Answers

Posters
Employee Rights: Paid Sick Leave and Expanded Family and Medical Leave under The Families First Coronavirus Response Act (FFCRA)
Families First Coronavirus Response Act Notice - Frequently Asked Questions

Field Assistance Bulletin
Field Assistance Bulletin 2020-1: Temporary Non-Enforcement Period Applicable to the Families First Coronavirus Response Act (FFCRA)

What consumers need to know about WA state's new surprise or balance billing
Saturday, February 01 2020

Starting Jan. 1, 2020, Washington state law protects you from surprise or balance billing if you receive emergency care at any medical facility or when you're treated at an in-network hospital or outpatient surgical facility by an out-of-network provider. 

What is surprise or balance billing?
Surprise billing happens because some types of medical providers, including anesthesiologists, radiologists, pathologists, and labs may not be contracted with your health insurer 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. 

The new Balance Billing Protection Act prevents people from getting a surprise medical bill when they receive emergency care from any hospital or if they have a scheduled procedure an in-network facility and receive care from an out-of-network provider. In this case, if an insurer and provider cannot agree on a price for the covered services, they go to arbitration and cannot bill the consumer for the amount in dispute.

What to do if you get a surprise bill
If you get a surprise medical bill for a services you had before Jan. 1, 2020, contact the provider or facility and tell them your concerns. See if you can get them to lower your bill. After Jan. 1, 2020, you cannot be surprise billed for certain services. If you get a surprise bill, contact the provider or facility and tell them you believe you've been wrongly billed. You can also file a complaint with our office and we will investigate on your behalf. 

The law applies to most, but not all health plans 
The Balance Billing Protection Act applies to all state-regulated health plans and state and school employee benefit plans. Self-funded group health plans are not regulated by the state and must notify the state if they want to opt-in to the law and offer the protections to their enrollees.  

How much do you pay? 
If you receive a surprise medical bill, you're not responsible for paying it. Your insurer must pay the out-of-network provider and facility directly. You are only responsible for your in-network cost-sharing, including any copays, coinsurance and deductible. 

What health insurers must do 
Base your cost-sharing responsibility on what it would pay an in-network provider or in-network facility in your area and show the amount on your Explanation of Benefits (EOB). 
Count any amount you pay for emergency services or certain out-of-network services toward your deductible and out-of-pocket limit.
Tell you, via their websites or if you ask, which providers, hospitals and facilities are in their networks.
Provide notice to you (PDF, 143KB) detailing your rights under the balance billing protection act and letting you know when you can and cannot be balanced billed.

What medical providers and facilities must do
Tell you which provider networks they participate in on their website or if you ask.
Refund any amount you overpay within 30 business days.
Not ask you to limit or give up these rights.
Provide notice to you (PDF, 143KB) detailing your rights under the balance billing protection act to let you know when you can and cannot be balanced billed. 


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