Happy New Year!
As we welcome 2025, we’re excited for the year ahead. With new hires, new administrations, and new challenges, we’re committed to staying informed and providing you with the latest insurance news and insights. We wish you a successful and prosperous New Year!
Humira Coverage Follow-up for Select and Value Plan Members
Members enrolled in Independence Blue Cross Select and Value plans who are currently using Humira or a Humira biosimilar have received a follow-up letter. This letter provides additional information about the upcoming modification to our coverage policy, which will be implemented on January 1st. For reference, visit this link.
Shift to High-Deductible Health Plans Continues
A recent National Health Statistics report indicates that enrollment in high-deductible health plans (HDHPs), including consumer-directed health plans, is increasing among individuals under 65. The report found a correlation between HDHP enrollment and higher family income and education levels.
Traditionally, individuals with directly purchased health insurance were more likely to be enrolled in HDHPs compared to those with employer-sponsored coverage. However, this trend may be shifting. Read more for reference.
Congress Eases ACA Reporting Requirements for Employers
Congress recently passed legislation easing Affordable Care Act (ACA) reporting burdens for employers. Key changes include:
- 1095 tax forms will only be sent to employees upon request.
- Employers now have 90 days to respond to IRS penalty letters.
- Electronic delivery of 1095 forms is now permitted. These changes aim to simplify ACA compliance for businesses.
Learn more about the Paperwork Reduction Act and Employer Reporting Improvement Act.
UnitedHealthcare and WellSpan Reach Agreement for Commercial Plans
UnitedHealthcare and WellSpan Health have reached a multi-year agreement for employer-sponsored commercial plans, ensuring in-network access to WellSpan’s hospitals and physicians. This agreement does not include Medicare Advantage plans.
WellSpan will continue to provide care for UnitedHealthcare Group Retiree Medicare Advantage members until December 31, 2024. Patients can still access out-of-network care at WellSpan, but they may be responsible for higher out-of-pocket costs.
Compliance Corner! ERISA Plan Documents and SPDs: A New Year’s Review
ERISA mandates that employers maintain written plan documents and provide employees with Summary Plan Descriptions (SPDs) for their employee benefit plans.
Key Requirements:
- Establish and maintain a written plan document.
- Provide employees with an SPD explaining plan terms.
- Ensure compliance with ERISA regulations.
Potential Issues:
- Insurance certificates may not fully comply with ERISA requirements.
- Noncompliance can lead to penalties and legal challenges.