Biden Admin Asks Employer Group Health Plan Sponsors to Extend Qualifying Event Periods
The Biden Administration has asked employer group health plan sponsors to extend their special enrollment periods for people who lose Medicaid or CHIP eligibility. This is because millions of Americans are expected to lose access to these programs in the next nine months, and the Administration is concerned that many people will miss their 60-day window to enroll in group coverage.
The Administration has also created a temporary federal health insurance exchange marketplace special enrollment window of March 31, 2023, through July 31, 2024. This window is open to anyone who has lost Medicaid or CHIP eligibility, regardless of whether they are eligible for group coverage.
Employers who choose to extend their special enrollment periods will need to amend their plan documents and distribute an updated summary plan description (SPD) or a summary of material modification (SMM) to plan participants. They must also make sure that the extension applies to all plan participants and is not made on a case-by-case basis.
The Biden Administration is also urging employers to communicate with employees about the impact Medicaid/CHIP income redeterminations will have on their coverage options. They have prepared several resources to help employers and employees during this time of transition.
Reminder: Update Your Address to Ensure Timely Receipt of Your MLR Rebate Check
Independence Blue Cross is preparing to mail 2022 medical loss ratio (MLR) rebate checks to our customers. These checks will be mailed to the address listed in your ROAM account under Correspondence Address.
To ensure that you receive your check on time, please update your address in ROAM by August 18. Once you have updated your address, please print out a copy of your ROAM account for your records.
Here are some additional things to keep in mind:
- The MLR rebate check will be for the amount of money that Independence Blue Cross saved by having lower-than-expected medical costs in 2022.
- The amount of the rebate will vary depending on your individual coverage.
Medicare to Make Prescription Drugs More Affordable in 2024
Medicare is making changes to its prescription drug coverage program, Part D, in 2024. The Extra Help Program will be expanded to include more people and the cost-sharing requirement for catastrophic coverage will be eliminated.
The Extra Help Program provides financial assistance to low-income beneficiaries. The expansion will make it easier for more people to afford their prescription drugs.
Catastrophic coverage is a phase of Part D that kicks in after beneficiaries have spent a certain amount of money on prescription drugs. The elimination of the cost-sharing requirement will help beneficiaries save money on their most expensive drugs.
These changes are expected to take effect in the fourth quarter of 2023. Beneficiaries should contact their Part D plan to learn more about the changes and how they will affect their coverage.
Compliance Corner
Do You Know What The Gag Clause Prohibition Compliance Attestation Is and How It Affects Your Insurance?
- The gag clause prohibition is a new law that went into effect in December 2020.
- The law prohibits health plans and health insurance issuers from entering into contracts with providers that restrict their ability to disclose cost and quality of care information to patients.
- This means that patients will have more information about the cost and quality of care when making decisions about their health care.
- The gag clause prohibition is a victory for patients and their advocates. It is an important step towards ensuring that patients have the information they need to make informed health care decisions.
Rob is an employee benefits expert with over 25 years of experience. He is the founder and principal of Precision Benefits Group, a leading provider of corporate benefits plans. He is a member of the Philadelphia Business Journal Leadership Trust and regularly contributes to the publication.