UPDATE: UPCOMING GAG CLAUSE ATTESTATION REQUIREMENT

On September 25, 2023

The Consolidated Appropriations Act, 2021 (CAA) prohibits the inclusion of “gag clauses” in provider contracts with insurers and group health plans. According to the law, a gag clause is a contract provision that directly or indirectly restricts a plan or issuer from sharing specific cost and quality information with another party. For example, if a […]

MMO: No Surprises Act – Pharmacy Reporting for small Groups

On September 14, 2023

Section 204 of the Consolidated Appropriations Act, 2021 (CAA) requires health insurers to share certain data related to prescription drugs and healthcare spending annually with the federal government. This data submission is referred to as RxDC reporting.RxDC reporting requires Medical Mutual to share premium split information for our Small Groups. Premium split represents the percentage […]

Medicare Part D Creditable Coverage Notice deadline October 15th

On September 13, 2023

Each year, group health plans that offer access to pharmacy benefits must notify all plan participants who are eligible for Medicare about whether their benefits are as extensive as the standard Medicare prescription drug plan before Medicare’s annual election period begins on October 15th. If the group plan’s benefits are as generous, it is considered […]

Anthem: SOCA MEWA Expands Chamber Members

On September 11, 2023

The Southern Ohio Chamber Alliance (SOCA) Benefit Plan is a self-funded solution for small Ohio employers and sole proprietors. The SOCA Benefit Plan lets eligible businesses join together to share in the overall health insurance claims risk. By being part of a large, self-funded pool, they receive financial protection backed by Anthem’s stop loss coverage. […]

Ohio Farm Bureau: Updated list of included SIC codes

On September 11, 2023

The Ohio Farm Bureau Health Benefits Plan is available to sole proprietors and employers with fewer than 50 employees who are headquartered in Ohio. Eligible businesses and sole proprietors must be in the agricultural economic sector. A helpful list of included SIC codes is provided here.

Anthem: Life and Disability clients will be administered separately

On September 11, 2023

In preparation for the move to The Standard, we are consolidating our Life and Disability business onto a single Anthem enrollment and billing system. We expect the deal with The Standard to close in Q1/24. For NEW business beginning 9/1/23 and later, a separate group number will be set up on Compass (the life/disability billing […]

New ACA COVERAGE AFFORDABILITY PERCENTAGE for 2024

On September 7, 2023

The Affordable Care Act’s “affordability percentage” for group health insurance coverage just nose-dived for 2024, and the change will significantly impact both applicable large employers subject to the ACA’s employer shared responsibility requirement (AKA the employer mandate) and their health insurance brokers. Many thought the affordability rate couldn’t go any lower than 2023’s 9.12%. However, […]