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Group health plans with network-based designs cannot enter into agreements with providers or Third-Party Administrators ("TPAs") if an agreement restricts the plan from: (i) providing provider-specific cost or quality of care data to referring providers, covered individuals, or plan sponso...
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Veröffentlicht in: | Employee Benefit Plan Review 2022-07, Vol.76 (6), p.3-6 |
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Hauptverfasser: | , , |
Format: | Artikel |
Sprache: | eng |
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Zusammenfassung: | Group health plans with network-based designs cannot enter into agreements with providers or Third-Party Administrators ("TPAs") if an agreement restricts the plan from: (i) providing provider-specific cost or quality of care data to referring providers, covered individuals, or plan sponsors; (ii) accessing de-identified claims and encounter data for each covered individual; and (iii) sharing such information with business associates consistent with applicable privacy regulations. Group health plans must report detailed information regarding health care and prescription drug costs and spending to the Departments. TPAs and Pharmacy Benefits Managers ("PBMs") may report this information on an aggregated basis for their books of business, but group health plans will have to provide certain information (e.g., premiums paid by the employer and employees) to the providers. Normally, only up to $550 (adjusted for inflation) would carry over in a healthcare FSA and no carryovers would be allowed in a dependent care FSA. * Unused FSA amounts from a plan year ending in 2021 could be used anytime in a plan year ending in 2022 (grace period extension) as an alternative to a carryover. * Healthcare FSAs can reimburse expenses for over-the-counter drugs and menstrual care products effective retroactively. * Midyear FSA changes in 2021 were permitted without a qualifying event. * Group health plan enrollment could occur at any time during the 2021 plan year, even if participants previously declined enrollment. * Group health plan enrollment in different health plan coverage (with the same employer) or change in tiers (e.g., from single to family coverage) could occur at any time during the 2021 plan year without a qualifying event. |
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ISSN: | 0013-6808 |