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This section focuses on health care compliance and regulations – both national and state – including the ACA. It includes changes in health care law, regulation, and court decisions and their impact on health insurance professionals, employers, and individuals.

Answers To Q4 Frequently Asked Questions

Throughout the year, especially during Q4, we know you are bound to have questions about Underwriting, Client Experience, Enrollment, and Compliance. That’s why we’ve compiled this list of the most frequently asked questions (FAQs) during peak season.

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House Committees Introduce New Healthcare Price Transparency Legislation

A trio of House committees unveiled new legislation (PDF) Friday to lower costs and increase transparency for patients. The Lower Costs, More Transparency Act includes provisions from the House Energy and Commerce Committee, the Ways and Means Committee and the Education and the Workforce Committee and is designed to help patients be more informed when making healthcare decisions regarding ...

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Another Annual Group Health Plan Compliance Deadline On The Horizon (Action Required By October 14th)

All employers offering prescription drug benefits to employees are required to provide annual notifications to Medicare-eligible employees and dependents before October 15th, regarding the drug status of their plan(s).

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AHA: Biden Admin’s Short-Term Plan Crackdown A Good Start On Addressing ‘Convoluted’ Coverage Gaps

Hospitals are on board with the Biden administration’s increased scrutiny of “inadequate” short-term health plans, and are hoping that the federal government will go further in its crackdown on payers’ “convoluted policies.” In early July, the White House said it was working to reverse a controversial Trump-era rule that expanded the duration of the controversial ...

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Will Drug Price Negotiations Work? Here’s What You Need To Know.

Many steps remain before older adults see the benefit of the Centers for Medicare and Medicaid Services’ upcoming talks with drugmakers.

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The Next COVID Booster Is On The Horizon: Will The Vaccine Be Covered By Insurance?

The national Covid emergency has ended, but a new strain of the coronavirus, called EG.5 or “Eris,” is rapidly circulating worldwide. “EG.5 is actually just a subvariant of omicron,” says Dr. Payal Patel, infectious diseases physician at Intermountain Health in Salt Lake City. “We are seeing a rise in this subvariant worldwide. We’re seeing it in the U.S. ...

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Texas Docs’ 4th Courtroom Win Over HHS Interrupts Out-Of-Network Billing Arbitration Yet Again

The Texas Medical Association (TMA) is now 4-0 on its legal challenges to the Biden administration’s rocky implementation of the No Surprises Act, which bans surprise out-of-network medical bills and outlines processes to resolve payment disputes between providers and payers. In a decision filed Thursday (PDF), U.S. District Judge Jeremy Kernodle largely agreed with the association’s late 2022 ...

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A Peek at Big Pharma’s Playbook That Leaves Many Americans Unable to Afford Their Drugs

Last year’s Inflation Reduction Act included what on its face seems a modest proposal: The federal government would for the first time be empowered to negotiate prices Medicare pays for drugs — but only for 10 very expensive medicines beginning in 2026 (an additional 15 in 2027 and 2028, with more added in later years).

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It’s Medical Loss Ratio (MLR) Rebate Check Time Again

The Affordable Care Act (ACA) requires fully insured group health plans to spend a minimum percentage of premium dollars on members’ health care expenses and services. Likewise, it sets a threshold on the maximum amount of premium dollars that can be spent on other administrative costs, such as marketing, profits, salaries, agent commissions, etc. These ...

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The No Surprises Act Left Out Ground Ambulances. Here’s What’s Happening Now

Minutes after Lainey Arebalo gave birth to her third child last September, hospital staff noticed her son was having trouble breathing. They recommended placing the infant in an ambulance so he could receive care at a better-equipped pediatric facility 23 miles away. Within days of receiving that extra care, Avebalo was able to bring her ...

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