Canopy Nation Blog

Insurance News
Christina Babu

What you need to know about Gag Clause Prohibition Compliance Attestation

Insurance companies now have to ensure patients have full access to their health care costs. Previously, insurance companies had gag clauses in place that prevented patients from seeing specific data regarding their treatment. With the new Gag Clause Prohibition Compliance Attestation in place, patients have easier access to their own data than ever before. The GCPCA prevents group insurance plans and health insurance issuers offering group health insurance from entering an agreement with a health care provider, network or association of providers, third-party administrator or other service provider that restricts a plan or issuer from the following: Providing provider-specific cost or quality of care information through a consumer engagement tool. This includes any other means to referring providers, the plan sponsor, participants, beneficiaries or enrollees, or individuals eligible to become participants, beneficiaries or enrollees. Electronically accessing de-identified claims and encounter information or data for each participant, beneficiary or enrollee in the plan or coverage upon request. It must be  consistent with the privacy regulations covered by section 264(c) of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), the Genetic Information Nondiscrimination Act of 2008 (GINA) and the Americans with Disabilities Act of 1990 (ADA), including, on a per claim basis: Financial information (the allowed amount or any other claim-related financial obligations in the contract) Provider information (including name and clinical designation) Service codes Any other data element included in transactions Sharing any information or data described in the previous two points, or directing such information to be shared with a business associate, consistent with the privacy regulations in section 264(c) of HIPAA, GINA and the ADA. On the flip side, PHS Act section 2799A-9(a)(2) prohibits health insurance issuers from offering individual health insurance from entering an agreement with a health care provider, network or association of providers, or other service providers that restrict a plan or issuer from the following: Providing provider-specific price or quality of care information through a consumer engagement tool. This includes any other means, referring to providers, enrollees or individuals eligible to become enrollees of the plan or coverage. Sharing, for plan design, plan administration, and plan, financial, legal and quality improvement activities, and data from the first point with a business associate, consistent with the privacy regulations in section 264(c) of HIPAA, GINA and the ADA. Plans and issuers are required to submit an attestation of compliance annually to the Departments of Labor, Health and Human Services and the Treasury. The Centers for Medicare & Medicaid Services collects GCPCAs on their behalf. Attestations are due on Dec. 31 of each year. If you have any questions or concerns about what GCPCAs mean for your organization, don’t hesitate to reach out to the CanopyNation team.

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Insurance Tips
Christina Babu

How to Spot Errors on Your Medical Bill

Health care advocates found that approximately 80% of medical bills in the U.S. contain at least one error. This alarming statistic means it’s crucial you carefully review your bill to make sure you aren’t overcharged for medical services. Checking your medical bill isn’t as complicated of a process as it may seem. We have a few tips to make sure you are being charged accurately. 1. Request and review an itemized bill. Bills received by mail are typically just a summary of the services you received. This means you can’t see every charge and what it was for. Itemized bills have specific medical codes that show exactly what the charges apply to. Once you receive the itemized bill from the billing office, carefully review it and look up any medical codes you don’t understand. 2. Verify dates of service. When you receive and look through your itemized bill, look closely at the small details. Double check the dates of your service, date of birth and insurance information. Although the date of service seems minuscule, it can impact how your insurance coverage assists your payments or how much of your bill counts toward your deductible. 3. Compare the Explanation of Benefits to the bill. Every bill should come with an EOB summary from your insurance provider. The EOB shows how much of each medical bill charge was covered by your insurer versus how much you owe. If you have questions about your EOB, reach out to your provider. 4. Check for upcoding. Upcoding is when there is a charge for a more expensive service than you received. If the charge seems too high or out of the ordinary, mark it as a potential error. Upcoding is difficult to check for but is one of the more costly mistakes that occurs. 5. Look for canceled services. It’s not uncommon to find inaccurate charges on your bill when a doctor cancels a particular lab or service. Doctors run many tests and labs and sometimes services that were canceled can still appear on your bill. If you aren’t sure if you received a particular service or not, reach out to your provider. 6. Call the billing office. Billing representatives are there to help answer any questions you may have about your bill. Once you’ve reviewed and marked up your bill with potential issues, it can be beneficial to talk it through with a billing representative. Medical bill errors are common, but you have the power to double check the bill and save your money. Take charge of your health care dollars by reviewing your medical bill thoroughly. If you have questions on your bill, be sure to reach out to your provider.

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Company Benefits
Christina Babu

What to know about offering life insurance as a benefit

Life insurance is one of the most common employer-provided benefits. Though life insurance is an important asset for future financial security, many employees don’t realize its significance. Teaching employees about the value of life insurance may increase loyalty to your company as they better appreciate this benefit. Employer-sponsored coverage can be offered in a variety of ways. Employers can choose between a term policy, permanent coverage or both. Term life insurance has a specified coverage period (term), but can usually be renewed or converted into a permanent policy at the end of a term. Premiums are generally affordable initially, but can increase substantially when renewed. Permanent life insurance is life-long coverage that generally also includes a cash value savings component. There are many types of permanent life insurance, including whole, universal and variable. This type of coverage has higher premiums, but offers more long-term value. Cost-sharing among employers and employees also varies between organizations. Some employers cover the full cost, some require employees to pay the full premium and others split the cost with employees. A common scenario among CanopyNation clients is a group-term policy, which is no cost to the employee and provides a coverage amount that is a multiple of their annual salary (usually one to five times their annual pay). Group-term policies often end when an employee leaves the organization (or passes away), but employees may be able to convert it to a permanent policy or renew it upon leaving. This is generally an affordable plan for employers to offer, though it does not offer as much long-term value to employees as a permanent plan. Many employers who offer such a group-term policy also offer additional voluntary coverage options, in which the employee pays the full cost but still receives the benefit of group rates and payroll deductions. Additional coverages offered may include: Spouse/dependent life insurance in which group-term policies only cover the employee. Supplemental term life insurance for the employee to elect a higher amount than the employer offers. Supplemental permanent coverage, which provides a whole, universal or variable life policy in addition to the term policy. Accidental death and dismemberment (AD&D) coverage. Premiums for life insurance offered by the employer are generally deductible as ordinary and necessary business expenses (unless the employer is the beneficiary of the policy). Additionally, the cost of employer-provided group-term life insurance is excludable from the employees’ gross income (up to $50,000 of coverage). However, the plan must meet special nondiscrimination rules or key employees may not be eligible to exclude the cost of their coverage from their gross income. Showing life insurance’s value to your employees Many employees do not realize the financial benefits of a life insurance policy until they think through life-altering issues. Ask employees to envision the debt and financial responsibilities that loved ones would face in the event of their death. If the employee is the primary household income, how will the family support themselves? If the employee dies and leaves behind a mortgage or substantial medical bills, who will have the burden of paying that debt? If you offer a permanent coverage option, explain the value of having the cash benefit component to the policy. Emphasize to employees that buying life insurance on their own is costly. Even if your group coverage is employee-paid, you are still offering significant advantages: Lower rates through a group policy than if buying individual coverage No medical review required for group policies, as opposed to individual policies where an unfavorable medical exam could disqualify the individual or trigger extremely high premiums Be sure to inform employees on restrictions regarding this issue, such as a requirement to enroll when first eligible to avoid a medical exam. Convenience of payroll deductions for premiums Educating employees on the benefits of life insurance in general and the advantages of purchasing through your group plan can help increase awareness and participation, boost loyalty, and support hiring and retention initiatives. What to consider before offering life insurance as an employee benefit When deciding to offer life insurance as an employee benefit, there are a number of factors to consider: What type of coverage will you offer? Will you offer term insurance, permanent or both? Who will be covered? Will you cover employees only or also retirees, spouses and dependents? Note: Only employees can be covered under a group-term policy. When is coverage effective? Will there be a waiting period? What amount of insurance will be available? How will that amount be determined, i.e., flat fee vs. multiple of salary? Will you, the employee or both of you pay the premiums? Will there be a minimum amount that employees are required to elect? What is the maximum coverage amount allowed? Once you have an idea about the type of coverage you’d like to offer, CanopyNation can help you find a plan that meets your needs. To get started or for more guidance, contact us at hello@joincanopynation.com or 901-805-2860.

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Legislation Updates
Christina Babu

IRS Releases 2024 Benefit Plan Limits

The Internal Revenue Service recently released the 2024 benefit plan limits in the Internal Revenue Code. These updates were based on the annual cost-of-living adjustments. The new limits take effect on Jan. 1, 2024. Employers should update their Summary Plan Descriptions and other materials highlighting the annual dollar limits. For assistance on updating your documents and communicating this new information with your employees, please contact the team at CanopyNation at hello@joincanopynation.com or 901-805-2860. Welfare plans and fringe benefits Health FSA: $3,200 limit proposed for 2024 (up from $3,050 in 2023) The proposed carryover amount from 2023 to 2024 is $640, up from $610 last year. Dependent care assistance plan: Married and filing together = $5,000 proposed for 2024 (same as last year) Married and filing separately = $2,500 proposed for 2024 (same as last year) HDHP minimum annual deductible: Self-only coverage = $1,600 for 2024 (up from $1,500 in 2023) Family coverage = $3,200 for 2024 (up from $3,000 in 2023) HDHP out-of-pocket maximum: Self-only coverage = $8,050 for 2024 (up from $7,500 in 2023) Family coverage = $16,100 for 2024 (up from $15,000 in 2023) HSA maximum contribution: Self-only coverage = $4,150 for 2024 (up from $3,850 in 2023) Family coverage = $8,300 for 2024 (up from $7,750 in 2023) Catch-up contribution for participants over age 55 = $1,000 (same as last year) “Key employees”: Officer group = $220,000 for 2024 (up from $210,000 in 2023) More-than-one-percent owner = $150,000 for 2024 (same as last year) Highly compensated employee: $155,000 for 2024 (up from $150,000 in 2023) Retirement benefits Social Security taxable wage base: $168,600 for 2024 (up from $160,200 in 2023) Basic limit on elective deferral amounts: $23,000 for 2024 (up from $22,500 in 2023) Limitation on catch-up contributions for participants over age 50 = $7,500 or 2024 (same as last year) Elective deferral limit for SIMPLE plans: $16,000 for 2024 (up from $15,500 in 2023) Limitation on catch-up contributions for participants over age 50 = $3,500 or 2024 (same as last year) IRA maximum contribution limit: $7,000 for 2024 (up from $6,500 in 2023) Limitation on catch-up contributions for participants over age 50 = $1,000 or 2024 (same as last year) 457 elective deferral limit: $23,000 for 2024 (up from $22,500 in 2023) Annual dollar limit on includible compensation: $345,000 for 2024 (up from $330,000 in 2023) Annual dollar limit on contributions: $69,000 for 2024 (up from $66,000 in 2023)

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Insurance Tips
Christina Babu

An Employee Guide to the Major Types of Health Plans

Health plans vary and have their own sets of benefits and drawbacks related to coverage, physicians, copays and premiums, among others. You’ll need to compare the different types of health insurance plans and choose the one that best fits your needs and budget. It’s important to note that the most suitable plan will depend on your personal health, family’s health and financial situation. There are a few main points of differentiation for health insurance plans. For one, some plans require you to have a primary care provider or have health services pre-authorized. Other plans have requirements to obtain a referral to see a specialist or whether you have to file insurance claims. Some plans pay for out of network health care, and others do not. One of the biggest differentiators is how much cost sharing (e.g., deductibles, copays and coinsurance) you’re responsible for paying when you use your health plan. Health Maintenance Organization (HMO) Plans An HMO plan typically has low premiums and deductibles with fixed copays for doctor visits. While cheap, HMO plans require the selection of only in-network providers. When you sign up for the plan, you’ll select a primary care provider (PCP) for your routine checkups. Your PCP will need to give you a referral before you can see a specialist, such as an allergist or dermatologist. HMO plans are generally most feasible if you don’t have many specific medical issues or needs. Although they are restrictive compared to other options, these plans tend to be the most cost-effective. Preferred Provider Organization (PPO) Plans PPO plans have pricier premiums than HMO plans, but they allow you to see specialists and out-of-network providers without referrals. Out-of-network care typically comes with greater employee cost sharing, but in-network copays and coinsurance are generally low. More paperwork is typically involved with this plan if you see out-of-network providers. A PPO plan could be ideal if you’ll need more health care or flexible options in the coming year, but you can afford higher premiums. Point-of-Service (POS) Plans A POS plan is a hybrid of an HMO and PPO plan. This plan allows you to choose whether to use HMO or PPO services each time you receive health care. For slightly higher premiums than an HMO plan, a POS plan can cover out-of-network doctors. As such, it’ll be more beneficial and cost-effective if you initially see a PCP and seek in-network care instead of not first seeing a PCP for a referral. A POS plan could be a good fit if you prefer out-of-network care but also want a PCP coordinating your regular care. Exclusive Provider Organization (EPO) Plans An EPO plan offers moderate freedom to choose your health care providers. Like HMO plans, EPO plans only cover in-network care; however, they typically don’t require specialist referrals from PCPs. Premiums are generally higher than those of HMO plans, but lower than PPO plans. An EPO plan may make the most sense if you don’t mind having a limited number of doctors and facilities and would rather not have to get a referral to see a specialist. High Deductible Health Plans (HDHPs) An HDHP can be designed as an HMO, PPO, POS or EPO plan. These plans have low premiums, but higher immediate out-of-pocket costs. An HDHP is often paired with a health savings account (HSA). An HSA is a tax-advantaged account used to pay for qualified medical expenses. An advantage of an HSA is that the remaining funds at the end of the plan year can be rolled over into the account for the following year. An HDHP might be a good option if you don’t need much medical care. As such, this type of plan is popular among young and healthy adults but could be costly to older adults or young families. Health insurance regulations vary by state, so be sure to read the fine print on each plan you consider before enrollment. It’s also likely that employer-offered plans could be more or less expensive based on certain factors. When comparing health plan options, consider your health, unique needs and financial situation. It’ll also be necessary to review costs, flexibility, coverage and convenience when making your decision. If you have more questions about health plans, contact your HR director.

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Company Benefits
Christina Babu

Group disability insurance explained

Economic, demographic and societal trends have led to an increasingly mobile, diverse and older workforce. In addition to this, increased stresses in the workplace and home are taking a toll on overall employee health, productivity and safety. The result is higher health care and disability costs that have a measurable impact on employers and the employee benefits packages that they offer. Many employers aren’t aware of group disability insurance options or they don’t understand the full benefits of them. So, what is group disability insurance and is it really necessary? We map out the basics below. What is group disability insurance? Group disability insurance provides income protection for employees. For employers, it covers the cost of overtime and hiring a replacement. For employers, lost time on the job due to a disability can significantly impact workplace productivity and profitability, so investing in a group disability insurance plan can help. Most employers also offer salary continuation plans, which is when the employer gets the full income and benefits after a disability prevents an employee from working. California, Hawaii, New Jersey, New York and Rhode Island also mandate temporary disability insurance, which requires employers to provide benefits equivalent to those working in non-statutory states. Why is group liability insurance necessary? The possibility of becoming disabled is very real for working Americans, and so are the financial consequences and costs associated with employee absence. Over 36 million Americans currently classify as disabled. Moreover, an illness or accident will keep one in five workers from working for at least a year during their career. It’s not pleasant to think about this potential scenario, but preparing your insurance plan in advance will save the employer and employee a great deal of stress. The population is aging, which in turn causes rising benefit utilization and cost. Beyond that, unscheduled absences disrupt workflow and increase cost, while human resource pressures are impacting the ability to dedicate adequate time and attention to situations where working time is lost. Group disability insurance protects your organization and employees alike, making it necessary if you want to protect your business. If you have more questions about group disability insurance options, reach out to our team at CanopyNation.

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