This week: Many employers think CDHC is old news, a relic of the past, but the truth is, consumer education and support tools are more critical than ever. High-deductible plans alone won’t cut it: employees need HSAs, pricing...
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Week 49: When Coverage Isn’t Enough: The Hidden Costs of Drug Access
Even with good insurance, many Americans face a second, quieter battle: getting their prescribed medications without delay or financial distress. Between sky-high drug prices, complex benefit designs, and prior-authorization...
Week 48: What’s in the Rest of the ACA?
The Affordable Care Act (ACA) is best known for Title I, which created exchanges, subsidies, and the employer mandate – but that’s just one part of the law. With 10 titles in total, the ACA also reshaped Medicaid, Medicare...
Week 47: Missed ACA Reporting? What an ALE Should Do When the IRS Comes Calling
Got an IRS Letter 5699 asking “Where are your Forms 1094-C/1095-C?” It’s a fixable situation – call the number to request a 30-day extension, note the agent’s name and badge, and work with a TPA to file missing years quickly so...
Week 46: How the ACA Look-Back Method Works for Variable-Hour Employees
The ACA’s look-back method lets employers average hours over time and “lock in” full-time status for variable-hour and seasonal staff, avoiding month-to-month surprises. Define and follow the four periods – measurement...
Week 45: Prior Authorization: Why Everyone Hates It (and What’s Changing)
Pre-authorization is supposed to control costs, but for many patients and providers it feels like a roadblock to timely care. With lawmakers now paying attention, this long-standing insurance practice could be facing some big...
Week 44: Employer Mandate Safe Harbors: A Practical Guide for ALEs
The ACA’s affordability test is based on household income – but since employers rarely know that figure, the IRS created three “safe harbors” instead. These methods (W-2 wages, rate of pay, and federal poverty line) make...
Week 43: The No Surprises Act Just Got a Major Overhaul
The No Surprises Act was designed to protect patients from unexpected medical bills – and it’s already prevented millions of them. But mounting arbitration backlogs and weak enforcement against insurers are putting those...
Week 42: HMO, PPO, or HSA? Clearing Up One of the Most Common Client Confusions
This week: HMO, PPO, or HSA? Employees mix these up constantly, and the confusion leads to bad plan choices and buyer’s remorse. This week we clear it up in plain language you can hand straight to clients and their teams...
Week 41: How long does COBRA last? That depends on the Qualifying Event.
How long COBRA lasts depends on the qualifying event: termination or reduction in hours usually means up to 18 months for the employee and covered dependents, while dependents may get up to 36 months for death, divorce/legal...