Bulletins

The Consolidated Appropriations Act (CAA) gag clause prohibitionrequires issuers and plan sponsors to attest that any agreements they enter with health care providers, third-party administrators or other service providers will not contain language restricting access to cost and quality-of-care...

Area insurers (carriers) are beginning to distribute 2023 plan year medical loss ratio (MLR) rebates. The Affordable Care Act requires insurers to meet MLR requirements each year. If an insurer doesn’t meet the minimum MLR (spend 80 to 85 percent of its premium dollars on health care or activities...

The IRS recently issued Revenue Procedure 2024-53, establishing the 2025 affordability threshold at 9.02% of annual household income. This is a 0.63% increase from the 2024 threshold of 8.39%. The rate is used to determine the affordability of employer-sponsored health coverage and eligibility for...

Employers have an annual obligation to issue a creditable or non-creditable coverage notice to all health plan participants who are Medicare-eligible, including dependents and retirees. The notice, due by October 15, informs Medicare-eligible participants whether their prescription drug coverage is...

Yesterday, a U.S. District Court judge for the Northern District of Texas struck down the Federal Trade Commission’s (FTC’s) April ruling banning most noncompete agreements. The judge ruled that the FTC exceeded its authority when it issued the ban, and the rule was “arbitrary and capricious.”

Each year self-funded plan sponsors must file the Patient-Centered Outcomes Research Institute (PCORI) fee. Applicable employers should use one of four methods to calculate how much is owed and submit the information to the IRS using Form 720 by July 31. Detailed guidance on filling out Form 720...

Effective July 1, 2024, Blue Cross and Blue Shield of Kansas City (Blue KC) will update prescription drug lists (PDLs) for small (ACA and non-ACA) and large employer groups. Blue KC’s Medical Pharmacy Management Committee regularly reviews and updates PDLs for “drug safety, effectiveness, clinical...

The Internal Revenue Service (IRS) recently announced the 2025 health savings account (HSA) contribution limits. Effective January 1, 2025, individuals with self-only coverage can contribute up to $4,300 annually to their HSA. Those with family coverage may contribute up to $8,550 annually.

Starting April 29, 2024, members enrolled in the Cigna Open Access Plus network no longer have access to providers and hospitals in the Kansas City area’s Prime Healthcare System. Cigna said the decision stems from the inability to negotiate lower costs with the health system, resulting in inflated...

Starting in June, Cigna members will have access to a Humira biosimilar used to treat a range of inflammatory conditions for $0 out of pocket. The biosimilar costs nearly 85% less than Humira and will lower patient costs by approximately $3,500 annually.