Who is NFP


The NFP Team

Compliance

2023 HSA Increase: HSA maximums increased to $3,850 (single) & $7,750 (family)


2023 Affordability Test: 9.12% -This is a non-issue for GSI, the single employee contribution for all plans is well within affordability requirements.


ACA “Family Glitch”: On October 11, 2022, the IRS finalized its proposed rule to fix the “family glitch” in eligibility rules for the ACA premium tax credit (PTC). The new final rule will be effective starting in the 2023 tax year. the new rule applies a separate PTC affordability standard for family members based on the full cost-share contribution for family coverage. Under the rule, an eligible employer-sponsored plan will be treated as affordable for family members (i.e., the spouse if filing jointly and tax dependents) if the portion of the annual premium the employee must pay for family coverage, that is, the employee's required contribution, does not exceed 9.12% of household income (indexed annually). As a result, an employee’s family may qualify for a PTC even if the employee does not. The new rule does not impact the employee affordability test and does not increase exposure to employer shared responsibility (employer mandate) penalties.


2023 ACA Reporting: Our records indicate that GSI had 50+ full time employees during 2021, this requires GSI to complete ACA reporting requirements. How will GSI be handling ACA reporting for the 2022 plan year? 1095-C forms due to employees on 1/31/2023 and due to the IRS by 2/28/2023 if filing by paper – or – by 3/31/2023 if filing electronically.


Massachusetts Health Insurance Responsibility Disclosure: The Health Insurance Responsibility Disclosure (HIRD) form, launched in 2018, is a state reporting requirement in Massachusetts that applies to in-state and out-of-state employers with employees in Massachusetts. Employers with six or more employees who worked in Massachusetts must submit a HIRD form annually. The most recent census reflects you have 1 employee in MA.


Payer Transparency: Health insurers are required to publicly display certain health care price information via machine-readable files on their websites as part of Transparency in Coverage. These machine-readable files will include negotiated rates with in-network providers and allowed amounts for out-of-network providers. The Departments of Health and Human Services (HHS), Labor and Treasury have issued guidance indicating they will enforce compliance of the machine-readable file requirements beginning July 1, 2022. This does not require any steps from GSI.

ACA Employer Mandate Reporting

NFP Whitepaper

ACA Employer Mandate Reporting

NFP Whitepaper

Payer Transparency

BCBSM/BCN Action Plan

Payer Transparency

BCBSM/BCN Action Plan

NFP Compliance Support

2023 Renewal Overview

BCBSM/BCN Medical/Rx: +6% overall increase (PPO +5%, POS & HMO +9%)


All other lines are renewing with no change for 2023!


Executive Summary for Renewal costs assumes no plan design changes and maintains the current employee contribution percentages.


Financial Workbook

Financial Workbook

Medical

Current vs Renewal

Current | 2022 Plan Year




Renewal | 2023 Plan Year

Assumes no plan design changes and maintains the current employee contribution percentages.


Marketing Results

Conducted market check with Priority Health & HAP, neither of which were competitive when comparing to the combination of the current PPO, POS, and HMO plans. UHC was not sought out due to their lack of competitiveness in the market with these particular types of plan designs.


BCBSM/BCN alternatives were explored.


PPO HSA Market Research



POS HSA Market Research



HMO HSA Market Research






Option 1 | Plan Design Consideration

Alternative Plan Design Option 1: Adding a Standard Copay Plan

  • Removing the HMO HSA plan as an option
  • Adding POS $3000 standard copay type plan - this gives another plan type option to employees who may have financial difficulties paying for high-cost services and prescriptions until their deductible has been satisfied.
  • Modifying the POS HSA 2000 contributions so that it is the lowest cost plan to employees


The option is illustrated with maintaining the current contribution split - 18% to employees on the PPO HSA; 18% to employees on the new POS 3000 plan (your new second level plan); 13% to employees on the POS HSA 2000 (now being the lowest cost option for employees).


The option does consider membership movement -

  • Majority of the current POS and HMO population electing the current POS HSA 2000 plan (now the lowest cost option for employees)
  • Slight reduction in the PPO plan enrollment dispersed through the new POS 3000 plan. If there is additional movement from the PPO down into the other options, this will result in further savings for GSI




Option 2 | Plan Design Consideration

Alternative Plan Design Option 1: Adding a Standard Copay Plan

  • Removing the HMO HSA plan as an option
  • Adding POS $3000 standard copay type plan - this gives another plan type option to employees who may have financial difficulties paying for high-cost services and prescriptions until their deductible has been satisfied.
  • Modifying the POS HSA 2000 to be a POS HSA 2500 plan and making this plan the lowest cost option for both GSI and employees


The option is illustrated with maintaining the current contribution split - 18% to employees on the PPO HSA; 18% to employees on the new POS 3000 plan (your new second level plan); 13% to employees on the POS HSA 2500 plan (increased deductible and now being the lowest cost option for employees).


The option does consider membership movement -

  • Majority of the current POS and HMO population electing the new POS HSA 2500 plan
  • Slight reduction in the PPO plan enrollment dispersed through the new POS 3000 and new POS HSA 2500, if there is additional movement from the PPO down into the other options, this will result in further savings for GSI



Blues News

PILLAR Rx Copay assistance is a program in which drug manufacturers will assist in paying most or all of the member’s copay. The Pillar Rx program reduces actual out-of-pocket costs on more than 300 high-cost drugs. Jan. 1, 2023, fully insured BCN standard benefit expansion for group plans with a health savings account or deductible for pharmacy benefits

  • Reduction of plan cost due to accumulator adjustments to reflect true out-of-pocket costs
  • Improved medication adherence and patient health outcomes
  • Savings for groups with a health savings account or deductible will vary based on members’ utilization of services.



Maternity Support This program provides a multichannel clinical support and educational app to guide members through their pregnancy, postpartum, parenting and return to work journey. It also includes support for high-risk pregnancies, prenatal, neonatal intensive care unit, and postnatal care and loss.

Benchmarking

Non-Medical

Dental

Vision

Life & Disability






Benchmarking

Planning Ahead

Employee Communications

Timeline

Q&A