Every self-funded employer should consider how Reference-based Pricing (RBP) will affect their health plan. In addition to reducing the medical claims payments on behalf of members, reference-based pricing can have an impact on the risk assessment and pricing of stop-loss underwriters. A well-chosen stop-loss carrier is vital for the Self-Funded Planning team since it can be more […]
The No Surprises Act requires health plans to notify eligible members when a provider or facility is terminated from the network due to contract expiration or non-renewal. This notice informs the plan members of their right, as a “continuing care patient,” to elect to continue the course of treatment for a period of time from […]
New regulations, effective January 15, 2022, require group health plans and health insurance issuers to cover up to 8 at-home Covid tests per covered individual per month. The rules require group health plans and health insurance issuers to cover rapid at-home COVID-19 tests with: No cost-sharing applied No prior authorization required No medical management requirements. Here are […]
What is the No Surprises Act? The No Surprises Act (the “Act”) took effect on January 1, 2022. The Act restricts surprise and excessive out-of-pocket balance bills for consumers. It also ensures coverage of emergency services without prior authorization and regardless of network status. Does the No Surprises Act prevent balance bills? No. The law […]
Copyright © 2024 6 Degrees Health Dx, LLC. All Rights Reserved..
Brokers and TPAs Need to be Aware: The December 31, 2024 Gag Clause Attestation Submission Deadline Nears
Cost ContainmentBrokers and TPAs may have the obligation to complete the Gag Clause Prohibition Compliance Attestation Submission (“Attestation”) on behalf of their self-funded group health plan clients, pursuant to an agreement with their clients. Although plans are responsible for filing the Attestation, TPAs and brokers may file on behalf of their clients. What is a Gag […]