Category: Health Insurance
Benefits 101: A Guide to PPO Plans
When navigating the world of health insurance, you will likely encounter the term PPO (Preferred Provider Organization). A PPO plan – whether medical or dental – is about balancing the cost and convenience of care. With a PPO plan, you get the flexibility to see a wide range of doctors. You’ll save money by staying…
Navigating Your Health Plan: A Guide to Your Explanation of Benefits (EOB)
Ever found a confusing document in your mailbox after a doctor’s visit, wondering if it’s a bill, especially with an “amount you owe” at the bottom? You’re not alone! That document is most likely an Explanation of Benefits (EOB) from your health insurance company. It’s crucial to remember: an EOB is NOT a bill. Think…
Health Insurance Terms You Should Know
Health care terms, medical bills, and forms can be hard to understand. Here are some common health care terms, and what they mean. Allowed Amount This is the maximum payment the plan will pay for a covered health care service. May also be called “eligible expense,” “payment allowance,” or “negotiated rate.” For example, if you…
Disability Insurance Explained: Short-Term Disability
Life sometimes throws you a curveball. You might sprain an ankle playing soccer, need surgery, or experience a difficult pregnancy. These situations can temporarily prevent you from working and earning an income. That’s where short-term disability insurance comes in. It acts as a financial safety net, providing income replacement while you recover and get back…
Benefits Buzz | January 2025
PCORI Fee Amount Adjusted for 2025 The IRS recently issued Notice 2024-83 to increase the Patient-Centered Outcomes Research Institute (PCORI) fee amount for plan years ending on or after Oct. 1, 2024, and before Oct. 1, 2025. The updated PCORI fee amount is $3.47 multiplied by the average number of lives covered under the plan.…
Benefits Insights: Key Drivers of 2025 Health Care Cost Increases
Healthcare costs are projected to increase substantially in 2025. Estimates show a similar growth in spending to 2024, marking multiple years of compounding costs. Specifically, healthcare costs in the United States are likely to increase by 7%-8% in 2025, according to the following data from multiple surveys: As 2025 approaches, many employers remain curious about…
Massachusetts Health Care Reform & Reporting Requirements
The Massachusetts Health Care Reform Act (Act) was enacted in April 2006 to provide nearly universal health care coverage forMassachusetts residents. To carry out this objective, the Act created an individual mandate and employer coverage andreporting requirements, among other things. The Act precedes the federal healthcare reform law—the Affordable Care Act(ACA)— that was enacted in…
Navigating Employee Benefits: A Glossary
Employee benefits can be a complex landscape, filled with acronyms and unfamiliar terms. In fact, more than 50% of American adults report that they don’t have a clear understanding of their health insurance. Many people are confused because they reach adulthood without ever learning the basics of health insurance terminology. Illiteracy about health insurance is…
Gag Clause Attestation Deadline
As the year comes to an end, a crucial compliance deadline looms for employers with health plans. Under the Consolidated Appropriations Act (CAA), health plans and insurance issuers must submit a Gag Clause Compliance Attestation by December 31, 2024. Since its enactment in 2020, this regulation prohibits health plans from including gag clauses—provisions that limit…
Health Plans Must Update HIPAA Policies for New Reproductive Health Care Rights
Beginning Dec. 23, 2024, covered entities and their business associates must comply with stricter HIPAA privacy protections for reproductive health care. These new protections prohibit regulated entities from using or disclosing protected health information (PHI) related to lawful reproductive health care: In addition, regulated entities must obtain a valid attestation when a request is made…