The Family and Medical Leave Act (FMLA) requires employers to continue coverage for certain employees as if they are still actively at work. But disability leaves outside the FMLA’s purview are a completely different story. There are no laws requiring employers to provide group health benefits in these other situations. So how do employers address this? (more…)
Everybody seems to agree that “big data” holds much promise (or potential) for better healthcare. To this end, the Affordable Care Act made it a priority to create more, and presumably, better health care data. However, with the rapid development of devices, tracking systems and data tools, who will benefit from this data: Patients? Plan sponsors (or payers)? Insurance companies? Healthcare providers? PBMs? Pharmaceutical and device manufacturers? Other enterprising service providers? (more…)
With spousal exclusions or surcharges gaining popularity as a best practice to help organizations control the cost of benefits for everyone, the growing interest in spousal coverage audits (SCAs) makes sense. (more…)
Individual stop loss insurance is an important way that many employers with self-funded health plans manage the financial risk associated with their large claimants. If you fall into this category, you’re probably no stranger to large stop loss rate increases following years of poor large claim experience. (more…)
Whether we admit it or not, this question has crossed the mind of many a benefits professional — especially as most of us head into open enrollment season. After all, if employees don’t understand their health plan options and appropriate factors to consider in the selection, they could end up making a costly mistake.
Ensuring employees are well educated will not only help them make the right choice, but ultimately lead to increased engagement and productivity. (more…)
![Only PBMs Benefit from Rebate-driven System [UPDATE]](https://chelkogroup.com/wp-content/uploads/2018/07/0-1080x630.jpg)
UPDATE: The following piece was originally posted to Linked In by Rick Chelko on June 28, 2018. Shortly thereafter, Rick met with a senior Health & Human Services (HHS) official working on drug pricing reform to discuss this and related issues. Ironically, the official expressed concern that the marketplace might view the removal of safe harbor protection for rebates to be “a windfall for Big Pharma.”
Nonetheless, we were pleased to see the Office of Inspector General (OIG) and HHS submit a proposed rule change on July 18 to the Office of Management and Budget (OMB). This proposed rule appears to remove the safe harbor protection for prescription drug rebates under the Federal Anti-Kickback Statute. If and when the rule will be finalized is unclear, as is the effective date. Here’s hoping that it will be soon.