Aliera Healthcare and Trinity Healthshare Ordered to Stop Selling Health Insurance

NH Insurance Commissioner John Elias ordered Aliera Healthcare, Inc. and Trinity Healthcare, Inc. to immediately stop selling or renewing illegal health insurance in New Hampshire.

Aliera, an unlicensed insurance company in New Hampshire, has been administering and marketing health coverage on behalf of Trinity Healthshare, who represents itself as a health care sharing ministry. A legal health care sharing ministry is a nonprofit organization in existence since December 31, 1999, whose members share a common set of ethical or religious beliefs and share medical expenses among members.

The Department’s Consumer Services Division received dozens of complaints and concerns from consumers.

“There are legitimate health care sharing ministries that offer coverage for their members, but Aliera and Trinity are not one of them,” said Elias. “Unfortunately, we are seeing entities in the marketplace that are misleading consumers and finding ways to try to avoid insurance regulation. It is important for consumers to be cautious when they purchase health coverage and to reach out to the Department when they have questions or concerns.”

Aliera also markets their products under the company name Ensurian.

Refer to the below press release and contact your NEEBCo representative with questions.

Press Release-Aliera

Federal Agencies Finalize Resources for Mental Health Parity Compliance

Federal agencies have finalized resources to promote compliance with the Mental Health Parity and Addiction Equity Act (MHPAEA), including final FAQs and a model disclosure request form. Employers should consider using these resources to review their group health plan’s compliance with MHPAEA.

Contact your NEEBCo representative to learn more about MHPAEA and these new compliance resources.

Mental Health Parity Compliance

Anthem Medical Loss Ratio (MLR) Rebates

The Medical Loss Ratio (MLR) provision of the Affordable Care Act (ACA) requires a health insurance carrier to refund part of the premiums it receives if it does not spend at least 80% (for individuals and small employer groups) or 85% (for large employer groups) of the premiums on health care services. These MLR requirements apply to fully insured employer and individual health plans (not self-funded employers).

Anthem NH did not meet the MLR requirement in the Individual and Large Employer markets for their Matthew Thornton Heath Plans HMO products. Therefore, Anthem is required to provide rebates to those individual plans and employer plans.

All other Anthem NH products did meet the MLR requirement, and no rebates are owed.

The rebate is calculated based on the employer’s pro-rata premiums vs. the applicable legal entity/market classification premiums, and is based on covered members (including the dependents) on the employer plan.

As rebate checks are generated by billing group numbers, some employers may receive more than one check.

Anthem has also mailed the required notice to employees of employer groups who will be receiving a rebate. This includes all employees enrolled at any point during the prior year, so this can include past employees.

Employers must follow certain rules for distributing the rebate if it qualifies as a “plan asset” under ERISA. In general, most employer plans are governed by ERISA, and the employer is the policyholder.

  • If the employer paid 100% of the premiums, the rebate is not a plan asset and the employer can retain the entire rebate amount.
  • If participants paid 100% of the premiums, the entire rebate amount is a plan asset.
  • If the employer and participants each paid a fixed percentage of the premiums, the percentage of the rebate equal to the percentage of the cost paid by participants is a plan asset.

Any rebate amount that qualifies as a plan asset under ERISA must be used for the exclusive benefit of the plan’s participants and beneficiaries. If a plan provides benefits under multiple policies, the employer must be careful to allocate the rebate for a particular policy only to the participants who were covered by that policy.

The rebate can be distributed to participants under a reasonable, fair and objective allocation method. If premiums were paid on a pre-tax basis, the rebate is considered taxable income. If the cost of distributing rebate shares to former participants approximates the amount of the proceeds, the employer may decide to limit rebates to current participants.

If distributing payments to participants is not cost-effective because the amounts are small or would cause tax consequences for the participants, the employer may utilize the rebate for other permissible plan purposes, such as applying the rebate toward future participant premium payments or benefit enhancements.

Rebates should be distributed within 3 months of their receipt to avoid the trust requirement under ERISA.

Refer to the below compliance bulletin for additional information, and contact your NEEBCo representative with questions.

How Employers Should Handle MLR Rebates

Massachusetts Paid Family and Medical Leave

In 2018, Massachusetts established the Paid Family and Medical Leave Act, a statewide paid family and medical leave program financed by employer and employee contributions. In 2019, leadership agreed to delay the required contributions for three months, from July 1 to Oct. 1, 2019. The paid family and medical leave program is funded by a mandatory payroll tax of 0.75% (adjusted from .63%) on the first $132,900 of an employee’s wages, to be adjusted annually. The payroll tax will be split between employers and employees. However, for employers with fewer than 25 employees, no employer contribution is required for family or medical leave premiums.

An employer is considered a Massachusetts employer with respect to services performed by a covered individual for the employer if the service is:

Localized in Massachusetts. Service is localized in Massachusetts if the service is performed:
(1) Entirely within Massachusetts; or
(2) Both within and outside of Massachusetts, but the service performed outside of Massachusetts is incidental to the individual’s service within Massachusetts (for example, is temporary or transitory in nature, or consists of isolated transactions); or

Not localized in any state, but some part of the service is performed in Massachusetts and:
(1) The individual’s base of operations is in Massachusetts or, if there is no base of operations, then the place from which the service is directed or controlled is within Massachusetts; or
(2) The individual’s base of operations or place from which the service is directed or controlled is not in any state in which some part of the service is performed, but the individual’s residence is in Massachusetts.

Effective September 30, 2019, employers must:
1) conspicuously post a workplace notice that informs employees of benefits provided under the paid family and medical leave program. The DFML provides a model poster for employers to use.
2) provide each new hire with written notice detailing the new family and medical leave program within 30 days from the employee’s start date. The employer must obtain each new hire’s written acknowledgement of receipt of the information above, or have the employee sign a statement that he or she refused to sign the acknowledgement. The DFML provides a model notice for employers to use.

Effective October 1, 2019, employers must begin remitting contributions to the trust.

Refer to the below bulletin for details and contact your NEEBCo representative with questions.

Massachusetts Paid Family and Medical Leave Contributions Delayed Until Oct 1 2019

Massachusetts PFML Employer FAQ’s

Harvard Pilgrim and Tufts Announce Merger

Wednesday, August 14th, Harvard Pilgrim Health Care and Tufts Health Plan announced an agreement to merge, consolidating Massachusetts’ 2nd and 3rd largest insurers. The board of directors will comprise equal representation from both directors.

“Through the combination of two strong organizations with a commitment to non-profit health care in New England, we will be able to provide even greater value to consumers, as well as improve access to care throughout the region,” said Joyce Murphy, chair of the board for Harvard Pilgrim Health Care.

“Building upon our collective synergies and strengths – which includes being among the top-rated health plans in the country for quality – will unlock value that can be immediately reinvested in our members and the communities we have the privilege of serving,” said Greg Tranter, chair of the board for Tufts Health Plan. “I am excited about the future.”

The new organization, not yet named, will serve 2.4 million members in Massachusetts, Maine, Connecticut, New Hampshire and Rhode Island. The merger will require review on both the state and federal level, including the assessment of consumer impact. During this time, both organizations will continue to operate as independent entities.

Considerations of a Harvard/Tufts merger date back to 2011.

Consolidation on the health insurer side is mirroring similar consolidation on the provider side in Massachusetts, with the Beth Israel Deaconess Medical Center and Lahey Health Hospital networks combining earlier this year.

NEEBCo will continue to monitor this consolidation and inform clients as further developments occur.

Harvard Pilgrim Press Release

Tufts Health Plan Press Release

Canadian RX Imports Development

While still in it’s development stage, HHS and the FDA are releasing the below Safe Importation Action Plan to describe steps that will be taken to allow the importation of certain drugs from Canada, as well as allow manufacturers to import versions of drugs they sell in foreign countries that are the same as US versions, potentially allowing them to offer a lower price that what current distribution contracts allow.

There are outlines specific to eligible and non-eligible drugs on page 2. This is not the final proposal, and future adjustments may occur.

It is a promising development in the continued struggle for affordable RX therapies in the US. Contact your NEEBCo representative with questions.

NEEBCo – RX importation action plan

2020 Open Enrollment Checklist

To prepare for open enrollment, group health plan sponsors should be aware of the legal changes affecting the design and administration of their plans for plan years beginning on or after Jan. 1, 2020. Items to consider include:

  • ACA Affordability Rate changes – employers may consider reducing their employee contributions for 2020 to avoid a penalty under the pay or play rules
  • Out-of-pocket maximum changes
  • HSA minimum deductible, maximum out-of-pocket and contribution limit changes
  • New HRA designs – Individual Coverage HRA (ICHRA) and Excepted Benefit HRA (EBHRA)

Refer to the attached 2020 Open Enrollment Checklist for detail on the above and other reminders, and contact your NEEBCo representative with questions.

2020 Open Enrollment Checklist

Maine Passes Employee Paid Leave Law

Enacted on May 28, 2019, Maine’s Earned Employee Leave Law is the first legislation in the United States to allow private employees to earn paid leave that may be used for any reason. Effective Jan. 1, 2021, this law allows eligible employees to earn one hour of paid leave for every 40 hours worked, up to 40 hours per year.

The paid leave requirements only apply to employers with more than 10 employees. Employers with 10 or fewer employees and employers in seasonal industries are exempt. The law does not provide any carryover, employer notice or posting requirements. However, the Maine Department of Labor is expected to adopt regulations that may contain additional requirements.

Maine employers with more than 10 employees should review existing leave policies to ensure that they will comply with the new paid leave requirements, beginning Jan. 1, 2021. Once regulations for these paid leave requirements are issued, employers should review them for additional information.

Refer to the attached compliance bulletin for additional detail and contact your NEEBCo representative with questions.

Maine Passes Expansive Paid Employee Leave Law 6-7-19