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Top Health Plan Compliance Issues for 2024

There are many requirements that employers have to abide by in relation to health insurance. Many of these were established by the Affordable Care Act, though there are plenty of others that are established and monitored by other government agencies. 

It’s essential that all businesses abide by these rules and regulations, as being out of compliance could be very costly. 

Below are some of top health plan compliance issues for 2024 that every business should be aware of. 

New Transparency Requirements 

There are many requirements put in place to increase transparency in health care, with the ultimate goal being to protect consumers against things such as surprise medical bills. Most employers meet these requirements through the usage of third-party administrators of their health insurance plans.  

There is some new transparency guidance that is being released for 2024 that all employers should be on the lookout for.  

This includes an internet-based price comparison tool that must be made available for all covered items, services and drugs. All health plans and issuers who aren’t grandfathered in must publicly post three machine-readable files (MRFs) for things such as in-network provider rates, out-of-network allowable amounts and billed charges, and prescription drug rates and prices. 

Health plans and issuers must also now report to the federal government every year regarding spending on health care and prescription drugs.  

Mental Health Parity Compliance 

The Mental Health Parity and Addiction Equity Act, or MHPAEA, prevents health plans and issuers from charging more or providing less favorable benefit limitations on care for mental health and substance use disorder than it does on medical or surgical coverage. These requirements apply to all employer-sponsored health plans for employers who have 50 or more employees. 

A reform in the ACA, though, resulted in these requirements applying to some smaller employers as well. A major recent focus for the U.S. Department of Labor has been enforcing parity requirements for NQTLs, or nonquantitative treatment limitations. 

These are generally provisions in a health plan that impose nonnumerical limits on either the duration or scope of benefits, including requirements for prior authorization, step therapy and reimbursement rates for providers.  

A rule that was proposed in August of 2023 also would make extensive changes to the requirements of MHPAEA, especially those that relate to NQTLs. As such, it’s important for employers to pay attention to these potential upcoming changes. 

Preventative Care Benefits 

The ACA requires all health plans and issuers who aren’t grandfathered in to cover a broad range of preventative care without charging copayments, coinsurance or deductibles, as long as the patient visits an in-network provider.  

What does change from year to year is the scope of the coverage mandate. For instance, now that the COVID-19 public health emergency has ended, health plans no longer are required to cover diagnostic tests or any related services without cost-sharing. 

Ongoing litigation could also change some of the preventative care requirements under the ACA. The Biden administration has appealed a March 2023 decision by the U.S. District Court for the Northern District of Texas that struck down one of the ACA’s key components.  

It’s unsure how employers will be affected should the decision stand and that part of the ACA be ruled unconstitutional. 

Expanded Electronic Filing Requirements 

All applicable large employers (ALEs) under the ACA, as well as employers that have self-insured health plans, must report information on their health coverage to both covered individuals as well as the IRS.  

Starting in 2024, paper filing of these reports is only available to employers who file fewer than 10 information returns with the tax agency for the entire year. That means that only the smallest of filers will be able to use the paper returns, with all other filers forced to do so electronically. 

Telehealth and HDHPs 

The CARES Act, passed during the early stages of the pandemic, provided some relief for high-deductible health plans (HDHPs) to provide telehealth or remote care services before the deductibles of the plan were met. That was previously a requirement for individuals to be eligible for contributions to health savings accounts. 

That relief is set to expire on December 31, 2024, though, unless an additional extension is passed. Congress has introduced bipartisan legislation that would make this exception for telehealth permanent, but it’s uncertain whether it will pass or not. 

All employers who offer HDHPs with either no deductibles or low deductibles for telehealth should pay attention to the developments of that pending legislation. 

Stay Compliant with Beckham Insurance Group 

Compliance is a major undertaking for any organization, but particularly those that have many employees. Health insurance tends to be a complicated web of ever-changing rules and requirements, placing a significant burden on employers to stay on top of new developments. 

If you own a business in South Carolina or Georgia, you should partner with Beckham Insurance Group to ensure you always remain in compliance. In addition to helping companies find the best benefits packages for their employees, our experienced professionals also help our clients stay in compliance with complicated health plan requirements. 

Contact us today to find out how we can help you.