While still in the midst of the COVID-19 pandemic, employers must look ahead to determine how benefits will be impacted in 2021.
To help, healthcare leader Mercer has unveiled its annual list of the top compliance issues employers should consider when putting together their benefits packages for the upcoming plan year.
Top 2021 compliance issues
Here are the key focus areas of Mercer’s “Top 10 compliance issues for health and leave benefits in 2021,” as well as its recommendations for employers:
COVID-19 issues for health plans: Employers should review their group health plans for COVID-19 coverage, specifically testing, treatment and future vaccines. Employers might expand employee assistance programs to add COVID-19 testing services but discontinue services once the emergency period ends.
Consider stand-alone benefit options, such as telehealth, for employees ineligible for group coverage. The Coronavirus Aid, Relief and Economic Security (CARES) Act allows HDHPs to cover telehealth services on a predeductible basis, which won’t jeopardize HSA eligibility. Also, review administration of delayed COBRA premium payments, which are due 60 days after the national emergency ends.
Paid leave: Evaluate processes for integrating COVID-19 paid leave requirements under the FFCRA and state paid leave mandates with existing benefit plans, then revise plans as needed to comply. Watch closely for state legislation for new or expanded leave mandates and programs that may stretch into 2021.
Prescription drug costs: Review new payment model and plan designs aimed at lowering plan costs for specialty medications to ensure compliance.
Watch for a Supreme Court case in the fall that will review whether ERISA pre-empts a state law regulating how pharmacy benefit managers set rates for certain generic prescriptions. Also, track FDA activities and states’ efforts to import certain medications from Canada that meet its standards.
Transparency rules: Review the final transparency rule for hospitals: They must publicly display negotiated charges on their websites as of Jan. 1, 2020. Explore new opportunities to directly contract rates with individual hospitals. Also, prepare to comply with the transparency rule for group health plans that will probably take effect sometime in 2022. Ask your provider if it will supply the disclosure.
HIPAA issues: Assess how healthcare changes due to the pandemic will change privacy concerns for group health plans. Wellness and transparency tools and mobile apps may implicate HIPAA and other laws. With expanded use of telehealth, expect updated HIPAA rules in 2021.
HSA, HRA and FSA plans: For 2021, ensure administrative practices comply with optional or required COVID-19 relief rules. The CARES Act now allows additional nonprescription items to be purchased with HSA, HRA and FSA funds.
Monitor pending COVID-19 relief legislation that could enhance HSAs or provide greater FSA flexibility for 2021.
Preventive services: Confirm non-grandfathered health plans cover ACA-required in-network preventive services without any deductible or copay. Also, monitor development of COVID-19 preventive services or vaccines, which non-grandfathered health plans must cover without cost sharing. Plans must cover these preventive items within 15 days after they’re recommended by the CDC.
ACA concerns: While the ACA is being challenged in court, employers need to monitor developments, as the outcome will likely have implications for group health plans. Self-funded employers will need to continue to calculate and pay the PCORI fee, which remains in effect until 2029.