Entries by Q4i Dev

Webinar:  Diving into the World of Mental Health Parity Compliance

    Join Q4intelligence and Marissa Rufo of MZQ Consulting for a compliance webinar.  When: Wednesday, June 12, 2024, 11:00 AM Pacific / 2:00 PM Eastern Where: Zoom | Register here   Prefer to listen instead of read? No problem! Listen to the blog post at any time by clicking here.   Diving into the World of Mental Health Parity Compliance You’ve heard all the buzz around mental health parity rules and enforcement. But what is it all about? Join us for a deep dive into the world of mental health parity compliance, including: How we got here What both types of analyses entail Who is subject to the rules Strategies going forward for your plan Learn how the Mental Health Parity and Addiction Equity Act and subsequent additional rules in the Consolidated Appropriations Act of 2021 have changed plan-sponsor requirements. Employer-sponsored health plans are required to conduct mental health parity analyses on their health plans to ensure that more restrictive limitations are not being placed on mental health and substance use disorder benefits than they are on medical/surgical benefits. These analyses come in two flavors, non-quantitative treatment limitations analyses and quantitative treatment limitations analyses. Every plan needs detailed reports on hand to show how it meets these requirements, especially if they come under audit.   Who is MZQ Consulting?  MZQ Consulting is a boutique ACA and benefits compliance consultancy helping people navigate the complex world of employee benefits compliance through deep expertise and superb client service. Want to attend? Save your seat by clicking here.  {% module_block module “widget_1cab5fe7-992d-479b-b8d1-f854882928af” %}{% module_attribute “btn” is_json=”true” %}{% raw %}{“link”:{“no_follow”:false,”open_in_new_tab”:true,”rel”:”noopener”,”sponsored”:false,”url”:{“content_id”:null,”href”:”https://us02web.zoom.us/meeting/register/tZAlfu2tqTotEt1u6mruOOyUF0X8PKz5CHJu#/registration”,”type”:”EXTERNAL”},”user_generated_content”:false},”title”:”I want to attend”}{% endraw %}{% end_module_attribute %}{% module_attribute “btn_type” is_json=”true” %}{% raw %}”cta”{% endraw %}{% end_module_attribute %}{% module_attribute “child_css” is_json=”true” %}{% raw %}{}{% endraw %}{% end_module_attribute %}{% module_attribute “css” is_json=”true” %}{% raw %}{}{% endraw %}{% end_module_attribute %}{% module_attribute “cta” is_json=”true” %}{% raw %}”160409781517″{% endraw %}{% end_module_attribute %}{% module_attribute “definition_id” is_json=”true” %}{% raw %}null{% endraw %}{% end_module_attribute %}{% module_attribute “field_types” is_json=”true” %}{% raw %}{“animation”:”group”,”layout”:”group”,”custom_class”:”text”,”is_in_viewport”:”boolean”,”cta”:”cta”,”style”:”group”,”anchor_link_id”:”text”,”btn”:”group”,”btn_type”:”choice”}{% endraw %}{% end_module_attribute %}{% module_attribute “label” is_json=”true” %}{% raw %}null{% endraw %}{% end_module_attribute %}{% module_attribute “layout” is_json=”true” %}{% raw %}{“alignment”:”center”,”margin_top”:0}{% endraw %}{% end_module_attribute %}{% module_attribute “module_id” is_json=”true” %}{% raw %}100522671426{% endraw %}{% end_module_attribute %}{% module_attribute “path” is_json=”true” %}{% raw %}”@marketplace/maka_Agency/POWER THEME/modules/mini-cta”{% endraw %}{% end_module_attribute %}{% module_attribute “schema_version” is_json=”true” %}{% raw %}2{% endraw %}{% end_module_attribute %}{% module_attribute “smart_objects” is_json=”true” %}{% raw %}[]{% endraw %}{% end_module_attribute %}{% module_attribute “smart_type” is_json=”true” %}{% raw %}”NOT_SMART”{% endraw %}{% end_module_attribute %}{% module_attribute “style” is_json=”true” %}{% raw %}{“cta_size”:”pwr-cta–full-width”,”cta_style”:”pwr-cta–primary-solid”}{% endraw %}{% end_module_attribute %}{% module_attribute “tag” is_json=”true” %}{% raw %}”module”{% endraw %}{% end_module_attribute %}{% module_attribute “type” is_json=”true” %}{% raw %}”module”{% endraw %}{% end_module_attribute %}{% module_attribute “wrap_field_tag” is_json=”true” %}{% raw %}”div”{% endraw %}{% end_module_attribute %}{% end_module_block %}

Innovation vs. Tradition: Striking the Right Balance in the Age of Change

Prefer to listen instead of read? No problem! Listen to the blog post at any time by clicking here.   Innovation is encouraged and expected in the business world; you’ll fall behind if you don’t keep up to date on new processes or technology. However, ignore traditions at your own peril. Workplace traditions like established practices, company culture, and values give employees a sense of comfort in the familiar, foster a sense of stability, and boost morale and productivity.  A healthy organization strikes a balance between tradition and innovation.

2025 Limits Announced for HSAs, High Deductible Health Plans, and Excepted Benefit HRAs

Prefer to listen instead of read? No problem! Listen to the blog post at any time by clicking here.   Late last week, the Internal Revenue Service released updates to the maximum annual 2025 contribution limits for health savings accounts (HSAs) under high deductible health plans (HDHPs). These inflation-adjusted limits, which have increased slightly from 2024, apply to both individual and family coverage. Of note, the annual limit for the additional catch-up HSA contribution eligible individuals aged 55 and over are permitted to make remains unchanged. The updates also include deductible minimums and out-of-pocket (OOP) expense limits for HDHPs and an increase to the maximum amount that may be made newly available for excepted benefit health reimbursement arrangements (EBHRAs). The HSA, HDHP, and out-of-pocket thresholds apply for the 2025 calendar year, while the EBHRA maximum applies to the 2025 plan year. The 2025 limits are summarized below in comparison to the 2024 limits:   Annual HSA Contribution Limits   2025 2024 Self-only coverage $4,300 $4,150 Family coverage $8,550 $8,300 Additional catch-up contribution for eligible individuals $1,000 $1,000 Annual Minimum Deductibles for HDHPs   2025 2024 Self-only coverage $1,650 $1,600 Family coverage $3,300 $3,200 Annual Maximum Out-of-Pocket Expense Limits for HDHPs   2025 2024 Self-only coverage OOP expenses may not exceed $8,300 $8,050 Family coverage OOP expenses may not exceed $16,600 $16,100 Plan Year Excepted Benefit HRA Maximum   2025 2024 Maximum amount for a plan year may not exceed $2,150 $2,100

Federal Trade Commission Weighs in On Non-Competes 

Prefer to listen instead of read? No problem! Listen to the blog post at any time by clicking here.   On Tuesday, April 23rd, the Federal Trade Commission (FTC) voted 3-2 to ban non-compete agreements. The rule was first proposed in January 2023, and the hope was that this change would increase worker’s earnings by almost $300 billion each year.   There were thousands of public comments sent in with many favoring the proposal. Interestingly enough, a large portion of those comments came from health care workers.  The FTC estimates that upwards of 30 million workers are subject to non-compete agreements. It is their contention that these agreements prevent employees from working for competitors or starting a competing business after they leave a job. That, according to the agency, is unfair and restricts competition. This is viewed as a violation of Section 5 of the FTC Act.  The final rule would ban new non-compete agreements for all workers and require employers to let current and past employees know they will not enforce them. Employers will also have to discard any existing non-compete agreements for most employees. One change in the final rule allows agreements to remain in effect for senior executives, which the rule defines as someone earning more than $151,164 annually in a policy-making position.  The agency believes that banning non-competes will allow for:  Reduced healthcare costs;  Increases in new business formations; and  Higher wages for workers.  The effective date of the new rule will be 120 days after it is published in the Federal Register. As with many controversial rules and regulations, opponents such as pro-business groups have already indicated they will be taking legal action to block the implementation of the new rule.  Business groups favor non-compete agreements, arguing that they are critical for protecting proprietary information and intellectual property. The new rule does nothing to alter current methods that protect that information, including nondisclosure and confidentiality agreements. Business groups also firmly question the FTC’s authority to even issue the ban, both retroactively and going forward. The dissenting commissioners on the FTC said they do not support non-compete agreements but contend that their agency does not have the authority to issue the rule without a Congressional directive. Congress has not given the agency explicit authority to ban non-compete agreements. Though there have been bills introduced in the past, none have passed into law.   The U.S. Chamber of Commerce, the largest pro-business lobbying group in the country, has stated that it plans to sue to block the rule. It appears there will likely be a protracted court battle on this issue, and it would not be surprising if it reached the Supreme Court.   In contrast, the Biden administration has commented in favor of the rule, arguing that non-compete agreements limit workers’ mobility, depress their wages, and harm entrepreneurship and competition in the U.S. economy.  Given the diverse opinions already shared about this new rule, we anticipate that it may evolve over time, and will continue to provide updates if and when they become available. 

Invisible Issues, Visible Solutions: Rethinking Mental Health at Work

Prefer to listen instead of read? No problem! Listen to the blog post at any time by clicking here. As mental health awareness grows, companies must change strategies, moving beyond traditional wellness perks that may feel static and nonpersonal, such as workout programs and mental health days, to tackle many visible and nonvisible challenges. From the trauma of global pandemics to anxiety and depression, companies are stepping up. They’re crafting cultures where it’s okay to talk about mental health openly, boosting support through technology like telehealth, and recognizing the real ROI that comes from happier, healthier employees. It’s not just about ticking boxes; it’s about building resilience, reducing stigma, and fostering an environment where everyone can thrive.

Annual RxDC Reporting Deadline Drawing Near

Prefer to listen instead of read? No problem! Listen to the blog post at any time by clicking here.   The Consolidated Appropriations Act of 2021 established a new data collection requirement for employers of all sizes and funding structures, where such entities must now submit annual prescription drug data collection (RxDC) reports on their plan’s prescription drug and health care spending to the Centers for Medicare and Medicaid Services (CMS). The calendar year 2023 reports are due by June 1, 2024. We encourage employers to ensure that these reports are submitted accurately and timely, as the “good faith” compliance standard applied to the initial 2020 and 2021 RxDC filings is no longer available.  RxDC reports from employer group health plans must include a file of general plan information (P2), details about the plan’s enrollment information and allocation of premium dollars (D1), and seven data files (D2-D8) that primarily reflect statistics about prescription drug usage and medical claims data.  Narrative files explaining the data contained in the D1-D8 reports are also required. Of note, RxDC reports are not required for retiree-only plans, excepted benefits, or account-based plans like HRAs, but they are required for all traditional group health plans in all U.S. states and territories.  Because employers do not typically have access to the claims data required to prepare D2-D8 files and their accompanying narratives, employers are permitted to have multiple vendors submit data files on behalf of their plan. Plan sponsors will likely rely on as many as three vendors to satisfy these complex reporting requirements:  PBMs will generally complete D3-D8 files (which include pharmacy data files and related data files).  Carriers and TPAs will generally complete and submit D2 files (which include health care spending files).  Depending on the circumstances, employers or their compliance vendors, carriers, or TPAs will generally complete and submit D1 files (including information about plan enrollment and premium data).  Each separate filing must also be accompanied by a P2 cover letter-type filing identifying the plan(s) included in that filing.  The 2023 RxDC instructions include a notable difference from previous years in that this is the first year that CMS will enforce the previously suspended aggregation restriction. This restriction prohibits the D1 medical premium and life years data and the D3-D8 pharmacy benefit data from being reported at a “less granular level” than the D2 medical benefit data. In other words, if the D2 is submitted on a plan-level basis, the D1 and D3-D8 files must be submitted similarly; they cannot be submitted by market segment unless the D2 file is also provided on a market segment-level basis. The D1 and D3-D8 files may be submitted at a more granular level than the D2 file, meaning that these reports can be created on a plan-level basis even if D2 reflects market segment-level information.  The most significant challenge many employers face for RxDC reports is identifying a solution for submitting the D1 data, which needs to be filed along with its own P2. Even though the P2 plan information and D1 premium data files are comprised primarily of information employers should know about the health plan they have offered, there are complex requirements within the P2 and D1 file specifications, and it takes weeks to obtain the account with CMS’s Health Insurance Oversight System (HIOS) required for their submission. As a result, most employers will need assistance from a vendor or compliance expert to create and submit these reports through HIOS.  Employers working with a health insurer, TPA, or PBM to submit D1 files on their behalf will likely encounter tight deadlines to provide their vendor employer-specific information for these filings.  In some cases, these deadlines may have already passed; in others, a plan’s vendor may refuse to help submit D1 data. The reluctance to help and tight deadlines exist because carriers, TPAs, and PBMs must focus on the “heavy lift” that submission of D2-D8 claims files requires.   For employers whose carrier/TPA/PBM is unwilling or unable to submit D1 on their behalf or for those who have missed their vendor’s deadline, MZQ Consulting is available to prepare and submit D1 and P2 files for your organization. Click here to get more information.  

The ROI of Empathy: Unveiling the Value of Always-On Employee Care

Prefer to listen instead of read? No problem! Listen to the blog post at any time by clicking here.   Empathy can sometimes take a backseat to productivity and efficiency. However, recent insights suggest that nurturing an always-on approach to employee care isn’t just good ethics—it’s smart business. This deep dive unveils the return on investment (ROI) companies can achieve by genuinely caring for their teams.  The essence of always-on care  Imagine a work environment where wellbeing is not merely an afterthought but an aspect of company culture. Always-on care embodies this vision, providing support to employees across all life’s phases—both professional and personal. It’s a holistic approach, encompassing mental health support, financial wellness, professional development, and a healthy work-life balance.

Final Rules Issued on Employer-Sponsored Indemnity Insurance

Prefer to listen instead of read? No problem! Listen to the blog post at any time by clicking here.   On March 28, 2024, the Departments of Health and Human Services (HHS), Labor, and the Treasury (collectively, the Departments) released final rules governing employer-sponsored indemnity insurance. This type of medical coverage is designed to provide limited-scope benefits and is therefore exempt from certain legal requirements that otherwise apply to major medical plans. As such, indemnity insurance is strictly regulated to ensure that consumers and employees understand what they are buying when they enroll in these plans. Many employers offer hospital or other fixed indemnity insurance products designed to qualify as “excepted benefits,” meaning that they do not have to comply with the Affordable Care Act’s coverage mandates. Under these arrangements, the insurance policy must pay a fixed dollar amount per day (or per other time period) for a hospitalization or illness, regardless of the amount of expenses incurred.  These plans are traditionally used as a form of income replacement upon the occurrence of a health-related event. They are not, nor have they ever been, a substitute for comprehensive coverage. Consumers have the option of using the fixed cash benefit as they wish, whether it be to cover out-of-pocket expenses not covered by comprehensive coverage, or to defray non-medical expenses such as rent or mortgage.  Notably, the guidance emphasizes that employer-sponsored indemnity plans are not permitted to reimburse participants on a per service basis, such as per doctor visit or surgical procedure. Thus, indemnity plans cannot provide benefits in varying amounts based on the type of procedure or item, such as the type of surgery being performed, or the type of prescription drug provided.  In proposed regulations issued last year, the Departments expressed concern regarding employers that offer these plans alongside medical plans that provide minimum essential coverage, but not minimum value (e.g., preventive-care only plans), and suggested prohibiting such arrangements. Specifically, the Departments were concerned that these arrangements are intended to circumvent the Federal consumer protections and requirements for comprehensive coverage that otherwise apply to employer-sponsored plans. Though the proposed prohibition was not adopted in the final rule, the Departments have indicated that they will continue to study the issue, noting that “[n]o inference should be drawn from the decision not to finalize the proposed . . . example[s].”  The Departments did finalize requirements relating to strict new notices that must be provided to employees who are offered indemnity insurance. These notices point out the differences between fixed indemnity excepted benefits coverage and comprehensive coverage. For plan years beginning on or after January 1, 2025, any employer offering hospital indemnity or other fixed indemnity coverage will need to include the notice below in at least 14-point font on the first page (in either paper or electronic form, including on a website) of any marketing, application, and enrollment materials that are provided to participants.   Please feel free to reach out to MZQ Consulting with any questions.

The Integrity Check: A Leader’s Guide to Authenticity

It’s all too easy to articulate a vision of the ideal company culture—emphasizing values like work-life balance, respect, and open communication. However, as many of us find out, the real challenge lies not in defining these values but in living them, especially when the pressure mounts. Whether it’s sending emails late into the night or working through weekends, these moments test our commitment to the very culture we advocate for. Ironically, in our bid to lead by example, we might set a standard that contradicts our preached values. This dissonance affects personal wellbeing and can erode trust within your team as they struggle to reconcile what you promote with the behaviors you exhibit. It’s a reminder that leadership is as much about introspection and self-regulation as it is about guiding others. To help maintain alignment between your actions and your stated values, consider this monthly reflection exercise. It can be a personal audit, ensuring you stay true to your vision and lead with integrity.