RxDC Reports for Group Health Plans
Under the Consolidated Appropriations Act (CAA), insurance companies and employer-based health plans must annually submit information about prescription drugs and healthcare spending directly to CMS. This data submission is called the RxDC report. The Rx stands for prescription drug, and the DC stands for data collection. Please click here to learn more on the CMS website.
Some of our carrier partners are requesting additional information. Please continue reading below for more information.
Anthem
Anthem has sent surveys to certain employers. Groups have until March 24, 2023 to complete the survey. If the group does not complete the survey, Anthem cannot file on their behalf.
Optima Health
Optima will be filing on behalf of their Fully Insured and Self-Funded Large Groups, but will be requesting each group to supply additional information. Please click here to learn more.
UnitedHealthcare
Select groups received a survey and had to complete by March 3, 2023. If your client received the survey and did not complete it, they need to contact UHC as soon as possible.
If this information is not filed by either the carrier or the employer, the plan will be out of compliance and the group may be subject to penalties.
Bon Secours Remains in Optima Health Network
We had previously notified brokers and clients of the possibility that Bon Secours would leave Optima's network on March 1, 2023. However, the two parties have since reached an agreement and Bon Secours will not be leaving Optima's network.
Optima members can continue to visit in-network Bon Secours hospitals, physicians, providers, or other healthcare facilities for covered services under their plan.
Mary Washington Remaining in Anthem's MA Network
Anthem has reached an agreement with Mary Washington Healthcare to keep them in their Medicare Advantage network. Anthem is sending letters to impacted members to share this good news.
If members already moved to a new provider, they can stay with them or switch back to Mary Washington Healthcare.
New Benefits from Delta Dental
Delta Dental has partnered with Amplifon Hearing Health Care to offer quality care and special savings for your clients' hearing needs! Amplifon’s hearing care provider network includes more than 145 provider sites in Virginia with more than 1,400 hearing aid options and an average savings of 66% off retail pricing. Learn more about Amplifon here.
Right Start 4 Kids from Delta Dental is an included benefit that helps remove cost barriers to dental care for children up to age 13. This program provides 100% coverage for diagnostic and preventive and basic and major services, with no deductible, when members visit an in-network dentist (coinsurance levels apply when visiting an out-of-network dentist). Learn more about Right Start 4 Kids here.
Compliance Updates
Health Plans Must Submit Gag Clause by Dec 31, 2023
The CAA prohibits health plans and issuers from entering into contracts with health care providers, third-party administrators (TPAs), or other service providers that would restrict the plan or issuer from providing, accessing or sharing certain information about provider price and quality and deidentified claims.
Plans and issuers must annually submit an attestation of compliance with these requirements. The first attestation is due by Dec. 31, 2023, covering the period beginning Dec. 27, 2020, through the date of attestation. Subsequent attestations, covering the period since the last attestation, are due by Dec. 31 of each following year.
Please click here to learn more.
New Electronic Filing Requirements for Employers
On February 23, 2023, the IRS released a final rule that substantially expands the requirement to file certain information returns electronically, including the ACA reporting requirements under Sections 6055 and 6056.
The final rule will eliminate paper filings for most employee benefit plan returns. Only very small employers will continue to have the option to file paper returns.
Please click here to learn more.
End of the COVID-19 Emergency Periods
The Biden Administration has announced its plan to end the COVID-19 national emergency and public health emergency (PHE) on May 11, 2023.
When the PHE ends, health plans will no longer be required to cover COVID-19 diagnostic tests and related services without cost sharing. Health plans will still be required to cover recommended preventive services, including COVID-19 immunizations, but this coverage requirement will be limited to in-network providers.
Please click here to learn more.
The information herein should not be construed as legal or tax advice in any way. This content is provided for informational purposes only. You should seek the advice of your attorney or tax consultant for additional or specific information.