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Action Item for Employers with HSA-Eligible Health Plans in Oklahoma

Beginning November 1, 2021, a new Oklahoma state insurance law requires health insurers providing pharmacy benefits and pharmacy benefit managers (“PBMs”) to count any amount paid on behalf of a participant towards that participant’s out-of-pocket maximum, deductible, copayment, coinsurance, or other cost-sharing arrangement. The law appears to be intended to apply only to pharmacy benefits. Counting such third-party payments, such as a prescription drug manufacturer’s coupon, towards a participant’s deductible could cause the participant to be ineligible for a health savings account (“HSA”). The Oklahoma Insurance Department has stated it is seeking clarification from the Oklahoma legislature regarding the conflict between the state statute and the federal rules governing HSA eligibility. Employers may want to contact their health insurers and PBMs (i) to determine whether any third-party payments are being applied toward the deductible under an HSA-eligible health plan and (ii) to communicate any relevant information to participants who may be affected. This new law… Continue Reading

HHS Announces Final 2022 Cost-Sharing Maximums under the Affordable Care Act

HHS recently issued its final ?Ç£Notice of Benefit and Payment Parameters for 2022?Ç¥ (the ?Ç£Notice?Ç¥), which includes the maximum annual limitations on cost-sharing that will apply to ?Ç£essential health benefits?Ç¥ in 2022 under non-grandfathered group health plans subject to the Affordable Care Act. For this purpose, cost-sharing generally includes deductibles, coinsurance, copayments, and other required expenditures that are qualified medical expenses with respect to essential health benefits available under the plan. The 2022 limitations are (i) $8,700 for self-only coverage and (ii) $17,400 for other than self-only coverage. The Notice is available here.

September 2022