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BY: Justin LeaderPresident & CEO, BenefitsDNA#wefixyourhealthcare On Monday, President Donald Trump officially signed an executive order that takes aim at one of America’s most broken systems: prescription drug pricing. But this time, he’s not just revisiting the “Most Favored Nation” (MFN) strategy from his first term — he’s widening the net. If the initial announcements […]

When it comes to employer-sponsored healthcare, there’s no such thing as a one-size-fits-all solution. For years, traditional group health plans have been the go-to, but rising costs, unpredictable renewals, and administrative headaches have forced employers to explore alternatives. Enter the Individual Coverage Health Reimbursement Arrangement (ICHRA), a model that lets companies reimburse employees for individual

We all have that little piece of plastic in our wallets. It’s convenient, right? But imagine if every time you swiped your card, your $4 coffee suddenly cost $60—except you didn’t see the charge breakdown. You only found out months later, buried in a statement, and even then, no one could explain exactly where the

Where’s Your Money Going? Imagine walking into Kohl’s, buying a cart full of clothes, and racking up a ton of Kohl’s Cash. But when you go to use it? Surprise—someone else already spent it. You never even saw it. Frustrating, right? Now, scale that up to millions of dollars in your health plan. That’s exactly

The latest Hospital Price Transparency Compliance Report from Patient Rights Advocate came out in November of 2024, and the findings are staggering: Only 21.1% of hospitals are fully compliant with the federal Hospital Price Transparency Rule. 💩 Compliance is getting worse, not better. This is a sharp drop from 34.5% compliance earlier this year and

On a recent call some of my peers, Jeff Smith, David Balinski, and Mike Miele, we kicked around a number of happenings as we often do — touching on politics, life, family, and the healthcare industry. As we dove into the complexities of healthcare, I floated an idea: what if we made some component of

Pharmacy Benefit Managers (PBMs) are finally feeling the heat. With President-elect Donald Trump’s recent vow to cut drug costs by eliminating the “middleman,” the stocks of major PBMs took a dive – and for good reason. For years, these middlemen have quietly operated in the shadows of our healthcare system, contributing to inflated drug prices

A health savings account (HSA) is a type of savings account that allows individuals to set aside money on a pre-tax basis to pay for qualified medical expenses. HSAs are typically available to individuals who are enrolled in high-deductible health plans (HDHPs), which are health insurance plans that have lower monthly premiums but higher out-of-pocket

Yes, you can go on Medicare even if your employer offers health insurance, but whether or not it makes sense for you to do so depends on your specific situation. If you are eligible for Medicare, which typically occurs at age 65, you have the option to enroll in Medicare regardless of whether you have

An employer should offer group disability insurance for several reasons: Overall, offering group disability insurance can be a win-win for both the employer and employees. It can provide peace of mind for employees, help attract and retain top talent, and potentially save the employer money in the long run.  Interested in offering a plan?  BenefitsDNA

An employer may offer group vision insurance as a benefit to their employees for several reasons. Here are some of the main reasons an employer might offer group vision insurance: Overall, offering group vision insurance can be a valuable benefit for both employers and employees. It can help attract and retain employees, promote eye health,

Employers may offer group life insurance as a way to provide an additional benefit to their employees, as well as to attract and retain talent. Here are some potential reasons why an employer might offer group life insurance: It’s important to note that group life insurance may not be appropriate for all employers or employees,

An employer might offer group accidental death and dismemberment (AD&D) insurance to employees for several reasons: Overall, offering group AD&D insurance can be a valuable benefit for employees, while also being a cost-effective way for employers to provide this type of coverage. BenefitsDNA has decades of experience in stand-alone, business travel and voluntary Accidental Death

Health Rosetta is a framework and set of guiding principles for designing and implementing high-performance healthcare benefits plans. It was developed by Dave Chase, a health policy expert, to provide employers with a blueprint for creating more effective and affordable healthcare benefits for their employees. The Health Rosetta framework is based on a set of

A laser in stop-loss insurance refers to an additional attachment that may be added to a stop-loss insurance policy. A laser is a form of underwriting that targets a specific high-risk individual or group within the policy’s coverage. The attachment is used to limit the insurer’s liability for claims made by the high-risk individual or

PCORI (Patient-Centered Outcomes Research Institute) fees are annual fees that employers who sponsor certain self-insured health plans or fully-insured health plans are required to pay. The fees are used to fund the Patient-Centered Outcomes Research Trust Fund, which supports research to improve the quality and effectiveness of medical treatments and patient outcomes. Employers who sponsor

As an employer who offers a group health insurance plan, you have several responsibilities when it comes to Affordable Care Act (ACA) reporting. Here are some key things to keep in mind: Failing to comply with ACA reporting requirements can result in significant penalties, so it’s important to ensure that you are meeting all of

As a health plan fiduciary, you have a legal obligation to act in the best interests of the plan participants and beneficiaries. Here are some of your key requirements: Failure to meet these requirements could result in legal liability and financial penalties. It is important for health plan fiduciaries to understand their obligations and take

Medical balance billing, also known as surprise billing, occurs when a patient receives a bill for the difference between what their health insurance company pays for a medical service and what the healthcare provider charges for that service. Balance billing usually occurs when a patient receives care from an out-of-network healthcare provider, or when an

An employer may consider purchasing business travel accident insurance to provide financial protection to their employees who are required to travel for work. Here are some reasons why an employer may choose to buy business travel accident insurance: Overall, business travel accident insurance can be a valuable investment for employers who want to protect their

Employers who offer certain types of employee benefit plans, including health plans, are generally required to file Form 5500 with the Department of Labor (DOL) and the Internal Revenue Service (IRS) annually. The filing requirement applies to employers who sponsor welfare benefit plans that cover more than 100 participants, including both employees and their dependents.

Designing an executive compensation package with additional fringe benefits, insurance, and financial incentives can be an effective way to attract and retain key people. Here are some steps to consider: Overall, designing an executive compensation package that includes fringe benefits, insurance, and financial incentives can be an effective way to attract and retain key people.

The No Surprises Act is a federal law that was passed in December 2020 as part of the Consolidated Appropriations Act. The law is designed to protect patients from surprise medical bills, including balance billing, in certain situations. Here are some ways that the No Surprises Act protects patients from balance billing: Overall, the No

How can you combine individual and group disability insurance, to maximize disability income for higher earners? Combining individual and group disability insurance is a strategy that can help maximize disability income for higher earners. Here are some ways this can be accomplished: Overall, combining individual and group disability insurance can be an effective strategy for

As an employer why should I consider a self-funded dental plan? Self-funding your dental plan can offer several benefits for employers, including: It is important to note that self-funding a dental plan also involves financial risks, as the employer is responsible for paying for all claims made by employees. However, with careful planning and management,

PBM Audit & Procurement is a process used in the healthcare benefits industry to ensure that the pharmacy benefit management (PBM) services provided to employers that sponsor a health plan are accurately priced. PBM’s are responsible for managing the purchasing, dispensing, and reimbursement of prescription drugs for their clients. These companies often have contracts with