Major changes are underway this year to promote transparency with employee benefit plans. As an employee, you may be wondering what changes are happening and if you need to prepare. Thankfully, new regulations to ERISA plans are in the favor of employees–2021’s Hospital Price Transparency Rule made it a requirement for hospitals to make their costs for service readily available to patients, and 2022 introduced regulations that employers must make the costs for all medical providers included in their health insurance plans readily available to employees.

Today, we’ll break down how these laws are beneficial to you as an employee–and how you can take advantage of them moving forward.

What Is an ERISA Plan, and How Is My Employer Involved?

First, let’s break down which plans these new regulations apply to. Under the 2022 regulations, employers who provide ERISA plans are impacted. An ERISA plan is protected by the 1974 Employee Retirement Income Security Act, a federal tax labor law that sets up minimum standards for pension plans in the private industry. Since these plans are considered a tax deduction for businesses, the federal government has regulations in place for them.

Under an ERISA-affiliated plan, your employer acts as plan fiduciary for your benefits. This means that they are the ones ultimately responsible for all decisions and administrations pertaining to your benefit plan. As such, the 2022 regulations hold them accountable.

Check our our past blog about ERISA plans and 2022 transparency regulations for more information.  

What Are the New Health Benefits Transparency Laws and Requirements for ERISA Plans?

As part of the new regulations, the federal government wants to promote transparency and efficiency within the healthcare industry–the goal of which is to protect employees. This includes regulations like the 2021 requirement of hospitals to publish their rates so consumers are aware of costs before treatment and can make financially-informed decisions about where they receive medical care. 

Now, in 2022, the government is trying to regulate what information employers, as plan fiduciaries, make available to their employees. This includes providing transparency for the amount of money paid for different services through a health insurance plan. Employees can see a list of the providers they can go to under their plan and the common procedural cost reimbursement rate. 

So, Why Should You as an Employee Care About ERISA Compliance Laws and Regulations?

The government’s main goal here is to make sure that when employees are making their required employee contributions, it’s clear to them where those dollars are going. Theoretically speaking, these regulations of employers as plan fiduciaries and hospitals as medical providers will create a transparent healthcare “marketplace” of sorts. Here, employees have the freedom to shop around for where they’ll go for treatment, as the publication of costs and full range of provider access under their benefits will help them make informed healthcare decisions.

Under these new regulations, employees have a higher level of consumerism when it comes to their healthcare–even if they’re locked into a specific broker-sponsored plan with their employer. For employees in a traditional plan with a preferred provider network, they still have some aspect of choice because their employer must provide all available options for care and the associated costs. Combined with regulations requiring hospitals to publish their rates, this provides greater financial freedom to employees. They have the resources available to do their research, select the most affordable option and plan for the expense.

Benefits Transparency in Action for Employees

Say you needed a knee replacement and knew your local hospital was covered under your employee health insurance plan. You’d book the procedure there, and pay the costs afterward for treatment. But what if there was another hospital nearby that also could perform this knee replacement for less, and they were included in your benefits plan? However, since they aren’t as close to you, you weren’t aware of their services.

Under the new regulations, not only would your employer be required to tell you every location in the area that is covered under your benefit plan, but you’d also be able to see how much it would cost to go to these different locations for treatment. Combined with price transparency regulations for hospitals, you can also now ask to see how much a procedure will cost you upfront before you receive it. 

Ready to Discover Even More Transparency in Benefits?

At Waypoint Benefit Solutions, we specialize in creating unique, data-driven benefit plans based on feedback from your valued employees, your unique data and our customized solutions. We make your company more competitive—contact us and get started today!