Kent Bermingham II (aka Kent Jr.) joined Milestone Benefits Agency in 1999 and on January 1, 2009 was named the new President.
Milestone Benefits Agency provides “Value Beyond Benefits”, and is built from the bottom up to support everything employers do for their employees’ benefits program. Shopping plans and negotiating the best cost for the right benefits is just the beginning. They dive deeper to support organizations with compliance, communications, reporting, benefit administration, strategic planning, open enrollment, employee service, employee education and more.
What is your background, and how did you get in the EB business? After graduating with a Bachelor’s degree in Accounting from a small university in Michigan, I accepted a position in Materials Management at a 300-bed acute care hospital in Maryland. While there, I passed the CPA exam and earned an MBA in Marketing at The Johns Hopkins University. Along the way I was promoted to be the Manager of Decision Support Services and then the Comptroller of the hospital. After working really long days for months on end, I needed a change and accepted a position in the Medical Economics Department at Aetna. In the fall of 1998, my dad started Milestone Benefits Agency and then in February of 1999, he convinced me to move to Ohio and join him. The rest is history.
What are your leadership principles? Follow the Golden Rule. Be honest and transparent. Have empathy and be compassionate. Recognize we’re human and we all make mistakes. Make sure everyone knows they’re valued, appreciated and essential to the success of the agency. Hire people to fill careers, not jobs. Treat everyone as a colleague, not an employee. Lead by example and be open to change.
What are you looking forward to achieving as a BAN member? Over the years, BAN has evolved, as has our agency and the people working in it. I’m looking forward to BAN continuing to assist us with that evolution by bringing collaboration, support, new ideas, and new partners to work with.
How are you advising your clients regarding ongoing inflation, higher interest rates and a shaky economy? Are you concerned about a recession? Medical inflation (aka “Trend”) has always been part of the medical insurance landscape. That said, it’s accelerating again as seen through exploding drug costs, higher fee schedules and higher utilization. For our 100+ groups, we send monthly plan performance tracking reports so we’re proactively talking about costs and preparing them for the upcoming renewals all year long. We are concerned about the economy in terms of how it impacts our groups, their ability to pay for benefits, and the number of people they employ which translates to lower revenues to the agency. However, the beauty of this industry is that even during a recession, people and businesses still need the products we represent.
What is your outlook for your agency in 2024? One of our biggest strengths has been our ability to retain clients through high levels of service and products (e.g., Employee Navigator) we provide to benefit managers and their employees. We have no reason to believe that will change. Building on that strength, we aim always to target manageable growth and bring the right kinds of clients into the agency.
What is this industry’s most significant challenge? Helping employers manage rising costs has always been and will continue to be the greatest challenge. For many groups, the runway of increasing deductibles, out-of-pocket costs, and employee’s share of premium contributions is running out.
What are two lessons you learned during your career that you can pass along to future leaders in the insurance industry? First, always do what’s in the best interest of your clients. Be honest and transparent with them. You’ll sleep well at night knowing you’ve always done right by them. The money and success will follow. Second, support and empower everyone in the agency. Make sure they know they’re valued and you appreciate them. The agency can only ever be as successful as they are in their roles.
On July 25, 2023, the agencies released an extensive proposed rule related to the Mental Health Parity and Addiction Equity Act (the “Proposed Rule”) as well as a Technical Release requesting comments on certain proposed data requirements for nonquantitative treatment limitations (“NQTLs”) and the potential for an enforcement safe harbor if certain data requirements are met. The Proposed Rule clarifies and solidifies requirements for group health plans and health insurance issuers (“plans and issuers”) to perform comparative analyses of the NQTLs imposed under their plans. To do this, plans and issuers must collect and evaluate data to reasonably assess the impact of NQTLs on access to mental health and substance use disorder (“MH/SUD”) benefits and medical/surgical (“Med/Surg”) benefits and demonstrate compliance with the MHPAEA as written and in operation. The Proposed Rule focuses on the following, which will directly impact plan design and analyses of those designs:
Applying the “substantially all” standard to NQTLs
Revising comparative analysis requirements
Enhancing definitions to better assist plans
Solidifying compliance deadlines
Applying the “substantially all” standard to NQTLS
The first significant change under the Proposed Rule is the application of the “substantially all” standard to NQTLS. Previously, this standard applied only to quantitative treatment limitations (QTLs). Specifically, group health plans that provide both Med/Surg and MH/SUD benefits may not apply any treatment limitation to MH/SUD benefits in any classification that is more restrictive (as written or in operation) than the predominant treatment limitation that applies to substantially all Med/Surg benefits in the same classification. The standard or test is determined separately for each type of treatment limitation. As a reminder, the six permitted classifications under the MHPAEA are: (1) inpatient, in-network; (2) inpatient, out-of-network; (3) outpatient, in-network; (4) outpatient, out-of-network; (5) emergency care; and (6) prescription drugs. Additionally, there is a special rule for outpatient sub-classifications. For purposes of determining parity for outpatient benefits (in-network and out-of-network), a plan or issuer may divide its benefits furnished on an outpatient basis into two sub-classifications: (1) office visits; and (2) all other outpatient items and services. Accordingly, separate sub-classifications for generalists and specialists are not permitted.
Thus, any NQTL that imposes conditions, terms, or requirements that limit access to benefits under the terms of the plan or coverage is considered restrictive, and an NQTL that applies to MH/SUD benefits can be no more restrictive than those that apply to Med/Surg benefits. The Proposed Rule provides an illustrative, non-exhaustive list of NQTLs, which includes medical management standards such as medical necessity or prior authorization, formulary design for prescription drugs (including multi-tier networks), network composition and standards, preferred provider networks, methodology for determining out-of-network rates, fail first or step-therapy requirements, and geographic location or provider type restrictions.
Moreover, an NQTL is considered to apply to substantially all Med/Surg benefits in a classification of benefits if it applies to at least two-thirds of all Med/Surg benefits in that classification (determined without regard to whether the nonquantitative treatment limitation was triggered based on a particular factor or evidentiary standard). If the NQTL does not apply to at least two-thirds of all Med/Surg benefits in a classification, then that type of NQTL cannot be applied to MH/SUD benefits in that classification.
When MH/SUD benefits are offered in any classification of benefits for that MH/SUD condition must be provided in every classification in which Med/Surg benefits are provided. Such benefits must be meaningful benefits for treatment of the condition or disorder in each such classification, as determined in comparison to the benefits provided for Med/Surg conditions in the classification. If the plan provides benefits in a classification and imposes any separate financial requirement or treatment limitation (or separate level of a financial requirement or treatment limitation) for benefits in the classification, then the rules apply separately with respect to the classification for all treatment limitations (or financial requirements).
Revising Comparative Analyses Requirements
The devil is in the details, and the Proposed Rule enhances the content requirements for the comparative analyses required under the CAA, 2021 and existing DOL guidance. Comparative analyses must include a high level of detail to demonstrate a plan’s compliance with the MHPAEA (as written and in operation). Some exceptions apply to independent professional medical or clinical standards and standards to prevent and prove fraud, waste, and abuse.
Generally, plans are required to:
describe NQTLs applicable to MH/SUD and Med/Surg benefits with regard to the benefits in each classification;
identify the factors used and evidentiary standards relied upon to design the NQTLs (including the source from which each evidentiary standard is derived);
describe how the factors are used in the design and application of the NQTL;
demonstrate comparability and stringency as written and in operation; and
address the findings and conclusions as to the comparability of the processes, strategies, evidentiary standards, and other factors used in designing and applying the NQTL to MH/SUD benefits and Med/Surg benefits within each classification, and the relative stringency of their application, both as written and in operation.
The Proposed Rule expands upon each of the above categories to describe the information the DOL expects to see demonstrated in the comparative analyses. Further, the Proposed Rule requires the use of outcomes data when NQTLs are designed so that plans can establish that relevant data was used in a manner reasonably designed to assess the impact of any NQTL on access to MH/SUD benefits and Med/Surg benefits and to determine whether the plan complies in operation. This includes analyses of claims denials, in-network and out-of-network utilization rates (including provider claim submissions), network adequacy (time and distance data, information on providers accepting new patients), and provider reimbursement rates relevant to any NQTLs. As the Proposed Rule suggests, any material difference in this data for Med/Surg and MH/SUD benefits would be a strong indicator of noncompliance and, therefore, plans would be required to both take reasonable action to address the material differences in access and document any such action that has been taken to mitigate these material differences in access to MH/SUD benefits.
Accordingly, the comparative analyses must:
Identify the relevant data collected and evaluated;
Evaluate the outcomes that resulted from the application of the NQTL to MH/SUD benefits and Med/Surg benefits, including the relevant data set forth in the Proposed Rule
Provide a detailed explanation of material differences in those outcomes that are not attributable to differences in the comparability or relative stringency of the NQTL as applied to MH/SUD benefits and Med/Surg benefits and the bases for such a conclusion; and
Discuss any measures that have been or are being implemented by the plan or issuer to mitigate any material differences in access to MH/SUD benefits as compared to Med/Surg benefits, including the actions the plan or issuer is taking to address material differences in access to ensure compliance with MHPAEA.
The Technical Release addresses the requirements for completing comparative analyses but seeks feedback on, among other things, the required data elements, the difficulty in providing data elements, information technology needed to collect the data elements (including cost), and whether plans have access to these data elements. Moreover, the Technical Release addresses the potential for an enforcement safe harbor if specific standards and data elements are met or exceeded by plans.
Enhancing Definitions to Better Assist Plans
To better facilitate complete, clear comparative analyses and compliance generally, the Proposed Rule aims to define terms previously not defined under the law and regulations. Specifically, Proposed Rule newly defines certain terms to help guide plans and carriers to ensure parity in aggregate lifetime and annual dollar limits, financial requirements, and quantitative and nonquantitative treatment limitations between mental health and substance use disorder benefits and medical/surgical benefits. This includes definitions for “DSM”, “ICD”, “evidentiary standards,” “processes”, “strategies, and “factors” and modifies the definitions of other terms for clarity, including “mental health,” “medical/surgical benefits”, treatment limitations, and “substance use disorder benefits.”
Solidifying Compliance Deadlines
The Proposed Rule solidifies the compliance deadlines for providing the comparative analyses to the DOL upon request. Specifically, they must be provided:
Within 10 business days of receipt of a request (unless an additional period of time is specified by the DOL)
If additional information is required after the comparative analyses are deemed insufficient, then the DOL will specify additional information that must be submitted, and it must be submitted so within 10 business days (unless an additional period of time is specified by the DOL)
If the plan is determined to be out of compliance, the plan must respond to the DOL and specify the actions the plan will take to bring the plan into compliance and provide additional comparative analyses meeting the requirements within 45 calendar days after initial determination of noncompliance.
If the DOL makes a final determination of noncompliance, within 7 calendar days of the receipt of the final determination, the plan must notify all participants and beneficiaries enrolled in the plan or coverage that the plan has been determined to be out of compliance with the MHPAEA. The plan must also provide the DOL, and any service provider involved in the claims process, with a copy of the notice provided to participants. Content requirements for the notice are included in the Proposed Rule.
The Proposed Rule specifies that copies of the comparative analyses may be requested (and must be provided to) participants and beneficiaries (or their provider or authorized representatives) who have received an adverse benefit determination related to MH/SUD benefits and any state authorities.
Conclusion
Once finalized, these requirements will apply to plan years beginning on or after January 1, 2025. Until then, the proposed rules require plans to continue to comply with existing MHPAEA laws and regulations, including completing their comparative analyses.
At this point, it is not a question of “if” the agencies will finalize the Proposed Rule, it is “when” it will be finalized. While the Proposed Rule and Technical Guidance go a long way to advise plans, third party administrators (TPAs) and pharmacy benefit managers (PBMs) of the goals of the agency, the Proposed Rules is unlikely to resolve many of the frustrations self-funded plan sponsors have dealt with since 2021 in either obtaining draft comparative analyses from their TPAs or PBMs or ensuring the comparative analyses meet the DOL’s expectations.
TPAs and PBMs hold virtually all of the information necessary to complete the analyses, but much of the details are kept as closely guarded secrets until the DOL requests the information. Accordingly, self-funded plan sponsors must be more assertive with their TPAs and PBMs to ensure (1) the analyses are completed, (2) the analyses are made available as required, and (3) that the analyses include all of the required detail, data, and elements in the CAA, 2021 and the Proposed Rule. One way to do this is by negotiating the plan’s ability to access or request all necessary data and documentation from the TPA or PBM during the contract negotiation process. Finally, as we wait release of the MHPAEA final rule plans are encouraged to ensure current MHPAEA comparative analyses are updated to meet the Proposed Rule requirements (even before it’s finalized) as it brings the plan one step closer to meeting the expectations of the DOL
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About the Author. This alert was prepared by Barrow Weatherhead Lent LLP, a national law firm with recognized experts on the Affordable Care Act. Contact Stacy Barrow or Nicole Quinn-Gato at sbarrow@marbarlaw.com or nquinngato@marbarlaw.com.
CLEVELAND, OH and PLANTATION, FL (11/29/23) – Benefit Advisors Network (BAN), an international network of progressive and visionary employee benefit brokers and consulting firms from across the United States and Canada – has partnered with MASA Medical Transport Solutions, the leading transportation benefit solution.
As a partner, MASA will provide BAN member firms with a new offering that covers the financial gaps related to medical transportation, namely ambulance rides.
“The services MASA provides are often overlooked, yet 86% of all ground ambulance rides could result in an out-of-network bill for the privately insured, according to Consumer Reports,” says Perry Braun, President & CEO of the Benefit Advisors Network. “It will really help set our members apart that they now can go to their employer clients and offer this service. For this reason, we are thrilled to partner with the MASA team.”
Consumers often receive bills due to an out-of-network ambulance, a transport deemed not medically necessary, an unmet health insurance deductible, or other factors. MASA works to ensure members incur no out-of-pocket costs, including out-of-network charges, healthcare plan co-pays, and other costs.
“Employees are facing higher out-of-pocket costs each year, including deductibles and balance billing during medical emergencies. They are looking to their employers to mitigate financial risks and offer meaningful supplemental benefits to ease their concerns. We believe medical transportation coverage is part of a well-rounded employee benefits program,” says Mark Miranda, Vice President of Group Sales at MASA Transport Solutions. “We are excited to partner with BAN to support their member firms as they seek to provide employer clients with holistic benefit offerings.”
About Benefit Advisors Network
Founded in 2002, BAN is an exclusive, premier, international network of independent, employee benefit brokerage and consulting companies. BAN delivers industry leading tools, technology, and expertise to member firms so that they can deliver optimum results to their employee benefit customers. BAN intentionally limits membership because of the highly collaborative interactions. For more information, visit: www.benefitadvisorsnetwork.com or follow them on LinkedIn.
About MASA Medical Transport Solutions
MASA MTS is the leading Emergency Transportation coverage provider for out-of-pocket costs associated with emergency medical transport. MASA’s coverage area includes the continental United States, Hawaii, Alaska, and Canada. For more information, visit www.masamts.com.
As CEO of TIG Advisors in Missouri, Jason is focused on positioning TIG to accomplish our mission to help our clients manage risk and achieve greater success. He is primarily focused on the agency’s strategic leadership and growth, creating a positive impact culture, and expanding our product lines and service offerings.
Status quo health plans have handcuffed employers. Jason passionately helps them chart a new path toward savings, sustainability, and success by engaging transparent partners, ensuring protection through contractual risk management, leveraging actionable health intelligence, and implementing relevant cost-containment solutions. Jason helps employers balance their employee needs with their bottom line by crafting, deploying, and optimizing benefits programs—utilizing the Health Rosetta principles as a guide.
What is your background, and how did you get in the EB business? I made the leap to EB (from pharmaceutical industry) in 2001. Like most everyone, I never planned to get into this business, but it found me. Or rather, I met my wife and married into our agency. I was (and still am) attracted to the entrepreneurial element of our business, and the never-ending opportunity to solve complex problems for clients.
What are your leadership principles? Leadership vs Management: Leadership is doing the RIGHT thing and management is doing things right. My eagle scout days taught me to be prepared–to have a plan. I like to think that my leadership is reflected in our TIG values (Make It Better, Care Deeply, Deliver Meaningful Solutions).
What are you looking forward to achieving as a BAN member? Collaboration with brightest minds. Sharing of best practices. Building out our laser light show for larger cases (via the resources/solutions BAN has vetted).
How are you advising your clients regarding ongoing inflation, higher interest rates and a shaky economy? Are you concerned about a recession? We are clients to have a sense of urgency. Health insurance costs are high because health CARE costs are higher. We must aggressively address UNIT costs of care in the coming years. The inflationary impact is real and is rearing its ugly head (example: hospital labor costs soared over the last few years due to the reliance on travel nurses, etc.). Mildly concerned about a recession, but the reality is, whether we are officially labeling our economic state as a recession or not, it doesn’t really matter. Tough sledding ahead.
What is your outlook for your agency in 2024? We anticipate growth of 12-15% in 2024.
What is this industry’s largest challenge? Amongst the many challenges—new talent: in this hypercompetitive climate for talent, we must create pathways for success with prospective talent.
What are two lessons that you learned during your career that you can pass along to future leaders in the insurance industry? 1) Meaningful = Hard. If I’ve done something that looks easy–it’s because I got lucky. Very few things that are meaningful are easy. Don’t settle for easy. 2) Refine your communication skills. People buy what is clearer, not necessarily what is best (this applies to YOU too). If you confuse, you’ll lose.
TIG Advisors is an independent insurance agency with offices in Columbia, Jefferson City, and St. Louis, Missouri. Established in 1898 as Rollins & Rollins, today they are a diverse advisory firm anchored by expertise in Business Insurance, Benefits and Employer Services, and Personal Solutions.
On November 9, 2023, the Internal Revenue Service (IRS) released Revenue Procedure 2023-34, which increases the health flexible spending account (FSA) salary reduction contribution limit to $3,200 for plan years beginning in 2024, an increase of $150 from 2023. Thus, for health FSAs with a carryover feature, the maximum carryover amount is $640 (20% of the $3,200 salary reduction limit) for plan years beginning in 2024. Of course, when carrying over funds from 2023 to 2024, 20% of the $3,050 salary reduction limit for 2023 is $610.
The Revenue Procedure also contains the cost-of-living adjustments that apply to dollar limitations in certain other sections of the Internal Revenue Code.
Qualified Commuter Parking and Mass Transit Pass Monthly Limit
For 2024, the monthly limits for qualified parking and mass transit are increased to $315 each, an increase of $15 from 2023.
Adoption Assistance Tax Credit Increase
For 2024, the credit allowed for adoption of a child is $16,810 (up $860 from 2023). The credit begins to phase out for taxpayers with modified adjusted gross income in excess of $252,150 (up $12,920 from 2023) and is completely phased out for taxpayers with modified adjusted gross income of $292,150 or more (up $12,830 from 2023).
Qualified Small Employer Health Reimbursement Arrangement (QSEHRA) Increase
For 2024, reimbursements under a QSEHRA cannot exceed $6,150 (single) / $12,450 (family), an increase of $300 (single) / $650 (family) from 2023.
Reminder: 2024 HSA Contribution Limits and HDHP Deductible and Out-of-Pocket Limits
Earlier this year, in Rev. Proc. 2023-23, the IRS announced the inflation-adjusted amounts for HSAs and high deductible health plans (HDHPs).
2024 (single/family)
2023 (single/family)
Annual HSA Contribution Limit
$4,150 / $8,300
$3,850 / $7,750
Minimum Annual HDHP Deductible
$1,600 / $3,200
$1,500 / $3,000
Maximum Out-of-Pocket for HDHP
$8,050 / $16,100
$7,500 / $15,000
The ACA’s out-of-pocket limits for in-network essential health benefits have also been announced and have increased for 2024. Note that all non-grandfathered group health plans must contain an embedded individual out-of-pocket limit if the family out-of-pocket limit is above $9,450 (2024 plan years). Exceptions to the ACA’s out-of-pocket limit rule are available for certain small group plans eligible for transition relief (referred to as “Grandmothered” plans). While historically CMS has renewed the transition relief for Grandmothered plans each year, it announced in March 2022 that the transition relief will remain in effect until it announces that all such coverage must come into compliance with the specified requirements.
The table below describes late filing penalties for ACA reporting. The 2025 penalty is for returns filed in 2025 for calendar year 2024, and the 2024 penalty is for returns filed in 2024 for calendar year 2023. Note that failure to issue a Form 1095-C when required may result in two penalties, as the IRS and the employee are each entitled to receive a copy.
Penalty Description
2025 Penalty
2024 Penalty
Failure to file an information return or provide a payee statement
$330 for each return with respect to which a failure occurs
$310 for each return with respect to which a failure occurs
Annual penalty limit for non-willful failures
$3,978,000
$3,783,000
Lower limit for entities with gross receipts not exceeding $5M
$1,329,000
$1,261,000
Failures corrected within 30 days of required filing date
$60
$60
Annual penalty limit when corrected within 30 days
$664,500
$630,500
Lower limit for entities with gross receipts not exceeding $5M when corrected within 30 days
$232,500
$220,500
Failures corrected by August 1
$130
$120
Annual penalty limit when corrected by August 1
$1,993,500
$1,891,500
Lower limit for entities with gross receipts not exceeding $5M when corrected by August 1
$664,500
$630,500
Failure to file an information return or provide a payee statement due to intentional disregard
$660 for each return with respect to which a failure occurs (no cap)
$630 for each return with respect to which a failure occurs (no cap)
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About the Author. This alert was prepared for [Agency Name] by Barrow Weatherhead Lent LLP, a national law firm with recognized experts on the Affordable Care Act. Contact Stacy Barrow or Nicole Quinn-Gato at sbarrow@marbarlaw.com or nquinngato@marbarlaw.com.
