ERIC: Allow Employer Sponsored Health Plans to Electronically Deliver AEOB

The ERISA Industry Committee (ERIC), a nonprofit that represents the largest employers who are sponsors of employer sponsored health plans, responded to the request for information on the advanced explanation of benefits (AEOB) and good faith estimate requirements in the No Surprises Act.

ERIC members supported the requirements, stating that they would recommend increased use of application program interfaces (APIs) and greater reliance on interoperability. They also urged CMS to refrain from trying to merge the AEOB with other complex information related to surprised billing.

“ERIC member companies provide comprehensive health care and retirement benefits to millions of active and retired workers and their families, and must send out many notices and disclosures that can pose an administrative burden to plan sponsors, overwhelm consumers, and negatively impact the environment,” James Gelfand, president of ERIC, said in the press release.

“We strongly urge the Departments to allow electronic delivery of AEOBs and other health plan communications required by law and coordinate the AEOB and Cost-Sharing Liability Tool set forth in the Transparency in Coverage (TiC) Rule to best benefit plan beneficiaries.”

The organization offered three primary reasons why CMS should allow group health insurance plans to electronically deliver the AEOB to members.

First, this method would ensure the harmonization of employee benefits and reduce costs. Receiving information from employers electronically is not a new concept. Many health plan members already receive employment-related financial services and pension plan communications digitally.

If administrators cannot do digital delivery, the process becomes less efficient because administrators have to find another way to disclose information. Based on the projections for costs related to pension plans switching to electronic delivery, ERIC suggested that not only would electronic delivery be more efficient and streamlined, but it would also reduce spending.

Second, electronic delivery would improve consumer experience. It would provide a centralized method of communication with members. ERIC argued that this could improve members’ healthcare literacy and ownership of their own health.

Lastly, electronic delivery would reduce printing, which would have a positive effect on the environment. Not only would it reduce the need to cut down trees to produce paper for printing, but it would also reduce the emissions that it takes to deliver mail and reduce trash.

ERIC also supported API information sharing and embracing interoperability standards. Specifically, the organization pointed out the need for timely delivery of good faith estimates—which are estimates of scheduled procedure and service pricing that providers must submit to health plans. ERIC affirmed the proposal to use FHIR-based APIs for good faith estimate submissinos.

ERIC noted that there is overlap between the Transparency in Coverage Rule’s cost-sharing liability tool and the AEOB. Specifically, there are five categories of data or information that both of these tools must disclose. Therefore, ERIC supported the proposal that health plans should be considered in full compliance with the price comparison tool if they are in compliance with the cost-sharing liability tool.

“ERIC strenuously opposes any attempts to coordinate and combine aspects of the Federal and State surprise medical billing rules with the AEOB,” the letter added.

“In our opinion, the surprise medical billing rules are already complex and confusing, especially for plan participants. As a result, requiring the AEOB to, for example, include two different sets of cost and benefit data based on how any applicable surprise billing protections may impact a participant’s cost-sharing liability will only add complication to providing a participant with meaningful, understandable, and consumable information.”