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Health plans - design

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2016 Health and Well-being Touchstone Survey Results
"Employers are continuing to rely on traditional methods for mitigating increasing costs through plan design changes and increasing contributions, and they aren't making transformational changes.... 72% of all participants offer a HDHP.... 69% of employers surveyed indicated that they will be financially impacted by the excise tax on high cost plans.... 76% of employers offer wellness programs and they've expanded them into well-being." (PricewaterhouseCoopers)
[Opinion] The Fantasy of Single Payer Health Care in the States
"Single-payer healthcare has long had a following in the United States, but it is unlikely to become federal policy.... So single-payer advocates are focusing on individual states. This November Coloradans will vote on single-payer healthcare. A couple of years ago, Vermont's governor tried to institute it, but gave up short of the finish line. Other states will surely try. .. Oregon and (maybe) Hawaii [might be] at the top of the list of states to watch." (National Center for Policy Analysis [NCPA])
[Guidance Overview] HHS Issues New Nondiscrimination Requirements for Plans That Receive Any Federal Funding
"[T]he disclosure requirements for individuals with limited English proficiency are different from similar requirements that govern plans under [ERISA] or recent rules implementing the Summary of Benefits and Coverage (SBC) forms that must be distributed by all group health plans.... [P]lan sponsors will have to refer to two sources for information as to which languages to use. In addition, the SBC requires only up to four languages, while the Section 1557 rule requires 15 languages -- an amount that will not fit on the SBC template." (Segal Consulting)
[Guidance Overview] EEOC Final Regs on ADA and GINA Compliance in Wellness Programs
"The ADA rules address incentives in wellness programs that ask disability-related questions and/or require medical exams. The GINA rules focus on inducements tied to requests for a spouse's health information as part of an HRA or medical exam under a wellness program. Wellness programs must provide a notice explaining what medical information will be obtained, how it will be used and who will receive it." (Willis Towers Watson)
[Opinion] Federal Standardized Health Insurance Plans Could Help Improve Access to Care Without Raising Premiums (PDF)
10 pages. "Health insurance companies should offer plans on the [ACA] marketplaces that cover the cost of basic outpatient care -- like primary care, specialty care, and prescription drugs -- before people pay off their deductible. The new federal standardized silver plans ... would have premiums that are comparable to current silver marketplace plans that cover little to no services before the deductible. Offering these standardized plans could improve access to outpatient care without driving up premiums." (Families USA)
[Opinion] National Business Group on Health Comments on House Republican Task Force Outline for Health Care Reform
"Rather than taxing benefits, we encourage Congress to focus more on removing payment incentives for health care providers and suppliers that drive unnecessary health care spending. This includes moving faster toward paying for value in Medicare rather than volume, and ridding Medicare of financial incentives that encourage providers to use more expensive care in more expensive settings when lower cost alternatives of equal or better quality exist." (National Business Group on Health [NBGH])
[Opinion] ERIC Statement About New Health Care Tax Proposed by House GOP
" 'We are concerned that the Task Force paper proposes creating a new tax on benefits, and justifies this by suggesting that taxing health insurance will make health insurance cost less,' said James Gelfand, Senior Vice President of Health Policy, ERIC.... 'The policy rests on the myth that employer-sponsored health insurance is overly generous -- that working families' benefits need to be reduced, and that more costs need to be shifted to employees.' " (The ERISA Industry Committee [ERIC])
House GOP Health Plan, Unsurprisingly, Is Market-Based
"[As] part of a full repeal of the [ACA], the current law's mandates for individuals and insurers would disappear under the GOP plan. It would overhaul Medicare by transitioning to a premium support system under which beneficiaries would receive a set amount to pay for coverage.... People who do not receive health insurance through their employer, Medicare, or Medicaid would receive an advanceable, refundable flat tax credit.... Although the white paper gives no specific value, it says the tax credit 'would be large enough to purchase the typical pre-Obamacare health insurance plan.' " (Morning Consult)
Text of Congressional Republican Proposals for Health Care Reform (PDF)
37 pages. "[This] plan advances a series of proposals that not only protects the health insurance Americans receive through their job, but also moves toward a fairer system that ensures access to coverage for all Americans. It allows for more choices, not top-down mandates, so that Americans can pick the benefits that work best for them. Recommendations: [1] Expanding Consumer-Directed Health Care Options; [2] Expanding Opportunities for Pooling; [3] Making Support for Coverage Portable; [4] Preserving Employee Wellness Programs; [5] Preserving Employer-Sponsored Insurance; [6] Protecting Employers' Flexibility to Self-Insure; [7] Purchasing Across State Lines; [8] Medical Liability Reform." (U.S. House Republicans)
[Guidance Overview] IRS Wellness Program Etiquette -- Don't Double Dip (PDF)
"[IRS Chief Counsel memorandum 201622031] addresses program designs that recently have been marketed to employers as a way to provide tax -free benefits to employees by reimbursing (on a tax-free basis) wellness program premiums paid with (pretax) salary reduction dollars. This kind of 'double dipping' offers a benefit scheme that might be too good to be true." (Xerox HR Services)
[Guidance Overview] HHS Final Rule Addresses Categorical Exclusions for Health Services Related to Gender Transition
"The Final Rule [states] that all health-related insurance plans or other health-related coverage ... that currently have explicit categorical or automatic exclusions of coverage for all health services or care related to gender dysphoria or associated with a gender transition are unlawful on their face; in sum, by singling out the entire category of gender transition-related services, such an exclusion or limitation systematically denies services and treatments for transgender individuals and is, by definition, prohibited discrimination[.]" (Littler)
HHS Targets Young Adults in Efforts to Improve Marketplace Risk Pool
"The [CMS] fact sheet focuses on efforts to improve coverage for young adults. Although ... the uninsured rate among young adults has fallen by more than half, young adults are still more likely than the general population to remain uninsured.... [This] undermines the individual market risk pool, as younger individuals tend to be healthier and, under the ACA's limited age rating, to cost less to cover in proportion to the premiums they pay than older enrollees" (Timothy Jost, in Health Affairs)
Boeing Contracts Directly with California Health System for Employee Benefits
"The move ... marks the expansion of Boeing's direct-contracting approach, which it has already implemented in recent years in Seattle, St. Louis and Charleston, S.C. Other large employers are also pursuing this idea in regions where they have big concentrations of workers. In some cases, they refer employees to nationally top-performing hospitals for select surgeries." (Kaiser Health News)
CBO Cost Estimate for H.R. 5447, Small Business Health Care Relief Act of 2016
"H.R. 5447 would amend the Internal Revenue Code to define a qualified small employer health reimbursement arrangement (QSEHRA) as an arrangement where an employer pays directly for or reimburses medical expenses of an employee and his or her dependents.... The staff of the Joint Committee on Taxation (JCT) estimates that enacting H.R. 5447 would raise both revenues and outlays by $363 million over the 2016-2026 period. JCT therefore estimates that enacting the bill would have no effect on federal budget deficits over the 2016-2026 period." (Congressional Budget Office [CBO])
Your Doctor Will See You in This Telemedicine Kiosk
"In the past several years, a growing number of employers have provided insurance coverage for telemedicine services enabling employees to connect with a doctor by phone using both voice and video. One limitation of such phone-based services is physicians cannot always obtain basic vital signs such as blood pressure and heart rate. That's where telemedicine kiosks offer an advantage. Hundreds of employers -- often supported by their health insurers -- now have them installed in the workplace[.]" (Kaiser Health News)
California Department of Managed Health Care Approves Aetna's Acquisition of Humana (PDF)
"The Department's conditions on this merger will help control health care costs, increase access to care and improve quality of care. Aetna also has committed to help improve California's health care infrastructure, and invest in programs that will serve the vulnerable populations enrolled in these plans." (California Department of Managed Health Care)
[Opinion] House Shouldn't Repeal Limits on Tax-Advantaged Health Accounts
"The House is expected to consider legislation this week ... to repeal health reform's limit on ... [FSAs and HSAs] to buy over-the-counter medicines. The limit, in effect now for more than five years, is both sound tax and health policy and should be retained." (Center on Budget and Policy Priorities)
[Guidance Overview] From the EEOC, Another Notice Requirement for Wellness Programs
"[E]mployers that already provide a wellness notice (for example, under [HIPAA]) need not furnish a separate notice to satisfy the notice requirement under the ADA final regulations, provided that the other notice informs employees of the required information[.]" (Practical Law Company)
[Opinion] Employers Outsmart the Government with Health Plan Design
"[A]lthough employers have actually expanded coverage with a 0.5% increase in employees offered coverage, there has been a decrease of 1.5% in employees actually taking their employers' plans. Apparently, employers have found ways to improve their 'offering' numbers while actually reducing the take-up rates and their resulting net costs.... Minimum value plans, dependent buy-ups, managing hours, and banding contributions by class or income are just some of the strategies ... employed." (Frenkel Benefits)
Employers Cut Down on Wellness Benefits
"As employers begin to analyze return-on-investment and participation data, they 'may be taking a step back' ... Just 37% of the employers studied offered health coaching ... Last year, nearly half of them offered that benefit. Fewer employers are making seasonal flu vaccinations available at work, with 54% doing so, down from 61% last year." (The Wall Street Journal; subscription may be required)
2016 SHRM Employee Benefits Report (PDF)
88 pages. "From 2015 to 2016, three out of five organizations (60%) report that their benefits offerings have remained the same, one-third (33%) report an increase and 7% a decrease in benefits -- similar to changes from 2014 to 2015. Compared with five years ago, more organizations are offering monetary bonus benefits ... Looking back 20 years, telecommuting benefits have seen a threefold increase, from 20% of organizations offering the benefit in 1996 to 60% in 2016." (Society for Human Resource Management [SHRM])
Struggling for Profit Selling Health Insurance in State Marketplaces
"In an effort to attract customers, insurers put prices on their plans that have turned out to be too low to make a profit. The companies also assumed they could offer the same sort of plans as they do through employer-based coverage ... But the market has turned out to be smaller than they hoped ... Fewer employers have dropped health insurance than expected ... keeping many healthy adults out of the individual market. And among the remaining population, the insurers cannot pick and choose their customers." (The New York Times; subscription may be required)
[Guidance Overview] Wellness Plans: Final ADA and GINA Regulations (PDF)
12 pages. "It's important for an employer to be aware of the subtle differences among the categories of incentive limits and to ensure that, based on program design, the incentive does not exceed the limit. That said, these categories don't appear to address some common wellness program designs. For example, it's not clear if the EEOC contemplated multiple coverage options offerings where only employees enrolled in the health plan are eligible for the wellness program." (Xerox HR Services)
[Guidance Overview] Agencies Release Guidance on Application of ACA Rules to Expatriate Health Plans
"Substantially all of the benefits provided under an expatriate health plan must be benefits that are not excepted benefits. The proposed regulations consider group or individual supplemental health insurance benefits and travel insurance to be excepted benefits.... The proposed regulations add new requirements for hospital and other indemnity insurance to comply with in order to be considered an excepted benefit. For instance, enrollment materials provided to enrollees must indicate that the coverage is a supplement to major medical coverage and that a failure to have MEC may result in additional taxes." (The Wagner Law Group)
[Guidance Overview] The Emerging Contours of the Rules Governing Wellness Programs Under (Conflicting) Federal Tax, Benefits and Employment Laws (PDF)
18 pages. "This paper ... examines the regulation of wellness programs under HIPAA and the ACA, with respect to which final regulations are in place ... provide[s] background on the ADA and GINA, respectively, as they affect wellness program design and operation ... surveys EEOC enforcement actions prior to its recent proposed rules ... offers a look at two recent proposed EEOC rules relating to voluntary wellness programs under the ADA and spousal participation in wellness programs under GINA ... [discusses] emerging trends in third-party wellness programs and vendors, with a particular emphasis on service agreements ... [and] offers some predictions concerning the eventual content of the final EEOC rules on the subject." (Mintz Levin, via Tax Management Compensation Planning Journal)
Will the 'Gig' Workforce Drive New Normal for Benefits?
"Consider the next generation of workers -- digitally savvy kids who see the global grid as their toy. Pair that with two more trends -- an increasingly global labor pool and the aging baby boomer population interested in retirement on their own terms. What does this mean as we think about the future workforce and a possible 'new normal' for benefits?" (Mercer/Signal)
[Guidance Overview] Healthcare Subsidies for Grad Students: An ACA Conundrum
"Colleges and universities historically have provided graduate student employees (e.g., teaching assistants) with a stipend or reimbursement to help defray (or even fully cover) the cost of their medical coverage under the student health plan. Competing guidance ... from [HHS, DOL,] and the Treasury ... will soon make such arrangements quite problematic." (Jackson Lewis P.C.)
Hearing Aids and the Sound of Mobile Health Disruption
"There are several reasons why innovative businesses harnessing modern technologies have found health care a difficult nut to crack.... [W]hat is the impact of health care regulation? Beyond the traditional trope that regulation stifles innovation, how does health care regulation impact disruption? Recent developments in the markets for hearing aids suggest some answers[.]" (Health Affairs)
Transparency Tools Work -- But Require Appropriate Incentives
"According to [author Reed] Abelson, transparency tools are mostly ineffective at reducing health care spending because patients aren't using them.... How can employers encourage workers to use the tools? It requires the appropriate application of training -- and incentives." (National Center for Policy Analysis Health Policy Blog)
[Guidance Overview] EEOC Final Regs Under ADA and GINA Increase Compliance Burden for Wellness Programs
"[D]ifferences between [the HIPAA/ACA] rules and the ADA and GINA rules [include] ... [1] New limit for ACA participatory (and non-ACA) programs that include disability-related inquiries.... [2] ACA health contingent (non-tobacco) programs that include disability-related inquiries generally must use lowest cost employee only coverage (even if employee is enrolled in another option).... [3] Reduced limit for ACA health contingent tobacco programs that include disability-related inquiries.... [4] Reasonable accommodations.... [5] Reasonable design." (Troutman Sanders)
[Opinion] Proposed 'World's Greatest Health Care Plan' Would Provide Sound Incentives for Fundamental Healthcare Choices
"Of 12 bold ideas in the legislation, fully half have never appeared in any previous bill or in any previous proposal -- Republican or Democrat. [T]he bill corrects the major ways in which federal policies create perverse incentives and removes the federal government as a source of some of our most important health policy problems.... [T]he legislation makes good on what many regard as the three broken promises of the [ACA]: universal coverage, cost control, and real protection for people with pre-existing conditions.... [T]he bill paves the way for a medical marketplace in which empowered patients can make more of their own choices, while enjoying protection against the cost of catastrophic illness -- both the financial cost and the cost of rationing by waiting." (John Goodman, in Health Affairs Blog)
California Insurance Commissioner Urges Feds to Block $54 Billion Anthem-Cigna Deal
"The U.S. Department of Justice is investigating the merger, and federal officials could seek divestitures to reduce market power or try to block it entirely on antitrust grounds. Anthem said it has received approval from 12 states thus far, but other reviews are pending.... California's other insurance regulator, the Department of Managed Health Care, is still examining the merger as is Connecticut, which plays a critical role since Cigna is based there." (Kaiser Health News)
Sizing Up ACA Risk Adjustment Volatility: How the Interplay Between Risk Adjustment and Issuer Size Influences Profitability Under the ACA
"In this study, [the authors] set out to explain how risk adjustment might influence profitability patterns in a more typical year and whether those patterns change with the size of a health plan. What [they] discovered is a paradigm that does not seem to meaningfully reduce the volatility of financial outcomes and may not have the pinpoint accuracy needed to adequately compensate all plans for the risks they are prohibited from pricing into their premium rates. [They] also explore the consequences of some mainstream proposals to modify risk adjustment long term, recognizing some of these ideas may be directly in reaction to the early 2014 results." (Milliman)
[Guidance Overview] EEOC Releases Final Rules on Wellness Programs (PDF)
"[W]ellness programs that do not include disability-related inquiries or medical examinations are not subject to this final rule, although such programs must be available to all employees and must provide reasonable accommodations to employees with disabilities.... [T]he final regulations are not entirely clear on how the financial limits are to be determined where multiple plans are offered, all of which allow for wellness program participation, or where an employer sponsors multiple benefit packages within a given group health plan." (Groom Law Group)
[Guidance Overview] Proposed Rules for Expatriate Health Plans and Certain Excepted Benefits under ACA
"It is important to remember that expatriates may still be subject to the individual mandate (but these plans may qualify as minimum essential coverage), employers still need to comply with the employer penalty rules, and the health plan reporting obligations through Forms 1094/1095 continue to apply to those covered by these plans." (Kilpatrick Townsend)
New Datasets: Offer and Take-Up of Employer-Sponsored Health Insurance Coverage
"These research files on offer and take-up of employer-sponsored health insurance coverage are based on new questions asked as part of the 2014 and 2015 Current Population Survey Annual Social and Economic Supplement (CPS ASEC). The questions refer to current coverage at the time of interview, covering February through April of the survey year." (U.S. Census Bureau)
Medical Network and Payment Reform Strategies to Increase Health Care Value (PDF)
17 pages. "To date, employers have relied on relatively blunt instruments for managing health care costs -- selecting health plans based on network discounts and provider access, and increasing consumer cost-sharing to mitigate cost trends.... Many large employers recognize a need to change the current dynamic of volume-based incentives to value-based contracting strategies that better reward quality care and efficiency in resource management. But employers no longer believe that the key differentiation is among health insurance plans; it's about the differentiation of their provider networks and the underlying provider contracting arrangements." (American Health Policy Institute)
[Official Guidance] Text of EEOC FAQs on the Sample ADA Wellness Program Notice
"[1] If wellness program participants already get a notice under the Health Insurance Portability and Accountability Act (HIPAA), do they need to get a separate ADA notice? ... [2] Who must provide the notice? ... [3] Does the notice have to include the exact words in the EEOC sample notice? ... [4] When should employees get the notice? ... [5] Is an employee's signed authorization required? ... [6] In what format should the notice be provided? ... [7] What notice must employers provide for spouses participating in an employer's wellness program?" (U.S. Equal Employment Opportunity Commission [EEOC])
[Official Guidance] Text of EEOC Sample ADA Wellness Program Notice
"New rules published on May 17, 2016, under the Americans with Disabilities Act (ADA) require employers that offer wellness programs that collect employee health information to provide a notice to employees informing them what information will be collected, how it will be used, who will receive it, and what will be done to keep it confidential. The EEOC has published [this sample notice] to help employers comply with the ADA[.]" (U.S. Equal Employment Opportunity Commission [EEOC])
How Much Financial Protection Do Marketplace Plans Provide in States Not Expanding Medicaid?
"This brief analyzes a sample of silver plans offered in the largest markets in 18 states that use the federal website for marketplace enrollment and have not expanded Medicaid eligibility. It finds that marketplace enrollees at this income level in most plans analyzed are at risk of incurring premium and out-of-pocket costs that are higher than what they would pay under Medicaid. For people with significant health needs, costs are estimated to be much higher in marketplace plans than what they would be under Medicaid." (The Commonwealth Fund)
U.S. Department of Justice Sues North Carolina Hospital System for Insisting on Anti-Steering Provisions in Insurance Reimbursement Contracts
"[T]he complaint is attacking a type of widely used contracting provision in which acute care hospital systems seek to prohibit insurance company payors from using 'steering' restrictions, which would otherwise be used to steer their insured patients to lower cost health care providers, including lower-cost hospitals, in exchange for lower premiums in so-called 'narrow network' insurance plans. The complaint then alleges that CHS has an approximately 50% share of the market for acute inpatient hospital care in the Charlotte metropolitan area, allegedly conferring market power on CHS." (Sheppard Mullin)
Ways and Means Advances Bills to Improve Access to Health Care, Provide Targeted Relief from Obamacare
"The bills include: ... The Small Business Health Care Relief Act (H.R. 5447) ... which allows employers to provide innovative employer payment arrangements; ... The Health Care Security Act of 2016 (H.R. 5445) ... which makes several commonsense reforms to expand access to HSAs, including increasing the annual contribution limits, allowing for catch-up contributions to the same account, and allowing for more flexibility between incurring expenses and actually setting up an account.... The Tribal Employment and Jobs Protection Act (H.R. 3080) ... which eliminates Obamacare's employer mandate for tribally owned businesses; [and] The Student Worker Exemption Act of 2015 (H.R. 210) ... which provides universities relief from the employer mandate for hours worked by student workers." (Committee on Ways and Means, U.S. House of Representatives)
[Opinion] Small Business Health Care Bill Raises Questions
"A bipartisan bill that the House Ways and Means Committee will consider today would let small employers use a health reimbursement arrangement (HRA) ... to help their workers buy individual-market coverage, rather than offer health insurance directly.... Among the unanswered questions: How will small employers respond? ... What will happen to health insurance market risk pools? ... How will small business HRAs affect workers' coverage?" (Center on Budget and Policy Priorities)
[Guidance Overview] Hospital and Fixed Indemnity and Disease-Specific Policies in the Crosshairs: Tri-Agency Proposed Rule Portends Some Disruption
"The proposed regulations establish a rule under which coverage for only a specified disease or illness (for example, cancer-only policies) or hospital indemnity or other fixed indemnity insurance is excepted only if the coverage meets [certain] conditions ... [The agencies] request comments regarding whether to limit the number of diseases or illnesses that may be covered under a policy as well as whether issuers should be required to disclose that policies are not Minimum Essential Coverage." (Mintz Levin)
Private Exchange Implementation: Ten Best Practices
"Choose your advisory partner wisely.... Perform comprehensive due diligence.... Get the right players on the team -- HR, payroll, IT, HRIS, legal, security, etc.... Set expectations at the outset.... Start early -- when it comes to implementation, the early bird gets the worm.... Be aware of system constraints.... Demand performance guarantees.... Train the private exchange enrollment team on your culture.... Deploy a robust employee communications campaign.... Take a long-term view." (The Institute for HealthCare Consumerism [IHCC])
Out-of-Network Still in Business
"[A] ruling by Judge Hoyt of the U.S. District Court for the Southern District of Texas suggests that health plans should be careful in refusing payment based on perceived [out-of-network (OON)] high charges, questions about OON co-insurance collection, or provider financial arrangements.... Judge Hoyt determined that CIGNA did not live up to its ERISA obligations when CIGNA interpreted plan language to allow it to avoid payment when [Humble Surgical Hospital] waived or discounted co-insurance amounts -- an interpretation that Judge Hoyt did not think would have been apparent to a plan beneficiary." [Connecticut General Life Ins. Co. v. Humble Surgical Hospital, No. 4:13-cv-3291 (S.D. Tex. June 1, 2016)] (Husch Blackwell)
[Guidance Overview] IRS Clarifies That Cash-In-Lieu Is Not an Employer Payment Plan Subject to the ACA's Group Health Plan Mandates
"New IRS guidance addresses a situation where a governmental employer provides additional taxable compensation for employees with other health coverage who forego coverage under the group health plan provided by the government.... IRS [Chief Counsel] Letter 2016-0023 advises that this type of arrangement does not constitute an employer payment plan or a health reimbursement arrangement. Therefore, this design does not result in a plan that is subject to the group market reforms." (Liebert Cassidy Whitmore)
[Guidance Overview] EEOC Issues Final ADA Regulations on Wellness Plans
"The provisions of the regulations requiring a notice and establishing incentive limits apply prospectively to wellness programs on the first day of the first plan year beginning on or after January 1, 2017. The other provisions are regarded by the EEOC as clarifications of existing requirements that already apply to wellness programs. The final regulations breathe new life into cases challenging these regulations in several federal appeals courts, casting a shadow on the already difficult path to compliance." (Poyner Spruill LLP)
Insurance Financing Increased for Mental Health Conditions But Not for Substance Use Disorders, 1986-2014
"The share of total mental health treatment expenditures financed by private insurance, Medicare, and Medicaid increased from 44 percent in 1986 to 68 percent in 2014. In contrast, the share of spending for substance use disorder treatment financed by private insurance, Medicare, and Medicaid was 45 percent in 1986 and 46 percent in 2014." (Health Affairs)
[Opinion] High Cost Sharing for Low-Value Services May Increase Overall Health Care Spending
"[T]he authors of this study find that 'increased cost-sharing may lead to modest increases in overall healthcare spending,' even though it may reduce utilization of some, but not all, targeted services.... [Value-based insurance design (VBID)] may not be a very effective tool for reducing overall health care spending.... If penalties were to be assigned for using low-value care, wouldn't it be more appropriate to apply them to the health care provider who would profit by selling more health care services with very limited value?" (Physicians for a National Health Program [PNHP])
Big Players Dropping HSA Business Despite Growth Potential
"Total HSA assets reached $30.2 billion in 2015, about triple the amount in 2009 ... The potential for growth in HSA assets has prompted giants such as Fidelity Investments, Boston, and Bank of America Merrill Lynch, New York, to continue pursuing their HSA management strategies.... [F]or the dropouts ... HSAs no longer fit their long-term strategies.... Wells Fargo is selling its HSA business to Optum Bank Inc., part of [UnitedHealth Group]." (Pensions & Investments)
Insurers Are Selling More Individual Health Plans in ACA Marketplaces
"[In] 2016, 17% of individual health insurance plans are being sold exclusively outside the marketplaces, a 28% drop from 2014.... [B]ronze level plans, the least expensive plans that provide the lowest amount of coverage, are equally popular on and off the marketplaces. The gold and platinum plans, which are the most expensive and provide the most coverage, are much more prevalent off the marketplaces." (American Journal of Managed Care)
ACA Coverage Expansions and Low-Income Workers
"This brief ... examines the change in health coverage among low-income workers following implementation of the ACA ... Less than one third (31%) of low-income workers had employer-sponsored insurance through their own job in 2014 compared to half (58%) of higher income workers. Low-income workers were also half as likely to have employer-sponsored insurance coverage as a dependent compared to higher income workers (11% versus 21%)." (Henry J. Kaiser Family Foundation)
How Patient Groups Have Begun to Influence the Value and Coverage Debate
"One important health care stakeholder that has not yet 'gotten the memo' is the payer community, which is the critical gatekeeper of access to treatments for patients and is increasingly questioning the value of existing and new treatments. They may not yet have seen a compelling value proposition for how engaging with patients and patient groups could help them achieve their mission of providing access to valuable health care products and services while controlling costs for their clients[.]" (Health Affairs)
Wellness `Carrots' May Cause Indigestion if Taxable
"[W]ellness plan cash awards can't be excluded from income because they don't qualify as de minimis fringe benefits, the IRS said. De minimis fringe benefits are defined under Section 132(e) as any property or service that is 'so small' that accounting for it wouldn't be reasonable ... [IRS Chief Counsel Memo 201622031] notes that a tee-shirt would be considered a non-taxable de minimis fringe benefit, but employer-paid gym membership fees would not be considered a non-taxable de minimis fringe benefit." (Bloomberg BNA)
Remarks of CMS Acting Administrator Andy Slavitt at the Marketplace Innovation Conference
"[T]he Marketplace is succeeding by almost any benchmark, but it is still in its early trial and error stage. Progress won't be even and for the first five years, we will continue to be in a learning and experimentation period ... [T]he Marketplace ... is a highly strategic opportunity for those who see health care evolving into a more B2C market to create new competitive advantages.... [E]ven though we are in the learning and experimentation stage, we are confident we have the tools to make sure the market is stable and succeeds for the long term." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
[Guidance Overview] EEOC Issues Important New Standards for Wellness Programs
"The EEOC/ADA rule sets new requirements for wellness programs that ask employees to provide medical information (whether through health-risk assessment questionnaires or medical exams/tests). The EEOC/ADA rule applies to any such program whether it is offered as part of a group health plan or outside of the plan.... The EEOC/GINA rule permits employers and plan sponsors to offer limited incentives for an employee's spouse to provide medical information." (Segal Consulting)
DOJ Sues Carolinas HealthCare Over Steering Restrictions
"Federal and state officials in North Carolina on [June 8] filed a civil suit ... alleging that the state's largest healthcare system used its market power to dictate 'steering restrictions' in contracts with commercial health insurance companies that ultimately led to higher costs for consumers.... 'These provisions,' the complaint [states], 'have prevented insurers from, among other things, introducing health plans that encourage patients to use medical providers that offer lower-priced, higher-quality services.' " (HealthLeaders Media)
[Guidance Overview] Expatriate Health Plan Rules Address ACA Information Reporting, Code Section 162(m)(6), and More
"The proposed regulations address: [1] How information reporting rules under the [ACA] apply to expatriate health plans. [2] Standards for travel insurance and supplemental health insurance coverage to be considered excepted benefits ... [3] A notice requirement for hospital indemnity and other fixed indemnity insurance in the group health insurance market to be considered excepted benefits." (Practical Law Company)
[Guidance Overview] DOL Flags Plan Provisions That May Violate Mental Health Parity Requirements
"This guidance provides a useful checklist of provisions that may be problematic under the mental health parity rules ... [W]hile the provisions described do not automatically violate the nonquantitative treatment limitation requirements, the DOL reminds plans and insurers that they must be prepared to provide evidence to substantiate parity compliance." (Thomson Reuters / EBIA)

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