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Health plans - design


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Crossing State Lines Is No Easy Jaunt for Insurers and Local Regulators
"[T]he GOP is drawing some opposition from state insurance regulators -- many of them Republican -- and insurance-industry officials, who question how such a plan would work, given that many aspects of insurance are regulated differently by each state.... Some Democrats say there might be room to compromise on earlier GOP proposals that would allow for interstate sales, but they express concern about the erosion of state consumer protections." (The Wall Street Journal; subscription may be required)
[Guidance Overview] EEOC Clarifies Incentive Limits in Wellness Programs
"The ADA wellness rules apply only to wellness programs that require a medical examination and/or a response to a disability-related inquiry. If the same incentive can be earned with or without a medical examination and/or disability-related inquiry, then the ADA wellness rules do not apply to that wellness program. Employers may offer incentives only to employees who enrolled in the employer-sponsored group health plan and complete wellness activities. If the wellness incentive is the same for all the employer's health plans, the employer must use the lowest-cost option to calculate the applicable incentive limit[.]" (Willis Towers Watson)
Yesterday's Luxuries Are Today's Necessities
"As prevalence of autism has increased, varying advocacy groups have been quite effective in persuading some state insurance departments and many large employers to incorporate [Applied Behavioral Analysis (ABA)] services as a covered benefit. In fact, proponents of coverage have effectively utilized the Mental Health Parity Act as further leverage with self-funded employers to exclude any dollar or hourly caps on ABA services. We are seeing faster adoption rates with each successive year as 1/3 of large employers are now covering the benefit after only seeing the most socially-progressive employers doing so a couple of years ago." (Frenkel Benefits)
2016 Retirement Confidence Survey of the State and Local Government Workforce (PDF)
25 pages. "One-third of public sector employees have been with their current employer for less than 10 years, and one-third for 20 years or longer.... Health insurance, retirement benefits, job security and salary are the most important job elements they would consider in deciding whether to switch employers. The vast majority are covered by a primary defined benefit pension plan; almost 20 percent of these workers reported changes to these benefits over the past two years. Two-thirds expect to receive retiree healthcare benefits from an employer when they retire; among these, one-quarter reported changes to their benefits over the past two years." (TIAA Institute, and the Center for State and Local Government Excellence)
Insurers' Flawed Directories Leave Patients Scrambling for In-Network Doctors
"As consumers review their coverage and shop for 2017 insurance through the federal health law's online marketplaces during the annual open enrollment period, many of the directories they are using are outdated and inaccurate. Some doctors in the directories are not accepting new patients and some are not participating in the network ... Still other physicians in the directories, who are listed as 'in-plan,' charge patients thousands of dollars extra per year in 'concierge fees' to join their practices." (Kaiser Health News)
How Private Exchanges Are Coming of Age
"The average number of products employers have made available on private exchanges has been inching upward over the past three years -- from 12.9 in 2013 to 14.2 in 2015 ... Employees at both large and small organizations had a choice of an average of six medical plans. (Some businesses went even further, with 10 percent offering 12 or more medical plans.) Likewise, the number of dental (three) and vision (four) options were the same on average regardless of company size." (Society for Human Resource Management [SHRM])
[Guidance Overview] ACA Nondiscrimination Rules Will Take Effect January 1
"You are still subject to Section 1557 even if you are unaware that you are receiving federal financial assistance. This could include grants, loans, government contracts, and other similar types of assistance.... Furthermore, if Section 1557 applies to an employer, it also applies to all employer-sponsored employee health benefit programs, which include health coverage, wellness programs, health clinics, and long-term care coverage or insurance." (Fisher Phillips)
[Opinion] The Problem with One-Size-Fits-All Health Insurance
"[E]mployer-sponsored health insurance is more highly subsidized for the rich than the poor.... But both high-wage and low-wage workers at the same company are effectively forced into the same plans. To qualify for the tax exclusion, federal law requires that companies offer the same plans to all or most of their employees, with no consideration for the variable demand for health care. Employees then pay for their fringe benefits by taking home lower wages -- and a flat, across-the-board cut in wages burdens low-wage workers disproportionately." (The New York Times; subscription may be required)
Employers Shouldn't Wait to Find Answers to Challenges of Unwinding the ACA (PDF)
"Plan sponsors may want to look to high deductible health plans and health savings accounts, which President-elect Donald Trump and Republican lawmakers favor ... Employers that choose this route will have to boost their education efforts for employees regarding basic health literacy concepts, such as copayments, coinsurance and deductibles.... [P]lan participants also need to be aware of cost-comparison tools, such as those for prescription drugs[.]" (Winstead PC)
Mental Health Parity Update (PDF)
"The White House Mental Health and Substance Use Disorder Parity Task Force recently released its final report recommending that agencies' future budgets include funding to expand MHPAEA compliance audit capacity. It also identified a need for more guidance on what group health plans and issuers are required to disclose regarding their mental health and substance use disorder benefits." (Xerox HR Services)
[Official Guidance] Text of IRS Notice 2016-75: 2016 Guidance with Respect to the Tax Credit for Employee Health Insurance Expenses of Certain Small Employers in Wisconsin (PDF)
"This notice provides guidance on section 45R of the Internal Revenue Code for certain small employers that cannot offer a qualified health plan (QHP) through the Small Business Health Options Program (SHOP) Exchange because the employer's principal business address is in a county in Wisconsin in which a QHP through a SHOP Exchange will not be available for all or part of 2016 calendar year. Section IV of this notice includes a list of those counties. With respect to those employers in Wisconsin, this notice provides guidance on how to satisfy the requirements for the section 45R credit for coverage provided during the 2016 calendar year and the portion of a health plan year beginning in 2016, if any, that continues into 2017." (Internal Revenue Service [IRS])
Health & Welfare Plan Update, December 2016 (PDF)
22 pages. Includes: [1] Top 10 developments, and [2] 2016 Health & Welfare Plans compliance calendar and highlights. (Alston & Bird LLP)
[Opinion] Why Obamacare Repeal and Delay Won't Work
"[C]ongressional Republicans say they want to pass a repeal bill early this year but delay implementation for three years so they can come up with a replacement plan.... They seem to be ignoring the risks in the transition period, particularly because they need insurance companies to provide insurance during the transition.... Generally speaking, many of these leaders in the industry are optimistic over the five-year timeline. But the question is, over the next few years, how do you get there? I think you'll have a lot of plans decide not to participate or participate with extraordinary high rates." (Robert Laszewski and Sarah Kliff, via Vox)
How Do Health FSA Carryovers Affect HSA Eligibility?
"Carryovers in a general-purpose health FSA will make an employee ineligible to contribute to an HSA for the entire subsequent plan year, even after the carryover is exhausted and even if the employee does not make or receive new health FSA contributions for that plan year. HSA eligibility should not be adversely affected, however, if the plan permits carryovers but the participant actually has a $0 balance at year-end." (Thomson Reuters / EBIA)
Legislation to Improve Mental Health Care for Millions Sails Through House Vote
"The 21st Century Cures Act, which provides funding for biomedical research and aims to speed up drug development, was approved by a vote of 392-26. Republican leaders added a number of other health-related items to the act, including the text of a mental health bill that was approved by the House last summer but which never got a vote in the Senate." (Kaiser Health News)
Wellness Programs: Regulatory and Litigation Update (PDF)
"Rather than issuing additional formal guidance, the EEOC has opened the lines of communication with stakeholders through their website and responded more actively to questions about the nuances of their final ADA and GINA wellness program regulations -- particularly on how these rules apply when an employer offers multiple health coverage options or a multi-faceted program.... [R]ulings in two pending cases questioning the validity of wellness programs and a new lawsuit brought by the AARP demonstrate that case law in the wellness arena is still very much in flux and ultimately could impact wellness program design and strategy." (Xerox HR Services)
House Passes 21st Century Cures Act with HRA Provisions
"This bill contains a provision ... [which] would establish new small employer health reimbursement arrangements [HRAs] so that eligible small employers can offer [an HRA] funded solely by the employer that would reimburse employees for qualified medical expenses including health insurance premiums." (Employers Council on Flexible Compensation [ECFC])
The Enrollees Who Actually Didn't Even Need Obamacare
"[A]bout 70 percent of the decline in the number of uninsured people [can be attributed to] three factors: the subsidies for buying insurance; the law's more generous criteria for Medicaid eligibility; and the 'woodwork effect,' in which people who were previously eligible for Medicaid 'came out of the woodwork' and signed up for the program in 2014.... The largest effect was due to that woodwork effect -- about 44 percent of the effect they can explain, or roughly 30 percent of the overall reduction in the number of uninsured in 2014. Call it 3.3 million people, out of the 11.6 million who gained insurance that year." (Bloomberg)
How Health Plans Harness Artificial Intelligence
"When it comes to artificial intelligence (AI), health plans are poised to use science fiction-like technologies to improve consumers' experiences and streamline their businesses. Some health plans have already ventured into AI.... [H]ealth plan members may not even be aware when AI helps smooth interactions between themselves and their health plan ... What matters most is improved communication -- and better service." (America's Health Insurance Plans [AHIP])
2016 Medical Stop-Loss Premium Survey (PDF)
"This year's survey ... reflects the ongoing rise in stop-loss premiums and a continued commitment to employer-sponsored, self-funded health plans. The occurrence of truly catastrophic claimants -- in excess of $1 million -- is further verified with over 18% of respondents reporting such a claimant in the last two policy years. Stop loss remains the primary focus of risk management, with interest in private exchanges nearly disappearing at 1% amongst respondents. Captive arrangements show increased interest, but still slight at 14%." (Aegis Risk, for the International Society of Certified Employee Benefit Specialists [ISCEBS])
How Tom Price Could Transform Employer Health Coverage
"On many key points, Price's ACA alternative mirrors the provisions in House Speaker Paul Ryan's blueprint for health reform released in June, including an emphasis on expanding the use of HSAs, allowing employers to provide a defined contribution health care benefit and, controversially, capping the deduction for premiums in employer-sponsored group health plans." (Society for Human Resource Management [SHRM])
Need Pricey Drugs from an Obamacare Plan? You'll Shoulder More of the Cost
"Substantially more health plans on the federal insurance marketplaces require consumers next year to pay a hefty portion of the cost of the most expensive drugs, changes that analysts say are intended to deter persistently ill patients from choosing their policies." (Kaiser Health News)
[Guidance Overview] Appropriations and Fund Transfers in the Affordable Care Act (PDF)
"This report summarizes all the mandatory appropriations and Medicare trust fund transfers in the ACA and provides details, where publicly available, on the status of obligation of these funds. The information is presented in two tables. The report also includes a brief discussion of the impact that sequestration is having on ACA mandatory spending. This report is periodically revised and updated to reflect important legislative and other developments." [Report No. R41301, Nov. 23, 2016.] (Congressional Research Service [CRS])
Avoiding Discrimination: HSA Contributions for Former Employees
"While contributions to former employee HSAs may or may not happen frequently, employers should always remain diligent with regard to nondiscrimination requirements. Failure to follow certain comparability requirements could result in a 35% excise tax on all employer contributions not just on the discriminatory contributions." (Compliance Dashboard)
Employers Alter Benefits to Attract, Retain Employees
"Nearly one-fifth of HR professionals altered their benefits program to aid in the retention of employees over the past 12 months. Of these organizations, about three-fifths altered their health care benefits; more than one-third altered their flexible working, retirement savings and planning, leave, and professional and career development benefits as well. About three-fifths of respondents indicated that benefits for professional and career development, flexible work, health care, and retirement savings and planning will increase in importance to retain employees in the next three to five years." (Society for Human Resource Management [SHRM])
What You Need to Know About Rep. Tom Price, Trump's Pick for HHS Secretary
"Price was the first Republican to craft a replacement plan for Obamacare.... The proposal repeals the [ACA] and replaces it with what Price said are 'patient-centered solutions.' The plan also creates a system of tax credits based on a consumer's age. It further calls for the creation of high-risk pools at the state level and allows people to opt out of Medicare, Medicaid, Tricare, and benefits from the Department of Veterans Affairs." (The Daily Signal)
Wellness Program Choices Should Take Into Account the Generational Differences in Employee Stressors
"[1] 7.2% of Millennials have reported issues of depression, the highest among the three generational groups. [2] Generation X workers are focused on raising children and providing for their families ... [3] Baby Boomers experience more stress due to loss of friends and family ... [4] Overall, 92 percent of employees have either high levels of stress with extreme fatigue/feeling out of control (60 percent) or constant but manageable stress levels (32 percent)." (Wolters Kluwer Law & Business)
From Obamacare to Trumpcare: What to Expect from the Likely 'Replace' Alternatives (PDF)
28 presentation slides. "[1] Repeal and replace Obamacare with Health Savings Accounts (HSAs); [2] Work with Congress to create a patient-centered health care system that promotes choice, quality, and affordability; [3] Work with states to establish high-risk pools to ensure access to coverage for individuals who have not maintained continuous coverage; [4] Allow people to purchase insurance across state lines, in all 50 states, creating a dynamic market; [5] Maximize flexibility for states via block grants so that local leaders can design innovative Medicaid programs that will better serve their low-income citizens." (ABD Insurance & Financial Services)
Wisconsin Employment Relations Commission Clarifies Scope of Health Insurance Components
"On November 16, 2016, the [State of Wisconsin Employment Relations Commission] reaffirmed the Legislature's intention to broadly limit an employer's duty to bargain over proposals related to the provision of health insurance plans ... [The city of Monona] ... successfully argued that incentive payments to bargaining unit members who choose not to be covered by a health insurance plan operated by the City are prohibited subjects of bargaining under Wis. Stat. Section 111.70(4)(mc)6, as such incentive payments are 'costs and payments associated with health care coverage plans' and not 'employee premium contributions.' " (von Briesen & Roper, s.c.)
The Future of the ACA, Part 1: Assessing the New Normal
"Even before the new administration takes office, there is at least one thing that seems certain: there will be no going back to the status quo ante. While the law was the subject of withering criticism by candidate Trump and his proxies, their mantra was and remains 'repeal and replace.' At the end of the process, it is unlikely that we be back at March 23, 2010 (the date of the ACA's enactment). We will instead be somewhere else. What remains to be seen is the extent to which the replacement resembles the ACA." (Mintz Levin)
Efficient Compensation Design (PDF)
"The decline of the private pension system in the United States results from mismanagement of total compensation costs rather than from the benefit plans. Insufficient employer resources remain after Form W-2 direct compensation costs to fund pension and welfare benefits.... [H]ow to design an efficient compensation program [is] summarized [in this article]." (H.C. Foster & Company)
[Opinion] A Bipartisan Approach to Amending the ACA
"[F]our principles for redesign and meaningful improvement of the ACA that should be supported by members of both parties[:] First, we must acknowledge that a successful individual marketplace relies, first and foremost, on a viable public-private partnership.... Second, it must be acknowledged that the current system of enrollment is unsustainable.... Third, too many young and healthy people are not participating.... Fourth, it is essential that policymakers understand that it is not just the individual health insurance market that needs repair, it is our entire health care sector." (Former U.S. Sen. Tom Daschle, via Morning Consult)
Employers Create More Flexible, Less Traditional Workplaces
"[D]espite their focus on time off, many employees do not use all of the days available to them: 44% of participants report that their employees take less than 80% of their allotted PTO time. And for the growing number of employees who work remotely, time off may not truly be time away from work. Employers are rethinking time-off program design to take into account all of these dynamics and help employees to achieve a healthier work/life balance." (Mercer U.S. Health News)
[Opinion] The Post-Election State of Our Health
"Repealing Obamacare is not as simple, however, as getting rid of the marketplaces and rolling back Medicaid eligibility to 2010 levels. A lot of Obamacare's changes are now entwined in the fabric of the provision of health insurance and may be harder to repeal. Think about policies providing free preventive care including contraception, allowing children up to age 26 to remain on their parents' health insurance plans, prohibiting annual and lifetime limits, capping yearly out-of-pocket costs, and prohibiting the denial of insurance due to pre-existing conditions." (National Health Law Program [NHeLP])
Testimony Shows Anthem and Cigna at Odds Over Proposed Merger
"Anthem and Cigna have quarreled for months behind the scenes even as their push to combine has moved forward, with each company accusing the other of violating their $48 billion agreement.... The newly unsealed testimony showed that, among other things, Cigna officials have questioned Anthem's plans for their company postmerger, while Anthem executives have tried to move forward unilaterally after Cigna ceased cooperating with them on various deal-related issues." (The Wall Street Journal; subscription may be required)
Engaging Consumers in Changing Health Behaviors (PDF)
"In order to positively impact workforce health and reduce costs, employers must move their health programs beyond words to a state of consumer engagement and action. This article summarizes relevant concepts and findings from the fields of psychology, decision research, and social marketing and identifies best practices in developing consumer engagement. Employers can utilize this information when creating health care programs and tools to control costs and improve workforce health and productivity." (Buck Consultants at Xerox)
Most Federal Employees Could Save $2000 or More by Switching Health Insurance
"Carriers have widely different claim dispute rates. For example, Blue Cross, NALC and SAMBA plans have about three to eight disputed claims for every 10,000 enrollees, while many plans have dispute rates that are twice as high. Plan comparisons vary significantly depending on age, family size and retirement status." (Government Executive)
[Guidance Overview] Employers That Hire Holiday Help: Understand the ACA Rules Around Seasonal Workers
"If you have at least 50 full-time employees, including full-time equivalent employees, on average during the prior year, your organization is an ALE.... If your workforce exceeds 50 full-time employees for 120 days or fewer during a calendar year, and the employees in excess of 50 during that period were seasonal workers, your organization is not considered an ALE. For this purpose, a seasonal worker is an employee who performs labor or services on a seasonal basis." (Internal Revenue Service [IRS])
Hidden Benefits of Wellness Programs
"[O]ne of the key messages of the university's study is that HR professionals should expand their focus beyond healthcare costs to how wellness programs impact other critical factors such as quality of life or employee engagement and retention. By doing so, they can capture the full value of wellness initiatives and evolve wellness into well-being programs that help shape employee behavior across social, emotional, physical and financial dimensions." (Human Resource Executive Online)
Spotlight on Government Funding and Future of ACA (PDF)
"During 2017, the Republicans will keep the spotlight on writing a playbook to repeal and replace the ACA.... [A]ny replacement law would, in all likelihood, maintain some or all of the ACA insurance market reforms ... The timing and roadmap for any repeal and replacement of the ACA is not yet determined, and employers should not expect such actions to be simultaneous." (Xerox HR)
Replacing the ACA: A Reality Infusion
"In theory, congressional Republicans could quickly bring forward the same reconciliation bill that the president vetoed earlier this year. That bill repealed the premium tax credits, individual and employer mandates, Medicaid expansion, medical device tax, the so-called 'Cadillac tax' on high-cost plans, insurer tax, high-income tax and small-business tax credit. It also ... removed the insurance risk-adjusted programs. That Republican package passed Congress with the full knowledge that it would be vetoed by President Obama, so there was no need for its backers to contemplate the real-life implications for patients, the health system or the markets were it to become actual law." (Dentons)
Benefits Litigation Update, Fall 2016 (PDF)
Articles include: [1] The Goldilocks Paradox for defined contribution plans: how will plan sponsors determine whether investment alternatives offered are 'just right'? [2] ERISA class action certified challenging behavioral health TPA's administration of mental health benefits; [3] Defining the scope of ERISA preemption; [4] Plan fiduciaries continue to be scrutinized; [5] Employers offering their own proprietary funds under their 401(k) plans at heightened risk for litigation; and [6] EEOC loses another wellness plan voluntariness challenge but prevails on its ADA safe harbor argument. (Epstein Becker Green; The ERISA Industry Committee [ERIC])
Knowledge About Health Insurance and Finance Linked to Higher Rates of Health Coverage
"For a typical person who was uninsured in 2013, the chance of being insured in 2015 was 9.2 percentage points higher if they had high health insurance literacy as compared to someone with low health insurance literacy ... The effects of high health insurance and financial literacy were significantly linked to obtaining coverage even after researchers considered other factors, such as a person's income level, employment and political affiliation." (RAND Corporation)
Insurer Anthem to Defend Cigna Deal in Court
"The Justice Department has been aggressive in challenging mergers recently, but none of its efforts is bigger than its lawsuits challenging the Anthem-Cigna deal, the largest ever in the industry, and a $34 billion deal that would combine insurers Aetna Inc. and Humana Inc. A trial on the latter transaction begins Dec. 5.... Rulings in both cases could come before President-elect Donald Trump's inauguration ... Anthem, Aetna and Humana are all defending their deals, saying they will produce notable consumer benefits without hurting competition." (The Wall Street Journal; subscription may be required)
Millennials Come of Age (PDF)
"The first step in reimagining the 21st century workplace with millennials at the center may be to change how we position benefits from the start. Insurance -- whether health and dental or life and disability -- has long been considered a vital tool to protect America's workers and their families from negative events that impact all of us. This thinking needs to evolve. For millennials, being healthy doesn't just mean not feeling sick. It's a commitment to ongoing healthy eating habits and exercise and avoiding activities that can be viewed as damaging." (Colonial Life)
[Official Guidance] Text of CMS Risk Corridors Payment and Charge Amounts for the 2015 Benefit Year (PDF)
13 pages. "[CMS is] confirming that all 2015 benefit year risk corridors collections will be used to pay a portion of balances on 2014 benefit year risk corridors payments. [CMS is] also announcing issuer-level risk corridors payments and charges for the 2015 benefit year. The tables [in this document] show risk corridors payments and charges calculated for the 2015 benefit year, by State and issuer, and the additional amount based on anticipated 2015 risk corridors collections that HHS expects to pay towards the calculated 2014 benefit year payments." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
The Individual Mandate: It's What Keeps Everyone in the Risk Pool
"When guaranteed issue health insurance went into effect in Washington in the 1990s, there was no individual mandate to accompany it. The results were higher premiums, lack of choice and no progress in reducing the number of uninsured. It was the same story in Kentucky, where guaranteed issue and community rating reforms enacted in the 1990s came without an individual mandate.... A number of studies looked at the impact of getting rid of the mandate while keeping key [ACA] market reforms. All the studies found that this would result in a dramatic rise in the uninsured population and higher premiums compared to health reform with a mandate." (InsuranceNewsNet.com)
Opt-Out Rules Go Into Effect in 2017
"[Proposed IRS regulations], which are intended to be effective for plan years beginning on or after January 1, 2017, provide that unless an opt-out arrangement qualifies as an 'eligible opt-out arrangement,' then the amount of the opt-out payment will be added to the cost of the employee's coverage for ACA affordability purposes.... [To] qualify as an eligible opt-out arrangement, opt-out payments can only be made available to employees who: decline employer-sponsored coverage; and provide reasonable evidence that they and their expected tax dependents have or will have minimum essential coverage other than individual market coverage during the plan year or other period covered by the opt-out arrangement." (Corporate Synergies)
2016 Trends: How Employers Use Wellness Programs (PDF)
"Employers are eager to offer incentives as a way to both encourage wellness and also lower health care costs. However, employee privacy is on the line, and some argue, at risk. Even though many employers may never see the data collected, there is a philosophical debate brewing about what should -- or should not -- be permitted." (United Benefit Advisors)
Nearly Half of Employers View Employer Mandate as Top Health Care Concern Going Into 2017
"[O]ther top areas of concern for employers include: Prescription drug costs -- 17 percent; Excise Tax -- 15 percent; Tax exclusion limitations on employer sponsored health care -- 10 percent; Paid leave laws -- 8 percent; Employee wellness programs -- 2 percent." (Aon Hewitt)
[Official Guidance] Text of OPM Final Regs: Coverage for Certain Firefighters and Intermittent Emergency Response Personnel under the Federal Employees Health Benefits Program (PDF)
"This final rule provides eligibility for health insurance coverage under the Federal Employees Health Benefits (FEHB) Program to certain wildfire protection employees and certain intermittent emergency response personnel.... OPM recognizes that there may be other groups of employees not currently eligible for the FEHB Program because of the nature of their work schedules, but who are similarly situated to firefighting personnel in that they perform emergency response services. Accordingly, OPM has also added a new subsection (i) to its regulations that permits agencies to request that OPM extend FEHB coverage to such employees. OPM intends to construe this subsection narrowly, applying it only to employees engaged in emergency response services similar to the services being performed by those responding to the wildfires, and only when requested by their employing agencies." (U.S. Office of Personnel Management [OPM])
[Guidance Overview] How the Final Regs on Supplemental Insurance Plans and Dollar Limits Will Affect Employees (PDF)
"[A]ny benefit included in the supplemental policy that is either (a) covered under the primary group health plan, or (b) is considered an EHB in the state where the coverage is issued would not be considered a supplemental excepted benefit plan.... [L]arge group health plans, self-funded group health plans and grandfathered plans (collectively 'exempt plans') are not required to provide EHB benefits. However, these exempt plans may not impose annual and lifetime dollar limits on any EHBs that they cover." (Cherry Bekaert Benefits Consulting, LLC)
[Opinion] Making American Healthcare Great Again
"The [ACA] got a few things right. There should be no pre-existing condition exclusions and no lifetime maximums. There should also be essential benefits which every American should be guaranteed. This system should not be government run. The Veterans Affairs healthcare system and Medicare funding paralysis give us a very sharp focus on the future if government is in charge of healthcare." (Frenkel Benefits)
[Opinion] Bill Clinton Is Right: Obamacare is Crazy for Workers
"The more you work, the more you earn; and the more you earn, the higher net premium you pay. This is not a characteristic of the employer-based group market in which most of us participate.... The proportion of workers who work part-time because they choose to limit their hours, rather than because employers will not give them more work, has increased from 71 percent of the part-time workforce in December 2013 (the month before Obamacare launched) to 78 percent this September." (National Center for Policy Analysis Health Policy Blog)
[Guidance Overview] IRS Letter Explains How HSA Nondiscrimination Rules Apply to Former Employees
"After noting that the IRS could only provide a definitive answer through the private letter ruling process, the letter explains that employers' HSA contributions generally are subject to a nondiscrimination rule that requires those contributions to be made in comparable amounts to the HSAs of all comparable employees.... Retirees and other former employees are tested separately under the comparability rules, so employers can give those individuals different HSA contributions than active employees when the comparability rules apply." (Thomson Reuters / EBIA)
HSA Enrollment May Surge During Trump Administration
"Since 2013, HSAs have seen a 53.7 increase in enrollments.... [If President-elect Trump] is able to successfully work with Congress to get his plan approved, the market would presumably see an even greater surge in HSA enrollment as they become more accessible. For third party administrators who offer HSA administration services, this could mean a potential bonanza in revenue." (DataPath)
Fewer Americans Say Cost Is a Barrier to Getting Care, But U.S. Still Has a Long Way to Go
"In 2016, 33 percent of U.S. adults said they did not fill a prescription, see a doctor when sick, or get recommended care because of the cost, down from 37 percent in 2013 ... Adults with incomes of less than $25,000 per year saw a particularly large decline of 8 percentage points." (The Commonwealth Fund)
U.S. Adults Still Struggle with Access to and Affordability of Health Care
"Using data from a 2016 survey conducted in eleven countries ... [the authors] found that US adults reported poor health and well-being and were the most likely to experience material hardship. The United States trailed other countries in making health care affordable and ranked poorly on providing timely access to medical care (except specialist care)". (Health Affairs)
[Guidance Overview] New Nondiscrimination Requirements Under ACA Section 1557: Do You Have to Comply?
"A covered entity is an entity that is a 'health program or activity' and that receives federal financial assistance from HHS. Examples of health programs or activities include group health plans, hospitals, health clinics, health insurance issuers, and physicians' practices.... An employer can be impacted by the regulations, even if the employer itself is not a covered entity. For example, if the employer sponsors a self-insured group health plan that accepts federal funds, such as Medicare Part D subsidies for retiree medical coverage, the plan will be subject to these new requirements." (K&L Gates LLP)
The Health Care Challenges Trump's White House Will Face
"The uninsured rate is down ... ACA exchange premiums are up ... Out-of-pocket costs continue to climb ... Drug price hikes make the headlines.... [O]verall drug spending continues to rise ... Medicare spending continues to rise (although the spending growth rate has slowed) ... Medicaid spending is also up ... MACRA sets the stage for the future of value-based payment in Medicare." (The Advisory Board Company)

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