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Health plans - design


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Proposed Bankruptcy Fairness and Employee Benefits Protection Act of 2014 Would Place Significant Restrictions on Employers in Bankruptcy
"Various changes to the Bankruptcy Code would place greater restrictions on corporations going through a bankruptcy by limiting reductions in the compensation and benefits of employees and retirees, requiring funding of retiree health benefits in excess of that approved by the bankruptcy court, increasing the amount of unpaid wages that receive priority treatment, limiting payments and bonuses to insiders, and forcing employers to continue funding pension plans after filing for bankruptcy protection." (Thompson Coburn)
71% of Obamacare Signups Traced to Expansion of Medicaid
"In the states that adopted and implemented Medicaid expansion under Obamacare, enrollment skyrocketed as an additional 5.7 million Americans signed up for coverage. In 21 states opting out of Medicaid expansion, however, enrollment was strikingly lower.... 355,674 Americans signed up for Medicaid in those states. In all, Medicaid enrollment increased by 6 million individuals for the first half of 2014." (Melissa Quinn, in The Daily Signal)
How the Supreme Court Could Still Wreak Havoc on Obamacare
"If you have Obamacare without the subsidies, it would essentially wreak major havoc on the individual insurance market ... Premiums would be 43.3 percent higher on average in the individual market in 2015, while enrollment -- on and off the exchanges -- would drop by 68 percent ... In all, 11.3 million fewer Americans would have health insurance[.]" (The Washington Post; subscription may be required)
[Official Guidance] Text of CMS Proposed Federal Funding Methodology for Basic Health Program, for Program Year 2016
"This document provides the methodology and data sources necessary to determine federal payment amounts made in program year 2016 to states that elect to establish a Basic Health Program [BHP] under the [ACA] to offer health benefits coverage to low-income individuals otherwise eligible to purchase coverage through Affordable Insurance Exchanges.... We propose that the total federal BHP payment amount would be based on multiple 'rate cells' in each state. Each 'rate cell' would represent a unique combination of age range, geographic area, coverage category ... household size, and income range as a percentage of [federal poverty level].... [We] would develop BHP payment rates that would be consistent with those states' rules on age rating. Thus, in the case of a state that does not use age as a rating factor on the Exchange, the BHP payment rates would not vary by age." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services)
[Guidance Overview] New York State Department of Health Releases Long-Awaited Proposed Regs Authorizing Formation of ACOs (PDF)
"The Commissioner of the New York State Department of Health will issue Certificates of Authority (COA) to entities that satisfy the regulatory criteria for ACOs. Among the ACO criteria are the existence of stated mechanisms for governance, accountability, and the distribution of funds. An ACO must have a plan for coordination of care to assure that all medically necessary health care services are available to and used by the patient, including evidence-based treatment initiatives and strategies for patient engagement. The regulations specify standards for the ACO's quality management improvement program, including a process for peer review." (Epstein Becker Green)
House Approves Health Care Bills Before November Elections
"During a brief September legislative session, the House of Representatives approved a bill defining a full-time employee under the Patient Protection and Affordable Care Act (PPACA) using a 40-hour-per-week standard. Another House bill would allow insurers to sell certain health plans that fail to meet PPACA requirements. Although Senate action is not expected, these provisions could reappear on the legislative agenda in 2015." (Towers Watson)
[Guidance Overview] Overview of 2015 QRS Requirements for QHP Issuers (PDF)
"QHP issuers offering family and/or adult-only health insurance coverage of any category through the Marketplaces ... must comply with QRS requirements, if they offered coverage during the previous benefit year and meet minimum enrollment criteria.... QHP issuers are required to collect and submit third-party validated QRS measure data that will be used by CMS to calculate QHP scores and ratings." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
Are Your Benefit Plans Ready for Ebola?
"Will Ebola treatment costs be covered by commercial carriers? Maybe.... [M]ost plans include an exclusion of coverage for employees who are traveling abroad on short-term assignment.... Critical illness policies need to have an infectious disease rider included (not standard), and currently, no policies specifically cover Ebola." (William Gallagher Associates)
Australia Will Raise $5 Billion by Privatizing Its Biggest Health Insurer
"[T]he sale would remove the current conflict where the government is both the regulator of the private health insurance market and owner of the largest market participant. Medibank provides cover to 3.8 million people.... Australia has been shrinking the role of government in health care. Although a national single-payer scheme was established in 1975, the federal government re-introduced private choice within a few years." (National Center for Policy Analysis Health Policy Blog)
Essential Health Benefits: 50-State Variations on a Theme
"The interim policy that defined EHBs by benchmark plans resulted in benefit packages that varied considerably across states. On one hand, chiropractic care was most frequently included (45 states). On the other hand, acupuncture was rarely included (5 states).... 19 states included infertility treatments, 26 states covered autism spectrum disorder, and 31 states covered treatments for TMJ.... For obesity, 23 states included bariatric surgery, but only 12 of them cover nutrition counseling and just three of them cover weight loss programs." (Robert Wood Johnson Foundation)
Advisory Council on Employee Welfare and Pension Benefit Plans to Meet November 3-4
"The purpose of the open meeting on November 3 and the morning of November 4 is for the Advisory Council members to finalize the recommendations they will present to the Secretary. At the November 4 afternoon session, the Council members will receive an update from the Assistant Secretary of Labor for [EBSA] and present their recommendations. The Council recommendations will be on the following issues: [1] PBM Compensation and Fee Disclosure, [2] Outsourcing Employee Benefit Plan Services, and [3] Issues and Considerations around Facilitating Lifetime Plan Participation. Descriptions of these topics are available on the Advisory Council page of the EBSA Web site[.]" (Employee Benefits Security Administration [EBSA], U.S. Department of Labor)
[Guidance Overview] Latest ACA FAQ Provides Additional Guidance on Applying Cost-Sharing Limit to Reference-Based Pricing
"The new standards preserve the flexibility to exclude certain amounts from the out-of-pocket maximum. But plan sponsors and insurers anticipating improved cost-effectiveness from a reference-based pricing design should not overlook the additional complexity these standards are likely to create for themselves or their service providers (e.g., implementing a formal exceptions process and tracking the availability of providers willing to accept the reference price for each procedure)." [FAQs About Affordable Care Act Implementation (Part XXI)] (Thomson Reuters / EBIA)
Wellness Programs Violate ADA, Claims EEOC in Lawsuits
"In the complaints, the EEOC emphasized that the wellness program requirements were not 'job related and consistent with business necessity.' This is the standard for many complaints under the ADA. However, if this becomes the standard for wellness programs, what wellness programs could possibly pass this test?" (Winston & Strawn LLP)
To Cut Healthcare Costs, Companies Emphasize Employee Wellness
"When companies can demonstrate that their wellness plan has encouraged a significant percent of employees to receive annual physicals, address potential health concerns and embrace healthier lifestyles, they often will experience lower increases in their health insurance costs, he says. Companies will have more leverage negotiating their health insurance costs when they have about 70 percent participation[.]" (Columbus CEO)
HSAs and the Coming 'Cadillac' Tax (PDF)
"Employers are waiting for clarification of whether certain items are included when determining the cost of benefits, such as the employee contributions to HSAs.... While your organization has likely already felt the pressure to slow the rate of your health care costs, this upcoming tax forces a necessary review of your strategy for the next five years. Now is the time to evaluate tactics that will provide better results over the long haul, and to consider a multi-year approach aimed at positioning your program best in the new environment." (Fidelity Investments)
Will Employers Favor Private Exchanges Over Healthcare Coverage Sponsorship?
"It remains to be seen whether private exchanges can outperform conventional self-funding arrangements over time. New data from private exchanges ... claim 5-plus percent health plan cost savings, but we don't know whether those numbers will be seen across the sector, or whether they'll be sustainable." (Health Affairs)
[Guidance Overview] New DOL Guidance Places Conditions on Employers Using Reference Pricing and Narrow Networks
"[E]mployer plans should: [1] Have procedures to ensure there are an adequate number of providers that accept the reference price ... [2] Have procedures to ensure that an adequate number of providers accepting the reference price meet reasonable quality standards; [3] Have an easily accessible exceptions process, allowing services rendered by providers that do not accept the reference price to be treated as in-network; and [4] Disclose through the plan's Summary Plan Description, or similar document, information on the pricing structure, the list of services the pricing structure applies to, and the exceptions process." (HR Policy Association)
Trends in Employment-Based Health Insurance Coverage
"Employee access to employer-provided health insurance declined from 1991 to 2000, chiefly because of relatively low rates of access among part-time workers.... From 1991 until 2012, the access rate for all workers declined from 77.3 percent to 70.2 percent. There was little change among full-time workers, whose access rates fell from 87.8 percent to 86.4 percent (although they were higher at some points during the period examined). The drop among part-time workers, however, was much steeper -- from 28.8 percent to 23.7 percent." (U.S. Bureau of Labor Statistics [BLS])
To 'SHOP' or Not: Finding the Right Exchange Path for Your Small Business
"Most smaller companies (approximately 64.8 percent) do not offer health insurance to employees, and although SHOP offers tax credits, they're only available to businesses with a high percentage of low-income workers who would likely be eligible for Medicaid or significant subsidies on the individual exchanges. In these cases, a business may be doing its employees a disservice by offering health insurance, because providing employer-sponsored insurance prevents employees from receiving subsidies on the individual exchange." (Society for Human Resource Management [SHRM])
Now That Almost Every Large Employer Has One, EEOC Targets Wellness Programs (PDF)
"According to the EEOC, wellness programs are becoming more popular, and 94 percent of employers with more than 200 workers offer one, as well as a majority of all employers.... [A]fter the initiation of the Orion suit, the EEOC reiterated that voluntary wellness programs are completely legal and encouraged, 'but they have to be actually voluntary.... Having to choose between responding to medical exams and inquiries -- which are not job-related -- in a wellness program, on the one hand, or being fired, on the other hand, is no choice at all.'" (Winston & Strawn)
Public and Union Employers Attack Upcoming 'Cadillac Plan' Excise Tax
"The truth for most employers is that the Affordable Care Act's feared excise tax is coming in 2018. In the public sector, major employers such as the City of Boston are utilizing vendor and plan management strategies, with the help of union negotiations, to control their health plan costs.... 'If you're trying to change the employer/employee contribution mix, that is not going to affect your excise tax liability,' [Kathryn L. Bakich, Segal's national health compliance practice leader] said ... That's 'because you're looking at the value of the plan -- not who pays the premiums.'" (Employee Benefit News)
Health Savings Accounts Under the ACA: Challenges and Opportunities for Consumer-Directed Health Plans
"Recent evidence suggests that high-deductible health plans in the employer market have played a significant role in moderating premium-cost increases over the last several years -- 'bending the curve' for employer health care spending. If HSA-eligible plans are structured correctly in ACA exchanges, such plans could play a similar role in the non-group market (as the number of enrollees with individual coverage grows quickly over the next few years)." (Manhattan Institute for Policy Research)
CMS Offers Some ACOs $114 Million for 'Upfront' Costs
"Administered through the CMS Innovation Center, loan eligibility targets ACOs that joined the Shared Savings Program in 2012, 2013, or 2014, and new ACOs joining the Shared Savings Program in 2016." (HealthLeaders Media)
California Health Plans on Notice: Drug Lists Will Be Standardized
"[A] new law in California ... will eventually require all plans in California to use a standard formulary.... The new law ... requires the two insurance state regulators ... to devise a standard formulary by Jan. 1, 2017. Within six months after the template is developed, all insurance plans in California, not just those on the exchange, will have to conform to that template and post regular formulary updates." (HealthLeaders InterStudy)
Administration Signals Doubts About Calculator That Allows Health Plans Without Hospital Benefits
"Treasury Department officials are preparing to reverse course on an official calculator that permits plans without hospital coverage to pass the health law's strictest standard for large employers ... HHS designed the calculator, but Treasury is charged with enforcing the minimum-value standard.... Preliminary results from a member survey by the American Staffing Association show that 46 percent of the temp and recruiting firms that responded are considering such coverage for next year[.]" (Kaiser Health News)
Majority of Companies Taking Immediate Steps to Minimize Exposure to Excise Tax on 'Cadillac' Health Plans
"Aon Hewitt's soon-to-be-released survey of 317 U.S. employers found that 40 percent expect the excise tax to affect at least one of their current health plans in 2018 and 14 percent expect it to immediately impact the majority of their current health benefit plans. Surprisingly, a quarter of employers said they still have not yet determined the impact of the tax on their health plans, and more than one-third reported that their executive leadership and finance teams have limited or no knowledge of the implications of the tax for their organizations. Of those employers that have determined the impact, 62 percent say they are making significant changes to their health plans for 2015[.]" (Aon Hewitt)
Supported State-Based Marketplace Model May Gain Traction
"The [supported state-based marketplace (SSBM)] is similar to the partnership model but allows for more state autonomy.... [A] primary point of difference between these two models is possession of final decision-making authority.... SSBM states will not be required to pay the 3.5 percent user fee for using Healthcare.gov in 2015.... SSBM states are provided full autonomy in setting the marketplace user fees and establishing a plan for sustainability, while partnership marketplaces are required to use the 3.5 percent premium assessment that is required by the FFM." (HighRoads)
Private Health Exchanges: Masquerading Cost Shifting as Savings?
"As the plan fiduciary, you have a considerable responsibility to run the plan in the interest of its participants. While it may seem daunting to uncover the details of the various exchange offerings, understanding the intricacies of the chosen plan model can arm you with the knowledge you need to make the best decision for your company and its employees.... [F]our financial areas to investigate: [1] Included services.... [2] Self-funding vs. fully insured.... [3] Defined contribution buy-down.... [4] Benefit limitations." (WorldatWork)
[Guidance Overview] Does the Section 4980H(a) Penalty Really Cap the Section 4980H(b) Penalty?
"[J]ust the minimum value requirement can trigger the discrepancy and not the affordability requirement. There is a potential planning opportunity as a result. In certain instances a minimum value plan offered at full-cost to the employee (i.e. the employee pays all of the premiums) could completely alleviate the costs of employees in a limited non-assessment period.... [O]ffering skinny plans alone is almost never a good option for an employer.... [T]his is magnified as a result of the limited non-assessment periods." (Health Care Attorneys P.C.)
D.C. Circuit Court Orders Government to Respond in Challenge to ACA Under U.S. Constitution's Origination Clause
"In a new and surprising development, the U.S. Court of Appeals for the D.C. Circuit has ordered that the Federal Government respond to their challengers' petition for an en banc hearing. This case, Sissel v. [HHS], centers on the Origination Clause and alleges that the Affordable Care Act was passed in an unconstitutional way.... Although Matt Sissel did not initially succeed at the D.C. Circuit, he has filed now for an en banc hearing ... The Court has now ordered the Federal Government to respond, indicating that judges are taking this request for a rehearing seriously." (Independent Women's Forum)
DOL Taking Hard Look at ERISA Health Plans
"The department has asked for additional funding and training programs and plans to hire additional staff. Can your plan documents pass a DOL inspection? ... DOL health plan audits will focus on: ACA compliance.... Claims denials.... Lack of fee transparency/disclosure." (International Foundation of Employee Benefit Plans [IFEBP])
[Opinion] Egg Freezing: A Unique New Benefit, or a Bad Idea?
"Earlier this year, Facebook began covering up to $20,000 for female employees to freeze and store their reproductive eggs, so they can put off pregnancy as they establish themselves during their prime career-building years. Apple has announced it will start doing the same in January 2015. Cryopreservation and egg storage could be seen as the latest advance from the tech firms that continue to blaze the trail for employee benefits that help attract and retain the best and brightest." (The Leader Board, by Human Resource Executive)
[Official Guidance] Text of CMS Accountable Care Organization Investment Model Fact Sheet
"This fact sheet provides a general description of a new ACO model being offered to support the Medicare Shared Savings Program ACOs, the ACO Investment Model.... The ACO Investment Model is a new model of pre-paid shared savings that builds on the experience with the Advance Payment Model to encourage new ACOs to form in rural and underserved areas and current Medicare Shared Savings Program ACOs to transition to arrangements with greater financial risk." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
ACA Resources for Frequently Asked Questions, Updated October 10, 2014 (PDF)
"The report provides basic consumer sources, including a glossary of health coverage terms. The next sections focus on health coverage: the individual mandate, private health insurance, and exchanges, as well as public health care programs ... It then lists sources on employer-sponsored coverage, including sources on employer penalties, small businesses, federal workers' health plans, and union health plans. It also provides sources on ACA's provisions on mental health, public health, workforce, quality, and taxes. Finally, the report lists sources on ACA costs and appropriations, legal issues, the treatment of non-citizens under ACA, and sources for obtaining the law's full text." (Congressional Research Service [CRS])
[Guidance Overview] New Regulations Issued for Dental, Vision, Long-Term Care and EAPs as Excepted Benefits under Healthcare Reform
"Many employers complained that the 2004 Regulations required them to charge a nominal fee solely to qualify for the excepted benefits status. The work required to collect the additional, nominal contribution often cost more than the contribution brought in as revenue. Employers also complained that these requirements created an unnecessary inconsistency between insured and self-insured plans. In response to these complaints, the 2014 Regulations issued by the Agencies instead provide that benefits are not an integral part of a group health plan (whether the benefits are provided through the same plan, through a separate plan or as the only plan offered to participants) if: Participants may decline coverage, whether or not there is a participant contribution required for the coverage; or Claims for the benefits are administered under a contract separate from claims administration for any other benefits under the plan." (McGuireWoods LLP)
[Guidance Overview] Updated Timeline of Highlights for Employer Group Health Plan Compliance with the ACA
"As the employer shared responsibility penalties become a reality for employers with plan years beginning on and after January 1, 2015, [the authors] have updated [their] timeline for employer group health plans to assist employers in staying current with the ACA's requirements and deadlines." (Epstein Becker Green)
Rethinking ACA Compliance Strategies Involving Reference Pricing Models and 'MVP' Arrangements
"[C]ertain applicable large employers -- principally those in industries in which coverage was not previously offered across-the-board to most, if not all, full-time employees -- have sought less expensive ways to offer coverage that is both 'affordable' and provides 'minimum value.' ... [S]ome of the emerging compliance strategies [include] the reference pricing models and 'MVP arrangements' ... Two recent developments, one in the form of a set of FAQs issued by [HHS, DOL and IRS], and the other a mere (though troubling) rumor, may cause employers to reconsider both these approaches." (Mintz Levin)
ACA Subsidy Challengers See Dire Problems Soon
"The problem of fixing the federal health care program will only grow worse if the Supreme Court does not promptly resolve the legality of subsidies to help lower-income individuals pay for insurance, the challengers to the subsidy scheme told the Justices on Tuesday. This was the formal reply to the Obama administration's argument early this month that the Court should wait to see how a federal appeals court deals with the subsidies' legality.... The filing of this brief completes the written preparation of the case for the Justices, so it can soon be sent to the Justices to set up a vote on whether to grant or deny review, or to hold the case." [King v. Burwell, No. 14-1158 (4th Cir. July 22, 2014; cert. pet. filed July 31, 2014)] (SCOTUSblog)
EEOC Files Two Lawsuits Challenging Employer Wellness Programs
"Until the EEOC provides further guidance on this issue, employers should ensure that their wellness programs are truly voluntary. Moreover, employers should make sure to avoid either significant penalties for employees who choose not to participate and/or significant rewards for employees who do participate in these programs. Finally, any medical information that employers obtain through a wellness program should be kept confidential and should not be used as a basis for making employment decisions involving the employee." (Bond Schoeneck & King)
Benefits Buyers Study 2015 Outlook: New Perspectives on Balancing Employer Costs and Employee Protection (PDF)
24 pages. "How health care reform and the economy are impacting benefits strategies; What your evolving workforce wants; Which buying trends you should watch." (Unum)
2014 Guardian Workplace Benefits Study (PDF)
"This year's study examines five key issues from both the employer and employee perspectives: [1] The early impact of the ACA on the employee benefits model; [2] An increased receptivity to outsourcing administration and enrollment functions; [3] The surprising benefits of a healthier workforce; [4] The importance of workplace benefits to the middle class; [5] How Do-It-Yourselfers, many of whom are Millennials, engage with their benefits." (Guardian)
Half of Employers Expect to Trigger Cadillac Tax on Healthcare Benefits in 2018
"73 percent of companies are very or somewhat concerned that they will trigger the tax, and 62 percent say it will have a moderate or greater impact on their health care strategy in 2015 and 2016.... The excise tax is based on both employer and employee premium contributions, not just what the employer pays for coverage. The definition of what is included for calculating the tax extends to tax-advantaged health care accounts such as health flexible spending accounts, health reimbursement accounts and pretax contributions to a health savings account." (Wolters Kluwer Law & Business)
Privately Insured in America: Opinions on Health Care Costs and Coverage (PDF)
"[A]bout 1 in 8 privately insured Americans -- or more than 16 million people -- face major financial hardships like going without food or using up all of their savings as a result of medical bills.... [In] 2007, 17 percent of the privately insured under age 65 were enrolled in a HDHP, and that proportion more than doubled by 2014. This new survey finds that the growing population covered by HDHPs is less likely than other privately insured adults to go to the doctor when sick or get recommended medical treatment, and is more likely to need to use their savings for medical care." (The Associated Press-NORC Center for Public Affairs)
From Competitors to Co-Adventurers, Seven Hospital Systems Join with Anthem Blue Cross to Shake Things Up in Southern California
"Anthem Blue Cross and seven competing hospital systems in Southern California are joining forces to establish a new health plan offering, Vivity. Operating with a combined 14 hospitals and approximately 6,000 physicians, the venture has already announced its first major customer: the State of California's pension fund manager, [CalPERS]. One of the more interesting features of the integrated delivery network is that it consists of seven separate health systems, each with its own physician strategies in place." (Sheppard Mullin)
The Benefits of Health Advocacy in Private Exchanges
"In order to ensure private exchanges are successful, it's critical that participating employees understand this new system and have access to resources to help them navigate the exchanges as well as their new coverage.... Without access to resources to help them fully understand their health care coverage, employees may not effectively utilize the benefits available to them, which can result in poor outcomes and later, higher healthcare costs for both employees and employers.... Health advocacy can serve as a safety net for employees, offering them somewhere to turn to make the private exchange experience easier and ensure the goals of the new program are met." (The Private Exchange Blog)
Supreme Court Declines to Hear Same-Sex Marriage Cases: How Does This Affect Employee Benefit Plan Administration?
"What should employers do now? [1] Account for those same-sex couples who may have been married in a state that permitted same-sex marriage ... [2] Determine if modification of benefit plan materials may be necessary; [3] Determine the appropriateness of a special enrollment opportunity to couples married in other jurisdictions prior to the Supreme Court's ruling who would not otherwise be eligible for a HIPAA special enrollment opportunity based upon the date of the wedding; and [4] Determine if modification of FMLA policy/forms is warranted based upon the changes." (Michael Best & Friedrich LLP)
[Opinion] Thanks to Obamacare, Health Costs Soared This Year
"The law reduced competition in most health-insurance markets. A limited analysis by the Kaiser Family Foundation found that in 2014, large states like California and New York were more competitive, but Connecticut and Washington were less competitive. The Heritage Foundation conducted a national analysis and found that between 2013 and 2014, the number of insurers offering coverage on the individual markets in all fifty states declined nationwide by 29 percent." (Robert Moffit, in The Daily Signal)
[Guidance Overview] Implementing Health Reform: Reference Pricing and Network Adequacy
"On October 10, 2014, the Departments of Labor, Treasury, and Health and Human Services issued a frequently asked question (FAQ) regarding the use of reference-based pricing in non-grandfathered large group employer plans. Although the issue the FAQ addresses specifically is the use of reference pricing, the FAQ is remarkable insofar as it is the first departmental guidance that [the author is] aware of that addresses the use of networks by self-insured ERISA plans." (Timothy Jost, in Health Affairs)
[Guidance Overview] CMS Cost Sharing Reduction Reconciliation Reporting for Qualified Health Plans
"To implement the cost sharing reductions required by the Affordable Care Act, [qualified health plans (QHPs)] must develop and offer three silver plan variations in addition to their standard silver plan offering.... Until 2016, QHPs may choose one of two methodologies -- standard or simplified -- to calculate cost sharing reductions paid and to report this information to CMS in order to reconcile the cost sharing payments made by the QHPs with the amounts advanced by CMS. After 2016, QHPs may only use the standard methodology to calculate cost sharing reductions." (Epstein Becker Green)
Companies Are Cautious on Private Health Exchanges
"While a number of companies signed up for private exchanges last fall, [one] survey of 136 large U.S. employers showed just 3% plan to use private exchanges for active employees next year, although 35% said they were considering doing so in 2016 or later.... Another survey of both large and midsize companies ... found that 4% of the large employers and 6% of midsize companies plan to move to private exchanges in 2015." (CFO)
[Official Guidance] Text of FAQ on Affordable Care Act Implementation, Part XXI: Reference Pricing and Maximum Out-of-Pocket Limitations (PDF)
"Based on comments received, set forth [in this document] is an additional FAQ regarding the [maximum out-of-pocket (MOOP)] requirements. This FAQ addresses only group health plans' and group health insurance issuers' obligations under section 2707(b) of the PHS Act. For non-grandfathered health plans in the individual and small group markets that must provide coverage of the essential health benefit package under section 1302(a) of the Affordable Care Act, additional requirements apply.... Pending issuance of future guidance, for purposes of enforcing the requirements in PHS Act section 2707(b), the Departments will consider all the facts and circumstances when evaluating whether a plan's reference-based pricing design (or similar network design) that treats providers that accept the reference-based price as the only in-network providers and excludes or limits cost-sharing for services rendered by other providers is using a reasonable method to ensure adequate access to quality providers at the reference price, including: [1] Type of service .... [2] Reasonable access .... [3] Quality standards .... [4] Exceptions process .... [5] Disclosure .... The Departments will continue to monitor the use of reference-based pricing and may provide additional guidance in the future[.]" (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
Private Exchanges Already Cover at Least 2.5 Million People
"Fifteen percent of large employers either have adopted or are considering the adoption of a private exchange approach to employee health coverage ... [It] is estimated that at least 2.5 million people already get their health coverage through private exchanges, including approximately 1.7 million group plan enrollees, 700,000 individual Medicare enrollees, and 100,000 individual enrollees, (not including the purely e-broker individual market). Kaiser further predicts that the market is expected to grow." (Wolters Kluwer Law & Business)
EEOC Tries to Ground HIPAA-Compliant Wellness Programs Through Litigation
"Nothing in the ADA restricts wellness programs to those that are 'voluntary.' To the contrary, the ADA contains a benefit plan safe harbor that limits ADA applicability in the benefit plan context to claims that a plan is used as a subterfuge for disability-based discrimination in non-benefit aspects of employment. The EEOC conveniently ignores this safe harbor." (Seyfarth Shaw LLP)
Five High-Level Issues to Consider in Shaping Your Organization's Employee Benefit Offerings (PDF)
"[1] There is a 'retirement crisis' in America.... [2] Healthy employees are more productive and less likely to be absent.... [3] Offer benefits programs that appeal to a multigenerational workplace.... [4] Prudent outsourcing can assist plan sponsors manage benefit plans.... [5] Address employee benefits early in corporate transactions." (Epstein Becker Green)
CMS Requests Input on Health Plan Innovation Initiatives
"CMS is specifically seeking information on stakeholder experiences with and perspectives on the following Medicare and/or Medicaid product types: Stand-Alone Medicare PDPs; Medigap and Retiree Supplemental health plans; MA and MA Prescription Drug (MA-PD) plans; [and] Medicaid managed care plans The information gathered will help CMS assess whether mechanisms used in the non-Medicare/Medicaid markets to reduce costs, improve quality, and enhance beneficiary satisfaction should be tested in the referenced product types." (Epstein Becker Green)
What's an Employer to Do About Health Care Coverage and Excise Taxes?
"The [ACA] has led to debates about specific provisions and political wrangling, but relatively little has been written to show employers how to use their own numbers to determine whether it's cheaper to provide coverage or pay the ACA excise taxes for not doing so. This article uses examples, formulas and realistic figures to prepare you to plug in your own numbers to see how some of your company's current and future decisions could affect finances." (Grant Thornton)
Eighth Circuit Finds Health Insurance Costs Could Be Proxy for Age When Employer Laid Off 'Oldest and Sickest'
"Evidence that an employer asked its health insurer for lower rates because it laid off its 'oldest and sickest' employees, that it disciplined an employee for poor performance after she refused to choose Medicare rather than the company health plan, and that she was the only one to have been issued a reprimand and put on probation could suggest that age was the but-for cause of her termination and that her purported performance issues were merely pretext, ruled an Eighth Circuit panel, reversing summary judgment for the employer on her ADEA discrimination and retaliation claims." [Tramp v. Associated Underwriters, Inc., No. 13-2546 (8th Cir. Oct. 7, 2014)] (Wolters Kluwer Law & Business)
Trends in Employment-Based Health Insurance Coverage: Evidence from the National Compensation Survey
"Although the reasons employers have historically been so central in providing health insurance in the United States are complex, the fact that they do play such a role means that health insurance has important effects on the labor market. Health insurance makes up the biggest share of noncash benefits received by private industry workers, and that share has grown from 32 percent in 1991 to 39 percent in 2012. Not only has it grown in importance among all noncash benefits, but the increase in costs employers pay for health insurance has outstripped the affected workers' wage growth: health insurance paid by employers tripled from 1991 to 2012, while wages paid increased by 83 percent." (U.S. Bureau of Labor Statistics [BLS])
2015 Medicare Part B Premiums and Deductibles to Remain the Same as Last Two Years
"Medicare Part B covers physicians' services, outpatient hospital services, certain home health services, durable medical equipment, and other items. For the approximately 49 million Americans enrolled in Medicare Part B, premiums and deductibles will remain unchanged in 2015 at $104.90 and $147, respectively." (U.S. Department of Health and Human Services [HHS])
Five ACA Issues That Employers Should Be Following
"[1] The ACA may have its day in court ... again ... [2] Planning for employer mandate reporting can begin... [3] How to minimize Section 510 liability... [4] If it sounds too good to be true, then it probably is... [5] The Cadillac tax is barreling down the road." (Epstein Becker Green)

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