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Health plans - design

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New EEOC Proposed Wellness Program Regulations Finally Address ADA Concerns
"[T]he ADA rules do not fully incorporate the increased ACA/HIPAA 50% incentive threshold for smoking cessation programs. Any incentive tied to biometric screening or medical examination that tests for the presence of nicotine or tobacco must be limited to 30% to meet the ADA requirements (even though an incentive up to 50% would be permitted under the ACA/HIPAA rules). Only a smoking cessation program that merely asks employees whether or not they use tobacco (or whether or not they ceased using tobacco upon completion of the program), without any medical examination to verify tobacco use, is permitted to reach the higher ACA/HIPAA 50% incentive limit." (ABD Insurance & Financial Services)
2015 Emerging Trends in Health Care Survey
"Health care costs for 2015 are projected to increase by 4% after plan changes. The 2018 excise tax on high-cost health benefits has placed a time clock on optimizing health plan performance. Employers expect to make moderate to significant changes to their health care benefits to combat rising costs." (Towers Watson)
[Guidance Overview] EEOC Issues Proposed Rule Addressing ADA Compliance and Wellness Programs
"The EEOC's proposed rule attempts to clarify what does and does not constitute a permissible wellness program in light of the ADA's protections.... The Commission stated that 'it has a responsibility to interpret the ADA in a manner that reflects both the ADA's goal of limiting employer access to medical information and HIPAA's and the Affordable Care Act's provisions promoting wellness programs.'" (Littler)
[Guidance Overview] The EEOC's Proposed Wellness Plan Regulation: Some Progress, But Issues Persist
"While the rule, if promulgated, would provide some clarity for employers, it would also raise some important questions related to the EEOC's power to strip employers of a statutory defense, and potentially muddy the waters if an affordability standard is included. In addition, the NPRM opens the door to uncertainty with reference to wellness program-related claims under Title VII and the ADEA as well." (Seyfarth Shaw LLP)
[Guidance Overview] EEOC Finally Lets the Wellness Cat Out of the Bag
"[U]nder the HIPAA rules, the incentive can be up to 30% of the total cost of family coverage if spouses and dependents are eligible to participate in the wellness program. The EEOC's proposed rules contain no such expansion. It is not clear whether the EEOC feels it does not have jurisdiction over non-employees participating in a health plan or if it is trying to reign in the possible incentives under wellness programs." (Benefits Bryan Cave)
[Guidance Overview] EEOC Issues Proposed Rule on Application of the ADA to Employer Wellness Programs
"In addition to setting a limit on incentives, the NPRM, which includes interpretive guidance that will be published along with the final rule, requires that employers provide employees a notice that describes what medical information will be collected, with whom it will be shared, how it will be used, and how it will be kept confidential. The interpretive guidance also includes an extensive discussion of both legal requirements and best practices that ensure confidentiality of employee medical information." (U.S. Equal Employment Opportunity Commission [EEOC])
[Official Guidance] Text of EEOC Proposed Regs: Wellness Programs and the ADA
"The proposed rule explains what an employee health program is, what it means for an employee health program to be voluntary, what incentives employers may offer as part of a voluntary employee health program, and what requirements apply concerning notice and confidentiality of medical information obtained as part of voluntary employee health programs. In addition, the proposed rule explains that compliance with rules concerning voluntary employee health programs does not ensure compliance with all the antidiscrimination laws EEOC enforces....

The proposed rule clarifies that an employer may offer limited incentives up to a maximum of 30 percent of the total cost of employee-only coverage, whether in the form of a reward or penalty, to promote an employee's participation in a wellness program that includes disability-related inquiries or medical examinations as long as participation is voluntary.... Voluntary means that a covered entity: [1] does not require employees to participate; [2] does not deny coverage under any of its group health plans or particular benefits packages within a group health plan for non-participation or limit the extent of such coverage (except pursuant to allowed incentives); and [3] does not take any adverse employment action or retaliate against, interfere with, coerce, intimidate, or threaten employees within the meaning of Section 503 of the ADA ...

Further, to ensure that participation in a wellness program that includes disability-related inquiries and/or medical examinations, and that is part of a group health plan, is truly voluntary, an employer must provide a notice that clearly explains what medical information will be obtained, who will receive the medical information, how the medical information will be used, the restrictions on its disclosure, and the methods the covered entity will employ to prevent improper disclosure of the medical information. Finally, the proposed rule allows the disclosure of medical information obtained by wellness programs to employers only in aggregate form, except as needed to administer the health plan[.]" (U.S. Equal Employment Opportunity Commission [EEOC])

Workplace Wellness Programs: Services Offered, Participation, and Incentives (PDF)
"The goal of this report was to leverage existing data to explore patterns of wellness program availability, employers' use of incentives, and program participation and utilization among employees. This report will be of interest to national and state policymakers, employers and wellness program vendors, employer and employee advocacy organizations, health researchers, and others with responsibilities related to designing, implementing, participating in, and monitoring workplace wellness programs." (RAND Corporation, for Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL])
[Official Guidance] Text of Agency FAQs on ACA Implementation (Part XXV): Wellness Programs (PDF)
"[A] health-contingent wellness program must be reasonably designed to promote health or prevent disease. A program complies with this requirement if it [1] has a reasonable chance of improving the health of, or preventing disease in, participating individuals; [2] is not overly burdensome; [3] is not a subterfuge for discrimination based on a health factor; and [4] is not highly suspect in the method chosen to promote health or prevent disease ... The fact that a wellness program that complies with the Departments' wellness program regulations does not necessarily mean it complies with any other provision of the PHS Act, the Code, ERISA, (including the COBRA continuation provisions), or any other State or Federal law, such as the Americans with Disabilities Act or the privacy and security obligations of [HIPAA] ... Satisfying the rules for wellness programs also does not determine the tax treatment of rewards provided by the wellness program[.]" (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]; Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]; and Internal Revenue Service [IRS])
Study Suggests Many ACA Exchange Plans Violate Federal Parity Laws
"According to a new study focusing on consumer information, nearly 25 percent of group health plans provided through [ACA] exchanges may be violating federal mental-health parity laws.... [B]ecause mental-health and substance-use disorder services are often more expensive than medical/surgical services, insurers may benefit when consumers are dissuaded from joining plans with more generous mental-health and substance-use disorder benefits." (Crowell & Moring LLP)
2015 ADP Annual Health Benefits Report
"Over the five-year period studied, the percentage of full-time employees (as designated by the employer) who were eligible for employer-provided health benefits rose by 2.0%. Despite a rise in eligibility, the number of eligible employees who opted to take insurance dropped by -1.7% during the same period, keeping the overall participation rate steady at 69.3%." (ADP)
2015 Workplace Benefits Report: Helping Employees Live Their Best Financial Lives (PDF)
20 pages. "[F]inancial wellness has evolved from a buzzword to reality and is likely to grow in importance in the future. Meanwhile employers face a challenging environment in which the complexities of benefits offerings require greater expertise from HR professionals, and rising health care costs force hard decisions about how to spend valuable benefits dollars. This report provides a clear picture of the data, trends and new ideas related to workplace benefits today. It uncovers new insights related to financial wellness, health care, incentives, the use of total rewards portals and employers' attempts to engage a multi-generational workforce." (Bank of America Merrill Lynch)
Seven Cost-Cutters You'll Need to Fight Emerging Healthcare Trends
"[1] Only offer a CDHP.... [2] Control rising drug costs.... [3] Add a spousal surcharge.... [4] Focus on chronic conditions.... [5] Review your life and disability plans.... [6] Link disability data to your wellness strategy.... [7] Use your data." (HR Benefits Alert)
Health Insurers Call for Stronger Rules on Medical Devices
"Nearly all U.S. medical devices ... reach the market through an FDA system known as 510(k), which clears tools deemed substantially similar to ones already on the market. That process typically doesn't require clinical studies on people to prove safety and effectiveness.... America's Health Insurance Plans called for strengthening the 510(k) system and efforts to track devices." (The Wall Street Journal; subscription may be required)
Recent Developments in Employee Benefits Law (PDF)
"This article surveys recent developments in employee benefits law from fall 2013 through fall 2014.... The first portion of the survey reviews two important Supreme Court cases from last term, Fifth Third Bancorp v. Dudenhoeffer and Heimeshoff v. Hartford Life & Accident Insurance Co. ... The second portion of the survey reviews eight important decisions issued by the appellate courts during the last year[.]" (Alston & Bird LLP, via Tort Trial and Appellate Practice Law Journal)
The Payment Reform Landscape: Impact on Consumers
"[As] we focus on reforming how we pay for health care, it is vital that we address key questions involving the very consumers who receive that care: How many consumers are directly touched by payment reform? How does payment reform impact employees and consumers and their experience with care? What, if anything, do consumers need to know about payment reform? As health plans implement a growing number of reforms to payment, these questions will only become more relevant." (Health Affairs)
Local Conditions Affect Wellness Program Design
"[An] across-the-board wellness program (beyond its many other limitations) [can] miss many needs by not addressing local conditions that could make life changes more difficult to sustain.... So, how do you find out about what life is like for your people outside of the workplace? One approach might be the Health Policy Institute of Ohio's Health Value Dashboard.... The Dashboard brings the data closer to home by allowing you to zero-in county-by-county to see local factors affecting health that you probably couldn't know otherwise.... The Dashboard can provide the same kind of data on counties across the country, allowing you to see what differences exist at your various locations, allowing you to localize your well being efforts. Got a plant north of Atlanta in Cherokee County? Take a look at the data. The well being job to do there might be completely different than in [Ohio's] Cuyahoga County." (Chelko Consulting Group)
[Opinion] A Smarter Way to Pay Doctors
"[T]he Committee for a Responsible Federal Budget is concerned that the doc fix will raise payments (without fully funding them) whereas the Medicare actuaries are concerned that the legislation will cut payments too much. They're both wrong, for different reasons." (Bloomberg View)
Health Insurance Shoppers Look to Limited Networks to Save Money
"Consumers seem increasingly comfortable trading a greater choice of hospitals or doctors for a health plan that costs significantly less money.... This year, nearly half of the plans offered on public health care exchanges are so-called narrow network options, which sharply limit the medical providers whose services will be covered ... Furthermore, nearly a fifth are considered 'ultranarrow networks,' which offer even fewer choices. At the same time, more employers are also embracing the plans for their workers, largely as a way to lower health care costs." (The New York Times; subscription may be required)
[Opinion] Testimony on Behalf of U.S. Chamber of Commerce to House Subcommittee Hearing on Individual and Employer Mandates in the ACA (PDF)
"Our reality today under the ACA is very different than what was promised. Over the last four years, our insurance premiums have risen 60%. Our single coverage now costs $6,400 annually and family coverage costs $19,200 annually. However, we have also had to double our deductibles to $2500 and raise the out-of-pocket limit by two thirds. While our insurance offering complies with the ACA as affordable, only 4% of our hourly staff have enrolled ... [and] my offering of coverage to employees in many cases makes them ineligible for ACA subsidies for their dependents.... The reporting required is costly, complex and confusing. All employers have had to either create or buy new software as we have, or contract with a service to do so. As I write this, it is unclear whether the federal government can actually use the data in its systems. It is clear that the assumptions inherent to the ACA were wrong." (U.S. Chamber of Commerce)
Wellness Committees: Four Reasons Why You Can't Afford Not to Have One
"[1] It makes it easier to get employee buy-in.... [2] It enables the company to tailor the program to a more diverse group.... [3] It gives you a number of different perspectives.... [4] It's a great recognition tool." (HR Benefits Alert)
[Guidance Overview] Summary of 2016 Medicare Advantage Final Notice and Call Letter (PDF)
40 pages. "The majority of the changes proposed in the Advance Notice were the result of continuing implementation of the provisions of the [ACA], as well as continuing steps towards CMS' efforts to provide [Medicare Advantage and Prescription Drug] enrollees with higher quality of care, more transparency and more information, and to continue moving towards quality based payments for both plan sponsors and providers. Most of the items proposed in the Advance Notice were adopted and finalized without modification in the Final Notice. Many of the changes for 2016, such as calculation/rebasing of the county Benchmarks, revisions to benefit parameters, and updates to risk score calculation components, will affect nearly all Medicare Advantage and Prescription Drug Plans. This document presents a summary of key changes for 2016 as adopted in the Final Notice." (Wakely Consulting Group)
UHG Piloting Rewards for Health in App Collaboration
"UnitedHealthcare is testing the waters of consumer rewards and digital engagement, in a new partnership with Walgreens that's aiming to spur better health choices. UnitedHealthcare's fully insured members in Arizona and Illinois will be able to earn Walgreens Balance Rewards points for completing health activities like walking. The two companies are collaborating with a pilot integration of the UnitedHealthcare Reward Me program, via its Health4Me app, and Walgreen's Balance Rewards loyalty program." (Healthcare Payer News)
Control Health Benefit Costs with Voluntary Coverage (PDF)
"Reluctant to stop offering benefits such as health insurance, many employers have turned to cost-sharing to keep premiums down. But this strategy is putting many of America's workers in serious financial jeopardy.... One solution to this seeming conundrum is offering your employees voluntary benefit plans designed to help bridge their financial exposure. Products such as hospital confinement indemnity plans can help offset the cost of hospitalization and some of the most common out-of-pocket expenses associated with a hospital stay. Some plans also offer additional coverage for health screenings, outpatient surgery and diagnostic procedures." (Colonial Life)
Are Declining HSA Contributions Caused by the ACA?
"[I]n 2014, employees saw a 10-percent decrease in their average single health-savings-account employer contribution from the previous year, from $574 in 2013 to $515 in 2014. On the employee contribution side, average family contributions also decreased seven percent during the same period, from $958 to $890. [Survey results] also reveal a correlation between enrollment in HSAs and Consumer Driven Health Plans (CDHPs), linking higher HSA contributions to increased enrollment in the cost-saving plans." (Human Resource Executive Online)
[Opinion] Why the Private Health Insurance Industry Has to Go
"After five years' experience with the ACA, we now know that insurers themselves are a major barrier to achieving the kind of access to affordable care that our population so desperately needs. Here are some of the major reasons why private health insurers warrant no further bailout by government and taxpayers. [1] Continued discrimination against the sick.... [2] Fragmentation, inefficiency, and exorbitant administrative overhead.... [3] Increasing costs for less coverage ... [4] Gaming the ACA for profits more than service to patients ... [5] Private insurance has priced itself out of the market.... [6] As their business plan dictates, insurers are leaving unprofitable markets without regard for patients' needs." (Physicians for a National Health Program [PNHP])
Olympic Athletes' Health Plan Fails to Meet ACA Rules
"It might seem like common sense that top U.S. Olympic athletes would have excellent health insurance to cover potentially serious injuries and illnesses. But it turns out that the health plan for about 900 elite athletes -- provided through the U.S. Olympic Committee -- fails to meet minimum requirements of the Affordable Care Act.... When it became apparent in recent months that athletes could face penalties for the 2014 tax year for having inadequate coverage -- through no fault of their own -- federal health officials decided to grant exemptions to all affected athletes who apply[.]" (The Washington Post; subscription may be required)
Health Care Coverage and Access in the the Four Most Populous States
"Across the country's four largest states, uninsured rates vary for adults ages 19 to 64 ... Differences also extend to the proportion of residents reporting problems getting needed care because of cost, which was significantly lower in New York and California compared with Florida and Texas. Similarly, lower percentages of New Yorkers and Californians reported having a medical bill problem in the past 12 months or having accrued medical debt compared with Floridians and Texans. These differences stem from a variety of factors, including whether states have expanded eligibility for Medicaid, the state's uninsured rate prior to the [ACA] taking effect, differences in the cost protections provided by private health insurance, and demographics." (The Commonwealth Fund)
Federal Marketplace More Adept Than States at Enrolling Customers
"[I]t's possible that more people over-reported their income on state-based exchanges for 2014 coverage and were subsequently shifted to the Medicaid program this year.... Such shifting could make it appear that some states had lost enrollees when instead they just moved to Medicaid.... But it's not clear why state-based exchanges would experience such shifts to a greater degree than states where the exchange is run by the federal government." (Kaiser Health News)
Benefit Design and the Rush, Hush, and Crush Cycles
"[W]hen notified toward the end of the plan year of impending reductions to their medical plans for the upcoming plan year, savvy members often 'rush' off to get deferred elective medical care in order to take advantage of the current richer plan design.... Subsequently, if more elective medical procedures are performed in the last quarter of the previous year during this rush period, there is a slowdown or 'hush' in medical care in the first few quarters of the new plan year.... In the second year of the new plan, as costs return back to normal levels there is a trend 'crush' compared with the previous year because it's compared with a lower base level of claims from the first year of the new design." (Healthcare Payer News)
Plan Selections by ZIP Code in the Health Insurance Marketplace
"The dataset provides the total number of Qualified Health Plan selections by ZIP Code for the 37 states that use the platform, including the Federally-facilitated Marketplace, State Partnership Marketplaces and supported State-based Marketplaces for the Marketplace open enrollment period from November 15, 2014 through February 15, 2015 ... The data represent the number of unique individuals who have been determined eligible to enroll in a Marketplace plan and had selected a plan by February 15, 2015[.]" (Assistant Secretary for Planning and Evaluation [ASPE], U.S. Department of Health and Human Services [HHS])
Essential Health Benefits: List of the Largest Three Small-Group Products by State (PDF)
16 pages. "This document provides information to facilitate States' selection of the benchmark plans that will serve as the reference plan for the essential health benefits (EHB). Using data from Health, this document provides a list of the three largest small group insurance products ranked by enrollment in the first quarter of 2014 for each State. In addition, we are providing a list of the three largest nationally available Federal Employee Health Benefit Program (FEHBP) plans, which is another benchmark option, ... [and] the single largest Federal Employees Dental and Vision Insurance Program (FEDVIP) dental and vision plans respectively, based on enrollment in the first quarter of 2014." (Center for Consumer Information & Insurance Oversight [CCIIO], Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
The National Compensation Survey and the ACA: Preserving Quality Health Care Data
"The [National Compensation Survey (NCS)] tracks the incidence and provisions of employer-provided benefits for workers.... This article provides an overview of efforts to research the effects of the ACA on NCS cost, coverage, and provisions data, including obtaining expert feedback and testing selected elements for potential inclusion in future data collection.... Starting in March 2015, the NCS initiated the collection of data on the ACA grandfathered status of health insurance plans. Other provisions are being considered for future NCS collection. The NCS is also evaluating provisions that are identified in the law but not fully implemented, such as the Cadillac tax." (U.S. Bureau of Labor Statistics [BLS])
CMS Presentation: FF-SHOP Business Development, April 7, 2015 (PDF)
25 presentation slides. Agenda: [1] Marketing Research; [2] Business Development Goals; [3] SHOP Value Proposition; [4] Business Development Strategy; [5] Business Development Tactics; and [6] Outlook for SHOP: 2016-2017. (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
Total Rewards and Employee Well-Being Practices
"Ninety-six percent of organizations support well-being components ... and 90% of their active employees, on average, are eligible. Nearly three-quarters (74%) of organizations are increasing or considerably increasing their well-being offerings in the next two years ... with the objectives of impacting health-care costs and increasing productivity as the top reasons for the increase.... [M]ost employers would retain their well-being offerings even if they were to stop offering employer-sponsored health-care." (WorldatWork)
[Opinion] A Cadillac Tax for Chevy Health Care
"What we have traditionally considered to be standard health plans -- 'Chevy plans' -- are now considered to be 'Cadillac plans.' These are plans that union members have paid for through forgone wage increases -- wage concessions merely to maintain standard health care coverage, not 'Cadillac' coverage. This attitude that standard coverage is somehow a 'Cadillac' plan shows how much the definition of standard coverage has deteriorated." (Physicians for a National Health Program [PNHP])
Americans Are Confident Health Care Consumers, But Ignore Cost in Care Decisions (PDF)
"Sixty-nine percent say they have enough information to get the right health care for themselves and their family, yet less than half (48%) always ask their doctor how much their care will cost.... Health coverage is a key reason workers stay in their jobs, as 70% indicate they depend on their benefits package; 89% say health benefits play a part in staying at their current employer.... Among employees who say the Affordable Care Act changed their benefits, 73% say the change made a negative impact." (Benz Communications, and Quantum Workplace)
State-Based Exchanges Saw Higher Attrition from 2014 to 2015 Than Federally-Facilitated Exchanges
"Federally-facilitated exchange states reenrolled 78 percent of their 2014 enrollees in 2015, on average. In state-run exchange states, that percentage drops to 69 percent of 2014 enrollees. California, the state with the highest enrollment in 2014, only retained 65 percent of their 2014 enrollees. It is unclear why state-based exchanges saw higher year-over-year attrition among their enrollees. One possibility is that state exchanges had more enrollees who over-reported income in 2014." (Avalere Health)
Nevada Legislature Seeks to Ban State's Health Insurance Exchange
"If the bills are successful, Nevada residents would still be able to get health insurance, but it would be through the federal insurance exchange Critics of the exchange and other supporters of the bill say the system is an initiative that steps on states' rights, and that premiums have increased since the health care law was enacted." (Nevada Public Radio)
[Opinion] Why Americans Need to Stop Getting Health Care Through Their Employers
"Customers are no longer shopping for health care directly. They're shopping for insurance, and the insurers are shopping for health care. In particular, insurers profit by taking in more revenue from premiums than they spend on health care for their customers.... What does employer-provided coverage have to do with all this? It introduces another middle-man. Workers negotiate with employers, then employers shop for insurance, then insurers shop for care." (The Week)
[Guidance Overview] IRS Provides Additional Guidance on Premium Reimbursement Arrangements (PDF)
"While Revenue Ruling 61-146 permits employers to pay or reimburse properly substantiated premiums paid for hospital and medical insurance on a tax-free basis, it should not be read as providing any direction about compliance with the ACA's market reforms. The principles of Revenue Ruling 61-146 could still be useful for situations where ACA rules do not apply. For example, an employer could reimburse premiums paid for retiree only coverage and excepted benefits, such as a specified disease policy, a hospital indemnity plan or a stand-alone dental or vision plan." (Buck Consultants at Xerox)
Text of Ninth Circuit Opinion Finding Explicit Trust Not Required for Assets of Welfare Benefit Plan (PDF)
"[We] conclude that under 29 U.S.C. Section 1103(a), a person (legal or natural) must hold legal title to the assets of an employee benefit plan with the intent to deal with these assets solely for the benefit of the members of that plan.... Neither [the employee] nor the Department of Labor (as amicus curiae) offers an alternative definition of these terms. Rather, they argue, in effect, that compliance with Section 1103(a) requires a party to record its responsibilities with respect to the assets of an employee benefit plan in a document that is entitled 'trust instrument,' uses the terms 'trust' and 'trustee,' and expressly states that the party is holding the assets 'in trust.' Further, the Department appears to interpret its regulation ... as requiring parties to use express words of trust to comply with Section 1103(a). We reject this argument." [Barboza v. Cal. Ass'n. of Prof. Firefighters, No. 11-15472 (9th Cir. Apr. 7, 2015)] (U.S. Court of Appeals for the Ninth Circuit)
The Coming Revolution in How Employers Provide Health Insurance
"About 6 million Americans with workplace coverage in 2014 received their health insurance through privately run health insurance exchanges, where employees can select coverage from a number of health plans -- double the number from the year before ... [In] the exchanges, the employer essentially outsources the work, and employees generally have a much greater choice of health insurance options. By pooling more workers together, the plans can have lower insurance rates[.]" (The Washington Post; subscription may be required)
Shifts in Earnings for Consumers Near Medicaid Line Can Threaten Coverage
"Low-income consumers whose earnings fluctuate or family circumstances change over the course of the year risk losing their health coverage if they shift between eligibility for Medicaid and coverage on the health insurance exchanges. That 'churning' isn't new to Medicaid, but the health law's addition of millions of customers whose incomes hover near the Medicaid line raises concerns about how well the insurance marketplaces can handle the flux." (Kaiser Health News)
Private Health Insurance Exchange Enrollment Doubled from 2014 to 2015
"An estimated 6 million members enrolled in their benefits on a private health insurance exchange for the 2015 plan year, continuing a remarkable adoption trend in excess of 100 percent annual growth since 2013." ... Accenture forecasts enrollment of employees under 65 years old and dependents will grow to 12 million in 2016 and 22 million in 2017. Accenture projects growth will remain on track to reach 40 million enrollees by 2018. (Accenture)
[Guidance Overview] Planning for the So-Called Cadillac Plan Tax (PDF)
"Many employers are surprised to learn that pre-tax employer contributions are included in the calculation.... Employer and employee pre-tax salary reduction contributions to HSAs are included in the Section 4980I calculation, as well as the cost of the underlying HDHP coverage. In the event that these amounts combined would exceed the tax thresholds, the employer could reduce the overall cost by reducing the employer contributions, the employee pre-tax contributions or both.... Any reductions would need to be consistent with the HSA comparability rules." (Alston & Bird LLP)
Informal EEOC Discussion Letter Addresses ADEA Implications of Paying Employees' Medicare Premiums
"The letter explains that the EEOC and some courts have found that distinctions based on Medicare eligibility are based on age, since most individuals qualify for Medicare by reaching age 65. However, the ADEA prohibits only conduct that treats older workers adversely; providing older workers with more advantageous options than younger workers does not violate the ADEA. Whether an arrangement provides more advantageous options to older workers or treats them adversely cannot be determined without a factual investigation." (Thomson Reuters / EBIA)
A Shared Nationwide Health IT Interoperability Roadmap (PDF)
166 pages. "This draft Roadmap proposes critical actions that the public and private sector need to take to advance the country towards an interoperable health IT ecosystem over the next 10 years.... [T]he Roadmap focuses on actions that will enable a majority of individuals and providers across the care continuum to send, receive, find and use a common set of electronic clinical information at the nationwide level by the end of 2017." (National Coordinator for Health Information Technology)
[Opinion] Brief on the Sad Status of Narrow Networks
"The complex policies behind narrow provider networks were not designed for patients. They were designed for the private insurance companies.... Narrow provider networks are only one more tool to reduce the cost of health care in order to keep their premiums competitive. As this report indicates, insurers select their network providers based on the lowest prices that they can negotiate -- not on quality." (Physicians for a National Health Program [PNHP])
Consumers Contributing Less to Health Savings Accounts
"Between 2011 and 2014, the percentage of people who said they contributed nothing to their health savings accounts (HSAs) more than doubled, to 23 percent ... Meanwhile, the percentage who said they contributed $1,500 or more dropped to 30 percent from 44 percent.... In 2014, 73 percent of companies with more than 1,000 workers offered an account-based health plan, up from 51 percent in 2009 ... A third of workers at those companies were enrolled in such accounts in 2014, the survey found, more than double the median 14 percent that were enrolled five years earlier." (Kaiser Health News)
[Guidance Overview] ACA Resources for Frequently Asked Questions, Updated March 27, 2015 (PDF)
"The report provides basic consumer sources, including a glossary of health coverage terms, followed by sources on how the ACA affects taxes. 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 the ACA's provisions on mental health, public health, workforce, and quality. Finally, the report lists sources on ACA costs and appropriations, legal issues, the treatment of noncitizens under the ACA, and sources for obtaining the law's full text." [CRS Report R43215] (Congressional Research Service)
What Does the ACA's Excise Tax on High-Cost Plans Actually Tax? (PDF)
"Depending on the combination of these premium-driving factors other than benefit level, premiums for a given employer can be expected to exceed the threshold for incurring the tax even for a plan without especially rich benefits. As a result, although the excise tax is often referred to as a tax on overgenerous health benefits, it is likely to be a tax based on factors other than benefit level and beyond the control of health plan members.... There are also many areas of the country where the combined effect of premium-driving factors will make it unlikely that the threshold could be exceeded, no matter how rich the benefit plan." (Milliman, for the National Education Association)
Noteworthy Developments of Interest to Sponsors of Public Sector Health Plans, Second Quarter 2015 (PDF)
"Health benefit plan cost trend rates projected for 2015 show a slight drop for some types of coverage, but a substantial increase for prescription drug coverage.... Employers are looking for ways to decrease health care spending before the ACA excise tax goes into effect in 2018. Strategies include: [1] Investing in wellness programs, [2] Moving to a consumer driven health plan, [3] Offering health care cost transparency tools, [4] Contracting directly with providers, [5] Introducing spousal surcharges, and [6] Monitoring the success of private exchanges." (Segal Consulting)
Time to Take Another Look at Stop-Loss Insurance (PDF)
6 pages. "This [article] reviews the basics of stop-loss insurance ... and how plan sponsors can use it to better manage the added risk and increased cost to plans that have made plan design changes to comply with the Affordable Care Act. It also looks at recent innovations and best practices for purchasing stop-loss insurance." (Segal Consulting)
[Guidance Overview] The ACA's Cadillac Tax: What Employers Need to Know
"Employers will be responsible for calculating whether the health plans employees enroll in provide an excess benefit. The calculations are based on the health coverage the employee actually enrolls in, not just what is offered to the employee. ALL employer plans, not just large employers, are potentially subject to the Cadillac Tax.... Similar to the COBRA rules, the Treasury anticipates the cost of applicable coverage for an employee will be based on the average costs of applicable coverage for an employee and all similarly situated employees, rather than based on the characteristics of each individual." (Liebert Cassidy Whitmore)
Six Instances Where California Public Sector Employers May Be Missing the Mark
"[1] Offering cafeteria benefits without a plan.... [2] Allowing 'opt-outs' of employee elections to make mandatory contributions.... [3] Permitting employees to 'retire' and then return to work.... [4] Converting non-reportable wages into reportable wages.... [5] Classifying employees as independent contractors.... [6] Not satisfying fiduciary requirements in connection with participant-directed section 457(b) plans." (Chang Ruthenberg & Long PC)
Insurance Premiums 2013-2015 Dataset
"The Insurance Premiums 2013-2015 Dataset provides information on average monthly premium costs for all 50 states. Data are presented for multiple demographics, including gender and age, and multiple metal tiers. Moreover, the data represent premiums across multiple years, from 2013-2015, and include variables tracking percent change." (Robert Wood Johnson Foundation)
Insurers' Marketshare 2010-2014 Dataset
"Dataset tracks insurance carriers' marketshare, pre- and post-ACA, from 2010-2014 in each state. Specifically, the dataset includes ... information on the three largest insurance plans for the Individual Market, The Small Group Market, and the Large Group Market." (Robert Wood Johnson Foundation)

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