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Health plans - design

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Cadillac Tax Bringing Unprecedented Changes to Benefits Enrollment and Coverage
"Purchasing 'rich' plans based on the assumption that 'the more they pay, the better the plan,' can result in a financial disservice to employees as it excludes HSA tax benefits and subsequent future retiree medical funding. While these employees are over-insured in medical coverage, they are under-insured regarding income protection coverage and life insurance.... [T]he Cadillac Tax will significantly impact employer involvement in the way employees view their overall benefit offering." (Benefitfocus)
[Guidance Overview] EHB Prescription Drug Standard: Pharmacy and Therapeutics Committees
"[B]eginning in 2017 HHS will require [qualified health plans (QHPs)] to establish Pharmacy and Therapeutics (P&T) Committees to review and update plan formularies in conjunction with the USP Medicare Model Guidelines. Although new to QHPs, all Medicare Part D plans and some state Medicaid programs operate P&T Committees.... Even though QHPs are not required to have P&T Committees until 2017 (or sooner in some states), health advocates and consumers have a new tool to ensure that [essential health benefit (EHB)] formularies meet the needs of enrollees P&T Committees demonstrate the importance of advocacy efforts and lay the groundwork for future improvements in EHB prescription drug standards." (National Health Law Program [NHeLP])
[Guidance Overview] EHB Prescription Drug Standard: United States Pharmacopeia Classification System (PDF)
"In the Essential Health Benefits Final Rule from February 2013 (Final Rule 2013), HHS chose the USP Medicare Model Guidelines classification system (version 5.0) as the comparison tool to determine EHB prescription drug coverage.... [H]ealth plans must cover at least the greater of [1] one drug in every USP therapeutic category and class or [2] the same number of drugs in each USP category and class as the state's EHB base-benchmark plan.... The Final Rule 2016 adopts an approach that combines: [1] the use of a [Pharmacy and Therapeutic (P&T)] committee and [2] the existing USP standard. This change will go into effect beginning with plan years on or after January 1, 2017." (National Health Law Program [NHeLP])
[Opinion] Is the California ACA Exchange a Model for the Nation?
"The last half century has confirmed that free markets in health insurance are highly dysfunctional. The reason that Covered California is working is that it is very highly regulated, dictating which insurers can participate, what benefits their plans must offer beyond those mandated by ACA, while aggressively negotiating with insurers on prices, rejecting those that are too high." (Physicians for a National Health Program [PNHP])
Looking Past Due Diligence for Benefit Plans in Mergers and Acquisitions (PDF)
"Corporate transactions involving the sale or purchase of another company or division are complex events. While employee benefit plans generally are considered in these transactions, the time and attention devoted to these plans are often minimal. This exposes the parties to additional risks, both in terms of direct costs and in long term administrative complexities. This article will review the various risks that often are undiscovered during the standard due diligence process. Health plans and retirement plans, including multiemployer plans, and executive compensation plans are all considered." (Benefits Quarterly, published by the International Society of Certified Employee Benefit Specialists [ISCEBS])
[Guidance Overview] Healthy Caution Advisable in Designing Wellness Plans Due to New Scrutiny of Medical Exams and Inquiries (PDF)
"This article explores the history of enforcement of the ADA's medical examination and inquiry provisions related to wellness programs, the EEOC's proposed ADA wellness program regulations and the intersection between the ADA, HIPAA and ACA in relation to the proposed regulations." (Alston & Bird LLP, via Bloomberg BNA Daily Labor Report)
Access to Retirement and Medical Benefits by Occupation, March 2015
"Retirement benefits were available to 66 percent of private industry workers in the United States in March 2015.... Among workers in management, professional, and related occupations in private industry, 80 percent had access to retirement benefits -- compared with 39 percent in service occupations.... Medical care benefits were available to 69 percent of private industry workers in March 2015. Within private industry, 87 percent of workers in management, professional, and related occupations had access to medical care, compared with 41 percent in service occupations." (U.S. Bureau of Labor Statistics [BLS])
Implementing a Medical Home Model at the Worksite: Measuring the Cost and Use of Health Services
" 'Casual users' of an on-site medical home had the highest claims costs and use of outside healthcare services. While 'major users' of the on-site medical home had higher use of on-site services, they had lower claims costs than the other groups for outpatient claims. Use of on-site medical homes is associated with decreased total use of outpatient care including preventive care services.... While many employers offer health promotion programs of various intensity and scope, we use the term 'workplace medical home' to denote a set of more comprehensive primary care services at the worksite, offering acute care and chronic disease management in addition to clinical preventive services provided by nurse practitioners and physicians." (American Journal of Managed Care)
Rethinking Responsibility and Strategy for Employee Benefits: Third Annual Workplace Benefits Study (PDF)
64 pages. "[E]mployees continue to value and rely on the benefits their employer offers. The average Benefits Value Index (BVI) score is 7.1, consistent with last year and up from 6.8 when the Index was established in 2013. Employees believe their benefits positively impact their financial security, and they feel they need help. Only 3 in 10 workers feel financially secure and this study shows what little security they feel hinges -- to a large degree -- on the insurance and savings benefits they receive at the workplace. Given their reliance on workplace benefits for overall financial preparedness, it's not surprising employees believe that employers have a responsibility to offer core insurance and retirement benefits to workers. Without those benefits, most say they would face financial hardship." (Guardian)
All Eyes on Regulators: How Will They Respond to Massive Health Insurer Mergers?
"Industry groups such as the American Hospital Association ... indicated they wanted regulators to heavily scrutinize the [Aetna-Humana] deal's impact on providers and consumers ... Multiple state officials also have indicated they intend to review the deal's effect on competition, and now that [the Anthem-Cigna agreement means] there are two deals in the works, federal regulators are likely to consider the effects of both mergers together." (FierceHealthPayer)
Supreme Court Decision on Same-Sex Marriage: Impact on Benefit Plans
"[P]lan documents, summary plan descriptions (SPDs), administrative processes and enrollment systems should be updated to reflect the Supreme Court's recent decision, which affects COBRA, the Family Medical Leave Act (FMLA) and the Health Insurance Portability and Accountability Act (HIPAA), as well as the treatment of health reimbursement accounts (HRAs), health savings accounts (HSAs) and flexible spending accounts (FSAs). Cafeteria plans must be updated to allow pretax contributions and apply the same midyear status change rules for all legally married couples.... Although employers are not legally required to cover spouses under their group health plans, covering opposite-sex spouses but not same-sex spouses could be considered discriminatory." (Towers Watson)
How Congress Can Prevent Big Health Care Cost Increases for Small Business
"Next year, the ACA will define employers with 51 to 100 workers as 'small businesses' for purposes of buying health coverage. Historically, these firms have been included in the large-group market.... Sixty-four percent of those in the newly redefined small-group market would see an 18 percent premium increase, on average. Some employers could easily see premiums jump 35 percent or more.... The Protecting Affordable Coverage for Employees Act (PACE Act), sponsored by Rep. Tony Cardenas (D-Calif.), would leave the definition of small employer up to the states." (U.S. Chamber of Commerce)
Reducing Employee Hours to Avoid ACA Obligations to Offer Coverage Violates ERISA Section 510, Class Action Alleges
"[T]he plaintiff is claiming that the employer reduced her hours of work to below that which the ACA would cause her to be a 'full-time employee.' In doing so, the defendant avoided the requirement under the ACA to offer her coverage, as well as any the corresponding penalty under Internal Revenue Code Section 4980H if she were a full-time employee. In other words, the essence of the plaintiff's claim is that by reducing her hours of employment, the employer interfered with her attainment of a right under the plan to be eligible to be offered coverage under the medical plan." [Marin v. Dave & Buster's, Inc., No. 1:15-cv-03608 (S.D.N.Y. filed May 8, 2015] (Jackson Lewis P.C.)
[Opinion] ACA Moves Insurance Market from Oligopoly to Duopoly
"Only massive bureaucracies with huge compliance and legal departments are equipped to deal with the approximately 40,000 pages of the [ACA's] laws and regulations. It is crushing competition. Ultimately ... we will end up with two nationwide carriers and at that point the market will be so broken we will need the government to intervene and set the market free or turn it into a fully socialized program." (Benefit Revolution)
Anthem-Cigna Merger Could Offer Opportunities for Employers
" 'Large employers will have concerns about the merger between Anthem and Cigna because employers will be left with only three major insurers who can support large multi-state employers on a nationwide basis,' adds Brian Marcotte, president and CEO of the National Business Group on Health.... 'The merger may rebalance provider negotiation leverage in Anthem's favor after years of provider consolidation that has gone pretty much under the radar screen,' Marcotte says. 'And employers will want to see the additional negotiating leverage, coupled with efficiencies of scale, translate into better pricing for them and employee plan participants.' " (Employee Benefit News)
[Opinion] What the 'Cadillac Tax' Accomplishes -- And What Could Be Lost in Repeal
"Repealing the Cadillac tax would be a significant setback to efforts to curtail tax breaks and other policies that, while popular, encourage overuse of the health-care system or favor inefficient health-care providers. Tweaking or replacing the tax with an alternative that accomplishes the same goals is a possibility, though finding one that would raise as much money will be hard. Abandoning it would be a worrisome sign that political timidity dooms almost any policy to slow the growth of health-care spending." (The Brookings Institution)
Employee Benefits in the United States, March 2015 (PDF)
"Retirement benefits were available to 66 percent of private industry workers in the United States in March 2015 ... Employer-provided retirement benefits were available to 31 per cent of private industry workers in the lowest wage category (the 10th percentile). By contrast 88 percent of workers in the highest wage category (the 90th percentile) had access to retirement benefits.... The share of premiums workers were required to pay for their medical coverage varied by bargaining status. Private industry nonunion workers were responsible for 23 percent of the total single coverage medical premium, whereas the share of premiums for union workers was 13 percent." (U.S. Bureau of Labor Statistics [BLS])
Anthem Announces It Will Buy Cigna to Create New Health Insurance Giant
"A merged company would serve 53 million people and is part of a dramatic, long-predicted reshaping of the health insurance landscape as a result of the Affordable Care Act. UnitedHealthcare has 45 million members, and Humana and Aetna announced they would merge in July, creating a company serving 33 million people. The new company is projected to generate $115 billion in annual revenues." (The Washington Post; subscription may be required)
[Guidance Overview] CMS Resources for ACA Section 1332: State Innovation Waivers
"Section 1332 of the Affordable Care Act (ACA) permits a state to apply for a State Innovation Waiver to pursue innovative strategies for providing their residents with access to high quality, affordable health insurance while retaining the basic protections of the ACA.... [T]he Secretaries are authorized to waive: [1] Part I of Subtitle D of Title I of the Affordable Care Act (relating to establishing qualified health plans (QHPs)); [2] Part II of Subtitle D of Title I of the ACA (relating to consumer choices and insurance competition through health insurance marketplaces); [3] Sections 36B of the Internal Revenue Code and 1402 of the ACA (relating to premium tax credits and cost-sharing reductions for plans offered within the marketplaces); [4] Section 4980H of the Internal Revenue Code (relating to employer shared responsibility); and [5] Section 5000A of the Internal Revenue Code (relating to individual shared responsibility)." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
Anthem to Buy Cigna -- and Then There Were Three
"While not yet a single-payer system, consolidation is causing the system to look more like a small oligarchy.... The consolidation is quite frightening for smaller providers of all sorts as it leaves them with fewer access points for patients. The leverage of providers with payers will take a significant hit.... The consolidation is unlikely to reduce employer costs or really bend the cost curve[.]" (Becker's Hospital Review)
Using Onsite Health Centers to Help Build High Performance Health Care Programs
Infographic. "Insights from the 2015 Employer-Sponsored Health Care Centers (ESHC) Survey[:] Some employers are renewing their focus on ESHCs to help improve the performance of health care programs for active employees. Here's how: Establish clear objectives ... Maintain or expand commitment ... Offer a broad range of services ... Outsource operations ... Define patient base ... Measure performance." (Towers Watson)
[Guidance Overview] Departments Publish Final Rules for Preventive Services Under the ACA
"The final rule makes three changes to the governing regulations: [1] If a plan's network does not have a provider who can provide a required item or service, the plan must cover that item or service when provided or performed by an out-of-network provider, and may not impose cost sharing for that item or service.... [2] [P]lan sponsors may continue to rely on the relevant clinical evidence base and established reasonable medical management techniques, and do not generally have to defer to the recommendations of a treating physician.... [3]  [O]nce the underlying guideline or recommendation has been changed.... plan sponsors [generally must] continue to provide the coverage (without cost sharing) through the end of the plan year[.]" (Sibson Consulting)
[Guidance Overview] Agencies Define the Closely Held, For-Profit Employers That May Invoke Accommodations for Religious Objections to Contraception
"The new regulations make the accommodation available to a for-profit entity that is closely held ... [which,] for this purpose, means: [1] No ownership interest in the for-profit entity is publicly traded; and [2] More than 50 percent of the value of the for-profit entity is owned directly or indirectly by five or fewer individuals (or a 'substantially similar' ownership structure applies). This change is effective for plan years beginning on or after September 14, 2015." (Lockton)
[Guidance Overview] IRS Finds HRA Contributions for Retirees and Dependents Were Exempt from Gross Income
"Contributions made by the taxpayer to the retiree HRA on behalf of eligible retirees, spouses, and eligible dependents that were used exclusively to pay for eligible medical expenses were excludable from the retirees' gross income under Code Sec. 106. Further, contributions made to the retiree HRA on behalf of eligible retirees, spouse and eligible dependents were not wages subject to FICA taxes ... FUTA taxes ... or income tax withholding ... The taxpayer represented that amounts in the retiree HRA would only be used to reimburse health insurance premiums and medical expenses[.]" [IRS Private Letter Ruling 201528004, dated Apr. 6, 2015, released Jul. 10, 2015] (Wolters Kluwer Law & Business)
Using HRAs to Pay Insurance Premiums: Proposed Legislation Aims to Bring Back Popular Obamacare Workaround
"The Small Business Health Relief Act would allow some firms to use stand-alone HRAs, plans that contributes un-taxed money an employee can use to pay for insurance premiums.... Specifically, the bill would: [1] Ensure small businesses and local municipalities with fewer than 50 employees are allowed to continue using pre-tax dollars to give employees a defined contribution for healthcare expenses; [2] Allow workers to use HRA funds to purchase health coverage on the individual market and for qualified out-of-pocket medical expenses if the employee has qualified health coverage; and [3] protect employers from being financially penalized for providing this cost-sharing option to employees." (HR Benefits Alert)
Health Plan Trends: Costs and Strategies for Containment (PDF)
9 pages. "Health care cost is a significant burden for most employers. Employers primarily control cost by shifting cost to employees through plan design or increased employee contributions. At some point, employers may also want to consider other strategies to control cost. New tools may soon be available to help. These could include: [1] Population health management. [2] Payment based on episodes of care or reference-based pricing. [3] Alternative care delivery options, with a focus on the least costly venue, such as telemedicine." (Marsh & McLennan Agency LLC)
[Guidance Overview] IRS Offers Rules of the Road for Cadillac Plan Tax
"[IRS Notice 2015-16] offers insight into the view the IRS has of the statute and how this view will influence its approach to future rulemaking. It proposes answers to several implementation questions regarding Code section 4980I that remained unanswered following the enactment of PPACA but are necessary for employers to calculate potential liability under Code section 4980I ... [This article] contains a brief overview of the Notice, which highlights certain key information and identifies steps that employers should consider taking at this stage of the regulatory process. [It also includes] a more detailed summary of the proposed approaches outlined by IRS in the Notice." (Sutherland Asbill & Brennan LLP)
Supreme Court Same-Sex Marriage Ruling Likely to Require More Changes to Benefit Plans and Payroll Practices (PDF)
"[The authors] are expecting some states to provide express guidance regarding when an employer may and/or must stop imputing income (including possibly on a retroactive basis) with respect to employer-paid same-sex spousal coverage. In the absence of such guidance, it appears employers should cease imputing income on a prospective basis in light of the Court's holding.... Claims for retroactive benefits may emerge or increase as a result of the Court's holdings in Windsor and Obergefell." (Groom Law Group)
Action Steps for Automotive Employers After Supreme Court Repudiates Vesting Presumption for Retiree Health Care
"In the past, automotive employers have avoided modifying or eliminating these benefits due to fear of protracted and expensive litigation.... Given the more favorable environment for changes or elimination of legacy retiree health care benefits, here are some practical strategies employers can use to eliminate vesting and control the duration and cost of retiree health care benefits.... Plan document/summary plan description ... Collective bargaining strategies ... Settlement strategies ... HRA for future retirees only" (Warner Norcross & Judd LLP)
The 'Cadillac Tax' -- What Employers Need to Know (PDF)
"What plans will be subject to the Cadillac Tax? ... What's included in the aggregate value of a medical plan ... How are HSA contributions calculated? ... Do employers pay tax on the total value of the plan? ... Who is responsible for calculating a company's plan value and tax liability ... What should employers do if they think their plan will be subject to the Cadillac Tax? ... Why offer supplemental benefits?" (Unum)
Nondiscrimination in Coverage of Alternative Health Care: States Stepping Up
"The national associations of integrative health care providers such as the naturopathic physicians, chiropractors, and acupuncturists have repeatedly asked the HHS for explicit examples of what constitutes discrimination and what does not. The revised FAQ released at the end of May is thought to be an improvement over the original and may give state insurance commissioners more leeway to act, but it does not contain any such examples.... For the remainder of 2015 and going into 2016, expect to see continued coalescence of integrative health providers in the states, including participation by patient groups that will replicate the legislation in Oregon and in Rhode Island[.]" (Altarum Institute)
Five Ways to Make Shopping for Health Insurance Easier
"New health benefit models available under the ACA open up affordable health insurance alternatives to [small and medium businesses (SMBs)]. But new options can also leave business executives with more questions than answers.... [1] Understand the value of health benefits.... [2] Set a budget.... [3] Are you on the hook for the ACA employer mandate? ... [4] Evaluate your options.... [5] Determine which type of plan works best for your business." (Entrepreneur)
Health and Welfare Benefits for Same-Sex Spouses After Obergefell: A New Mandate for Employers?
"[P]ost-Obergefell, the EEOC reaffirmed its position that discrimination based upon sexual orientation is unlawful discrimination 'based on sex' under Title VII ... [If] a private sector employer decided to offer health insurance benefits to opposite-sex spouses but not same-sex spouses, it seems very likely the EEOC would take the position that such a practice is unlawful sex discrimination under Title VII." (Bradley Arant Boult Cummings LLP)
Clinic Network with a Health Plan Looks to Upend Entrenched System
"At 28 neighborhood clinics and 'advanced care studios' in Portland, Vancouver, Washington, and Seattle, Zoom patients get team-based care from MDs, NDs, NPs, and PAs, with same day appointments, telemedicine, health coaching, food and exercise counseling, parenting help, mental health treatment and basic dental services, which will all come as part of the health plans." (Healthcare Payer News)
Major Health Insurers Capitalize on Population Health
"[D]espite ... hurdles, providers are embracing payers' plans to help them implement alternative payment models... UnitedHealth's health services platform Optum -- whose offerings are sold to various doctors, insurers and self-insured employers -- racked up $26.4 billion in the first half of 2015, growing 15 percent year-over-year.... Aetna, meanwhile, has invested more than $1.5 billion in its population-health-driven Healthagen business ... And the company expects Healthagen's growth to accelerate when it combines with Humana, which boasts its own population health management businesses under the Transcend brand." (FierceHealthPayer)
Millennials -- the 'Digital Natives' -- Are Changing Health Care
"[M]illennials are willing to change their behavior to get better service or a better price.... 54 percent will delay health care due to its cost, compared to 18 percent of seniors. 46 percent are willing to switch providers for price reasons. 43 percent are willing to go out-of-network for care. 56 percent are willing to wait a few days when seeking care for a child." (The Alliance)
Private Exchanges Bring More Health Plan Choices at Work. What's the Catch?
"Despite the benefits to a company's bottom line, and more choices for employees, ... relatively few businesses [are] using a private health insurance exchange. According to research by the Kaiser Family Foundation, last year only 3 percent of employers (excluding the federal government) insure their employees this way. But it's a trend that some experts expect to pick up steam soon." (National Public Radio)
The Latest Pharmacy Data and Insights for Public Exchange Plans (PDF)
35 pages. "[E]xchange members continue to use their prescription drug benefits. Their significant use of specialty medications continues to drive up plan and individual costs. However, new enrollees are demonstrating signs of broader market engagement as they are younger with a relatively lower prevalence of specialty conditions, such as HIV. If trends continue in this direction, these younger, healthier members will prove beneficial for managing overall health plan risk." (Express Scripts)
Congress Wows with Medicare Telehealth Parity Act of 2015, But Will It Succeed?
"Containing three implementation phases over a four year horizon, the Act proposes changes to Medicare telehealth payment methodologies and expands coverage not only to residents of rural areas, but urban areas as well." (Foley & Lardner LLP)
[Opinion] DOL Shatters the American Dream
"The practical effect of [Administrator's Interpretation 2015-1] will be to deprive many individuals of the freedom to be self-employed.... This new Interpretation affects every employer utilizing the services of independent contractors. The potential adverse consequences of misclassification can be severe. An employer confronted with an adverse DOL decision may be liable for payroll taxes, overtime payments, and other taxes and back benefits for a period of two or more years." (The Lowenbaum Partnership, LLC)
The Oregon Health Insurance Experiment
"This brief summarizes findings of the Oregon Health Insurance Experiment, a randomized controlled study made possible by a unique lottery process used in 2008 to expand Medicaid coverage in the state. The study addresses many of the issues being considered by policy makers, including take-up rates and characteristics of enrollees; use of health services; health outcomes and measures of well-being; enrollee finances and medical debt; as well as indirect societal effects on labor markets, private insurance coverage, and participation in other public programs." (Health Affairs)
The Evolving Rationale for Consolidation in Health Care
"Historically, mergers and acquisitions have been motivated by acute financial distress, clinical deficiencies, or capital needs. While these factors remain relevant, recent activity appears to be focused on repositioning for a value-based healthcare system. Consolidation is now driven at least in part by a desire to access new competencies, and is more proactive than defensive. In fact, many hospitals and health systems are combining from a position of strength." (Healthcare Financial Management Association [HFMA])
Satisfaction With Health Coverage and Care: Findings from the 2014 Consumer Engagement in Health Care Survey
"The overall satisfaction rate among consumer-driven health plan (CDHP) enrollees increased in most years ... while it decreased in most years among enrollees in traditional health care plans. Differences in out-of-pocket costs may have explained some of the differences in overall satisfaction rates.... Satisfaction with out-of-pocket health care costs has been trending upward among CDHP enrollees. CDHP and HDHP enrollees were found to be less likely than those in a traditional plan both to recommend their health plan to friends or co-workers and to stay with their current health plan if they had the opportunity to switch plans." (Employee Benefit Research Institute [EBRI])
Exchange Plans Include 34 Percent Fewer Providers Than the Average for Commercial Plans
"[E]xchange plan networks include 42 percent fewer oncology and cardiology specialists; 32 percent fewer mental health and primary care providers; and 24 percent fewer hospitals. Importantly, care provided by out-of-network providers does not count toward the out-of-pocket limits put in place by the ACA." (Avalere Health)
[Guidance Overview] Agencies Issue Final Regs on Preventive Services Mandate, Including Contraceptive Coverage Accommodation
"The guidance about what constitutes a closely held business should help employers that object to providing contraceptive services under their health plans determine if they are eligible for the accommodation. Before eliminating any coverage, however, they should remember to address any administrative issues, such as providing notice of the modification ... And there may be more to come -- the preamble indicates that the agencies are continuing to explore options for funding contraceptive services where an accommodation is requested." (Thomson Reuters / EBIA)
Wal-Mart Sued for Retroactive Availability of Spousal Benefits for Same-Sex Spouses
"The lawsuit seeks compensation for medical expenses for the years in which Dee was denied spousal coverage.... The suit argues that because Wal-Mart would have provided Jackie with coverage for her wife [Dee] if she had been a man, failing to provide it because she is a woman constitutes sex discrimination.... The EEOC's Strategic Enforcement Plan (SEP) ... lists 'coverage of lesbian, gay, bisexual and transgender individuals under Title VII's sex discrimination provisions, as they may apply' as an enforcement priority for FY2013-2016. In Jackie's case, the EEOC issued a final determination on January 29, 2015 that Wal-Mart's failure to provide spousal coverage of Dee constituted sex discrimination." (Calhoun Law Group, P.C.)
The ACA Contraceptive Coverage Controversy, Made Simple
"Almost no observer of this legal saga expects [the recently-issued final regulations] to be the end of the matter. The main reason for that skepticism is that the rules do keep the religious institutions in the mix: they have to do something to get the protection they want.... That is basically a legal as well as a theological and moral argument, and, in its legal form, is a claim under the federal Religious Freedom Restoration Act that the institutions' lawyers have been using in the court cases. They had remarkable success in the federal trial courts -- the district courts -- where they won more than eighty percent of the time. But, when the cases have reached the federal appeals court level in the wake of the Supreme Court's Hobby Lobby ruling, the institutions' objections have been turned aside each time, so far." (SCOTUSblog)
Tenth Circuit Upholds HHS Procedures for Opting Out of Contraceptive Coverage
"[The Court] found that the nuns could opt out of a requirement to provide contraceptive coverage under an 'accommodation' devised by the administration. The rule does not impose a 'substantial burden' on the nuns' free exercise of religion, the court said. Four other federal appeals courts -- in the District of Columbia, Philadelphia, Chicago and New Orleans -- have issued similar decisions upholding the accommodation ... The court rejected the Little Sisters' assertion that this arrangement imposed a substantial burden in violation of the Religious Freedom Restoration Act of 1993." [Little Sisters of the Poor v. Sebelius, No. 13-1540 (10th Cir. July 14, 2015)] (The New York Times; subscription may be required)
Exactly When May Employers Cut Off Medical Coverage to Adult Dependent Children?
"Small employers are not subject to penalties under PPACA's adult coverage mandate if they do not offer dependent coverage at all, or terminate dependent coverage on the child's 26th birthday; but large employers that are subject to the employer mandate are subject to penalties if they do not offer dependent coverage to the children of their full-time employees through the entire month in which the dependent attains age 26." (Benefit Revolution)
HSA Balances, Contributions, Distributions, and Other Vital Statistics, 2014 (PDF)
28 pages. "Enrollment in HSA-eligible health plans is estimated to be about 17 million policyholders and their dependents, and it has also been estimated that there are 13.8 million accounts holding $24.2 billion in assets as of Dec. 31, 2014. Almost 4 in 5 HSAs have been opened since the beginning of 2011. The average HSA balance at the end of 2014 was $1,933, up from $1,408 at the beginning of the year. Average account balances increased with the age of the owner of the account.... About 6 percent of HSAs had an associated investment account.... Four-fifths of HSAs with a contribution also had a distribution for a health care claim during 2014." (Employee Benefit Research Institute [EBRI])
The Consumer Finance of Health Savings Accounts (PDF)
24 pages. "More than 40 percent of HSA account holders save nearly all of their annual contributions within a 12-month period. About 30 percent of account holders spend nearly all of their contributions. The remaining account holders spend or save in relatively equal proportions.... Only 4 percent of account holders eligible to invest their HSA balances actually chose to invest.... The median account holder with an employer contribution defers over 200 percent more into an HSA than the median account holder without an employer contribution ... About 5 percent of account holders contributed the maximum amount allowed by the IRS to their HSA[.]" (HelloWallet)
[Guidance Overview] Reminder: Non-Grandfathered Plans Must Implement Embedded Out-of-Pocket Maximums
"[A]s employers plan for 2016 open enrollment, they must ensure that their benefit structures are consistent with this new rule. This includes updating their summary plan descriptions and contacting their vendors to ensure that the administration is consistent with this rule. Particular attention must be paid to non-grandfathered high deductible health plans (HDHPs), to which this new rule also applies. High deductible plans often have no embedded limit, applying the family out-of-pocket maximum to all family members in the case of family coverage." (Proskauer's ERISA Practice Center)
Health Plan Networks and Specialty Hospitals
"Consumers have access to specialty hospitals through health plan contracts with these facilities, centers of excellence, and processes to access out-of-network care when necessary. A recent AHIP analysis found striking differences between the average charges of specialty versus non-specialty hospitals for many routine procedures. Maintaining flexibility for health plans to design their provider networks is essential to promoting access, affordability, and value for consumers." (America's Health Insurance Plans [AHIP])
[Guidance Overview] Final Rules Issued on Coverage of Preventive Services
"[T]he final regulation continues to provide that when a recommended preventive [service] is not billed separately or tracked separately from an office visit, plans may look to the primary purpose of the office visit to determine whether cost sharing may be imposed ... [The final regulation] provides that a plan must provide coverage for recommended preventive items and services for the entire plan year, even if the recommendation or guideline is changed during the year ... Plans do not need to make changes to coverage and cost sharing requirements based on a new recommendation or guideline until the first plan year beginning on or after the date that is one year after the new recommendation or guideline goes into effect." (The ERISA Industry Committee [ERIC])
[Opinion] Paying the Deductible Year After Year
"Of health plan members or their family members who were in the top 10 percent of spending in a given year, 43 percent were still in the top 10 percent the following year, and an astonishing 34 percent were still in the top 10 percent five years later.... When you think about the financial protection that you should be receiving from your health plan, it is deplorable that one-third of those who have the greatest needs for health care are exposed to years of recurrent, persisting financial burdens simply because of the fundamentally flawed design of our private health plans." (Physicians for a National Health Program [PNHP])
[Opinion] Will Competition Arise for Multi-State Health Plans? (PDF)
"This article describes what the law says and does through the [multi-state plan (MSP)] program, the possible effect on health insurance markets, recent regulatory changes to the MSP program, and possible effects of the changes. [The authors] aim to shed light on a program within the ACA that, contrary to its intended purpose, could damage competition. [They] also explore the possible effect of recent regulatory changes that may contribute to more or less competition in health insurance markets." (Cato Institute)
Benchmarking Study on Trends in Advisory Firm Hiring, Typical Employee Benefits, and Average Advisor Compensation
"[T]he most common employee benefit is the typical offering of vacation time, offered by a reported 90% of firms (along with 81% who provide sick time, 57% that provide bereavement leave, and 46% offering maternity leave).... From there, the next most common employee benefit was health insurance, offered to staff in 75% of advisory firms (and paired with a Health Savings Account in 33% of firms, and a Flexible Spending Account in 25% of firms).... When it comes to employer retirement plans, there were 67% of firms offering a 401(k), another 14% of firms using a SIMPLE IRA, 10% providing a pension, and 3% using a SEP IRA.... the next most common employee benefit was covering the cost for licensing and exam fees, at 68% of firms, followed closely thereafter by financial support for professional development (e.g., conferences) at 61%, and financial support for designations/technical training at 56%." (Michael Kitces in Nerd's Eye View)
Healthcare Packages Likely to Be Revised in Automaker/UAW Contract Negotiations
"Health care costs will be a central issue in the talks, as the automakers face paying a so-called 'Cadillac tax' of 40 percent on rich UAW medical plans starting in 2018." (Reuters)
The Crackdown and Costs of Independent Contractor Misclassification
"Over the last half-dozen years, employers have seen a crackdown on the misclassification of employees as independent contractors. Part I of this article will first address how this form of misclassification has arisen and what its consequences are for companies caught in the crackdown. Part II will next detail how regulators, legislators, plaintiffs' class action lawyers and union organizers have sought to counter businesses that are believed to engage in independent contractor misclassification. Finally, Part III will discuss how businesses can minimize or avoid the risks of this type of misclassification." (Pepper Hamilton LLP)
Governmental Plans: Moving Forward After the Obergefell Decision
"The Obergefell decision will now impact state level eligibility and benefit plan designs that are not governed by the qualification requirements of the Internal Revenue Code.... [T]he Supreme Court relied on the Fourteenth Amendment to find that state laws prohibiting same-sex marriage was unconstitutional.... For governmental plan administrators that have not yet extended same-sex spousal coverage under their health and welfare plans, the time may be ripe to consider amending these plan provisions." (Ice Miller LLP)

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