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Health plans - design


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CBO Releases Report on Private Health Insurance Premiums and Federal Policy
"The CBO report examines the effect of 10 ACA regulations on insurance premiums. The CBO estimates that the individual mandate will have a significant effect on lowering premiums, by as much as 20 percent, because it drives healthy individuals into health insurance markets.... The CBO projects, on the other hand, that the employer mandate will not have a noticeable effect on premiums, as it will simply shift individuals from the non-group to the group market and does not increase the size of the pool." (Health Affairs)
Private Health Insurance Market Reforms in the ACA (PDF)
23 pages. "This report provides background information about the private health insurance market, including market segments and regulation. It then describes each ACA market reform. The reforms are grouped under the following categories: obtaining coverage, keeping coverage, cost of purchasing coverage, covered services, cost-sharing limits, consumer assistance an d other health care protections, and plan requirements related to health care providers. The Appendix provides details about the types of plans that are required to comply with the different reforms." [Report No. R42069, Feb. 10, 2016.] (Congressional Research Service [CRS])
The Ongoing Saga of the ACA Contraceptive Mandate: Where Are We Now? (PDF)
"This very public debate that has involved federal authorities, the Supreme Court, interest groups and individuals has left many confused about where the mandate comes from, what it says and how it applies to different groups. In this white paper, [the authors] attempt to combine and summarize the complex and many times disjointed answers federal authorities have provided to these important questions." (Lockton)
Obama Administration Budget Proposals Would Again Impact Retirement and Health Benefits (PDF)
"[T]he 2017 package ... includes several new items of significance, including proposals to: [A]mend [ERISA] to permit unaffiliated employers to adopt a defined contribution multiple employer plan (MEP) that would be treated as a single plan for purposes of ERISA.... Account for geographic variation by increasing the threshold for the 'Cadillac Tax' ... Give the [PBGC] the authority to adjust premiums for multiemployer plans ... [P]rovide $6.5 million to allow three states to pilot and evaluate state-based 401(k)-type programs or automatic enrollment IRAs ... [P]rovide $100 million in new funding through the [DOL] to allow States and nonprofits to design, implement, and evaluate new approaches to expand retirement and other employer-provided benefit coverage ... [I]ncrease DOL's budget by 4.9% -- with a 64% increase for [EBSA] -- and the [IRS] budget by 12%." (Groom Law Group)
[Opinion] 'Risk Adjustment' Threatens Obamacare
"Risk adjustment is intended to smooth out the unpredictability of the health insurance marketplace ... While well-intended, the implementation of this safeguard has had the unintended consequence of ... taking money from predominantly new, small, innovative plans ... and giving it to the big, established insurance carriers.... The simplest option is a percentage limit on risk adjustment payments assessed to insurance carriers." (Peter Beilenson, in The Baltimore Sun)
A Closer Look: Workplace Wellness Outcomes
"When it comes to measuring wellness program success ... employers are using value-on-investment (VOI) measures in addition to return-on-investment (ROI) numbers. Just over one-quarter (28%) of organizations are measuring their wellness program success with traditional ROI. Half are using at least one VOI measure to track success including employee engagement (30%), turnover (22%), absenteeism (18%), productivity (17%) and recruitment/referral rates (13%)." (International Foundation of Employee Benefit Plans [IFEBP])
[Guidance Overview] IRS Issues Private Letter Rulings on Reallocation of VEBA Assets
"IRS has released two PLRs regarding VEBA funds that were originally intended to pay for retiree health benefits but will now be reallocated to provide health benefits for active employees.... Employers interested in using this strategy, however, should keep in mind the following: [1] Legally, PLRs may only be relied upon by the recipient. [2] For ERISA-covered benefit plans, all affected benefits generally must be provided under the same ERISA plan (and the plan needs to permit reallocation) to satisfy ERISA's exclusive benefit rule. [3] Although, in the first PLR, the employer must recognize income under the tax benefit rule, this same amount may be deducted from the employer's income when it is used to fund active employees' benefits." [See PLR 201530022 and PLR 201532037.] (The Wagner Law Group)
[Opinion] It's (Not) All in the Genes (PDF)
"Once genetic testing is perfected and predictive reliability established, can we believe that their revealed knowledge will be enough to make people change? Unfortunately, knowing what is right does not mean people will do what's right.... [T]ime after time, we see human frailty trump test results.... We must be creative, determined and persistent in our employee education, and in our related efforts to foster healthy habits. We're not just fighting healthcare costs. We're fighting for people's lives." (Chelko Consulting Group)
Fiscal Year 2017 Federal Budget: The ACA's Excise Tax
"[The budget proposal would modify the Cadillac Tax] threshold to be the greater of either the current law threshold ... or a 'gold plan average premium' to be calculated and published for each state.... For health Flexible Spending Arrangements (FSAs), the cost of coverage with respect to salary reduction contributions would be defined as the average amount elected for the year by similarly-situated employees (rather than amounts actually contributed on an employee-by-employee basis)." (Segal Consulting)
[Guidance Overview] San Francisco's 2016 Minimum Health Care Spending Requirements (PDF)
"San Francisco's Office of Labor Standards Enforcement has issued the minimum health care spending requirements for 2016. The requirements apply to San Francisco employers with employees who work in the city." (Xerox HR Services)
Study: Favorable Ruling for House of Representatives in ACA Challenge Would Cost $47 Billion
"A ruling in favor of the Republican-led House of Representatives in its lawsuit challenging the [ACA's] cost-sharing reduction payments could cost the federal government $47 billion over 10 years. An analysis funded by the Urban Institute ... also determined that such a ruling could eventually cause insurers to pull out of the marketplace altogether." (Wolters Kluwer Law & Business)
[Guidance Overview] Pension and Health Plans: 2015 Year End Review (PDF)
Topics include: [1] The 'Cadillac Tax'; [2] Delayed ACA reporting; [3] Legal challenges to the ACA; [4] Repeal of automatic enrollment; [5] Expanded preventive care services; [6] Substantial hospital inpatient services and minimum value; [7] Pace Act; [8] ACA fees and penalties; [9] Nondiscrimination for fully insured health plans; [10] IRS determination letter program; [11] Form 5500 filing deadlines remain the same; and [12] NYC Commuter Benefits Law. (Schulte Roth & Zabel LLP)
[Guidance Overview] Subsidizing Student Health Insurance with Stipends: New Agency Guidance and Relief
"The guidance does not say which subsidy type arrangements create [employer payment plans (EPPs)] and which do not. All we know is that not all arrangements whereby a school subsidizes coverage under student health plans will be EPPs. It appears that, if the student is an employee, and the amounts are paid towards student health insurance coverage, then the subsidy is an EPP. If the student not an employee, then a stipend towards student health insurance coverage will not be an EPP because there is no employer-employee relationship with which to create an EPP." (Mintz Levin)
2015 in Review: ERISA Civil Enforcement Recoveries Remain Low, Criminal Investigations Continue to Rise
"The DOL reported total monetary recoveries of $696.3 million in FY 2015, an increase of $96.6 million over FY 2014. While this was a significant increase ... the total monetary results for FY 2015 still lagged behind the 15-year average of approximately $1.3 billion in annual recoveries.... In FY 2015, almost half of the $96.6 million improvement -- $46.7 million -- came from the Informal Complaint Resolution System, which has been steadily replacing Prohibited Transactions Corrected and Plan Assets Protected as the largest source of recovery." (Sutherland Asbill & Brennan LLP)
Feds Want Healthcare.gov to Become an Active Purchaser
"The proposed reforms, tucked into the 2017 Notice of Benefit and Payment Parameters released by [CMS] late last year, suggest that CMS wants to trade a wide array of plan choices on the federal exchange for more tailored options.... These standardized options for bronze, silver and gold plans would include a single provider tier, a fixed in-network deductible, a fixed annual limitation on cost sharing, and standardized copayments and coinsurance for a key set of essential health benefits ... Insurers would not be required to offer standardize options in 2017 and 'would retain flexibility to offer non-standardized plans.' " (FierceHealthPayer)
[Guidance Overview] Parity of Mental Health and Substance Use Benefits with Other Benefits: Using Your Employer-Sponsored Health Plan to Cover Services (PDF)
"If you are someone who is trying to figure out how to use your health coverage provided by your employer to pay for your mental health or substance use [MH/SU] services -- this sheet is for you.... In this document, we explain MH/SU parity, answer questions about the parity law, and provide ways to learn more. We hope you use this information to get the mental health and substance use services you and your family need paid for (either fully or partially) by your health plan." (Substance Abuse and Mental Health Services Administration [SAMHSA], U.S. Department of Health and Human Services [HHS])
San Diego Church Challenges California Abortion Coverage Mandate
"California's mandate does not include an exemption for group health insurance plans purchased by churches or other employers that have religious beliefs against abortion. Skyline claims the mandate is at odds with the way the Knox-Keene Act treats religious employers, citing an exemption that allows religious employers to opt out of providing contraceptive coverage. Religious employers are also exempt from providing health insurance coverage for infertility treatments, according to the complaint." (Courthouse News Service)
Farm Contractors Balk at Obamacare Requirements
"Contractors who provide farm labor must now offer workers health insurance are complaining loudly about the cost in their already low-margin business. Some are also concerned that the forms they must file with the federal government under the Affordable Care Act will bring immigration problems to the fore. About half of the farm labor workforce in the U.S. is undocumented." (National Public Radio)
[Guidance Overview] IRS Delays Enforcement Action Against Employers Offering Premium Reduction Arrangements in Connection with Student Health Coverage
"[T]his guidance does not grant any relief to colleges and universities who are using student health insurance coverage to satisfy the employer shared responsibility requirement to offer coverage to full-time employees or pay a potential penalty. Since student health insurance coverage is not group health plan coverage, an institution providing such coverage to graduate students who are full-time employees of the institution may also face additional penalties under the employer shared responsibility regulations." (Ice Miller LLP)
[Guidance Overview] Text of DOL Report to Congress: Improving Health Coverage for Mental Health and Substance Use Disorder Patients Including Compliance with the Federal Mental Health and Substance Use Disorder Parity Provisions (PDF)
337 pages. "Since the passage of the Mental Health Parity and Addiction Equity Act (MHPAEA), the Departments of Labor, Treasury and Health and Human Services have enforced the law, assisted consumers, and continuously clarified the responsibility of plan sponsors and insurance companies providing mental health and substance use disorder coverage.... Through investigations of employment-based plans, regulations and guidance, and outreach, the Departments strive to ensure that coverage for mental health and substance use disorder treatment is provided comparably with that offered for other medical care.... This report includes examples of situations where EBSA was able to intervene on behalf of participants and ensure that participants received coverage for the healthcare they needed." (Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL])
State Health Coverage Innovation and Section 1332 Waivers: Implications for States (PDF)
10 pages. "This health policy brief presents a number of potential waiver-associated coverage alternatives, including those being discussed by some states.... [S]tates may include multiple innovative concepts in their applications.... [E]ven with the new HHS and Treasury guidance, the analysis required to support a 1332 waiver application may require states to leverage actuarial, policy, technology, and data expertise.... If a state can show that its state law would more effectively accomplish the ACA's coverage, affordability, and regulatory goals, the law gives states the flexibility and autonomy to try new approaches." (Deloitte Center for Health Solutions)
[Guidance Overview] Health and Welfare Plans: Big Compliance Burdens, Big Penalty Exposures
"This post examines the compliance environment of health and welfare plans generally and group health plans in particular. An employer who offers benefits must also meet the requirements of a number of laws including the Affordable Care Act, ERISA, the Internal Revenue Code, HIPAA, the Public Health Service Act, and state insurance laws. These laws vary depending on the type and size of plan and may require governmental reporting, disclosures and notices to participants, administrative practices (such as claims processes) and mandated coverages.... [W]hat if an employer fails to meet its health and welfare plan legal requirements? Here are some of the key penalties[.]" (Mintz Levin)
A Comparison of the Availability and Cost of Health Care Coverage for Workers in Small Firms and Large Firms
"This brief expands on information presented in the 2015 Kaiser/HRET Survey of Employer-Sponsored Health Benefits to look exclusively at differences in offer rates, plan costs, and cost sharing between small firms and large firms." (Henry J. Kaiser Family Foundation)
High-Deductible Health Plans: Effects and Alternatives
"A number of studies have shown that increasing consumers' share of costs reduces their care use.... At least some of the research so far seems to indicate that high deductibles and out-of-pocket expenses reduce use of necessary as well as unnecessary care, particularly in specific populations.... With an increased health system focus on value, one policy to more specifically target unnecessary care use may be value-based insurance design." (Robert Wood Johnson Foundation)
Federal Employees Health Benefits (FEHB) Program: An Overview (PDF)
25 pages. "This report provides a general overview of FEHB. It describes the structure of FEHB, including eligibility for the program and coverage options available to enrollees, as well as premiums, benefits and cost sharing, and general financing of FEHB. The report also describes the role of the Office of Personnel Management (OPM) in administering the program." [Report No. R43922, dated Feb. 3, 2016.] (Congressional Research Service [CRS])
[Guidance Overview] IRS Private Letter Ruling Addresses Elections to Contribute Unused Vacation to Retiree HRA or 401(k) Plan
"Prior IRS rulings have looked favorably on the automatic and mandatory contribution of unused vacation into another plan -- and a recent ruling allowed employees to choose which of two retiree medical plans would get the contribution ... However, the choice between an HRA and a 401(k) plan is a new twist.... The nondiscrimination rules could be an obstacle in other situations and for other plans (including HRAs), depending on the design." (Thomson Reuters / EBIA)
[Official Guidance] Text of IRS Notice 2016-17: Application of the Market Reforms and Other Provisions of the ACA to Student Health Coverage (PDF)
"[T]he Departments recognize that schools may need additional time to adopt a suitable alternative or make other arrangements to come into compliance. Accordingly, the Departments will not assert that a premium reduction arrangement fails to satisfy PHS Act section 2711 or 2713 if the arrangement is offered in connection with other student health coverage (insured or self-insured) for a plan year or policy year beginning before January 1, 2017 (therefore including, for example, plan years or policy years that are roughly coterminous with academic years beginning in the summer or fall of 2016 and ending in 2017)." [Also issued as EBSA Technical Release 2016-01 and as an unnumbered CMS insurance standards bulletin.] (Internal Revenue Service [IRS])
Twenty Major Companies Form New Alliance to Target Healthcare Costs
"The newly formed alliance of companies, which cover about four million people among them, plan to share information about members' employee health spending and outcomes, with an eye toward using findings to change how they contract for care. Ultimately, some members say, they could even form a purchasing cooperative to negotiate for lower prices, or try to change their relationships with insurance administrators and drug-benefit managers." (The Wall Street Journal; subscription may be required)
District Court Decision Highlights Importance of Carefully-Drafted Provider Assignment Clauses
"While the assignment conferred the Laboratories the right to collect benefits stemming from a 'collateral source,' the 'core focus' of the assignment was on the assignee's ability to recover benefits 'owed under any policy of insurance' and to pursue any rights to collect from the insurance company if for any reason the 'insurance company fails to make payments due.' Because a self-funded plan is not a form of insurance, the Court granted Cigna's motion to dismiss with respect to those claims. [This] decision is the latest in a number of cases in which a healthcare provider's ability to bring ERISA claims against insurers has turned on the language of the assignment, further underscoring the importance of careful drafting of those provisions." [BioHealth Medical Laboratory, Inc. et al. v. Conn. Gen. Life Ins. Co., No. 1:15-cv-23075 (S.D. Fla. Feb. 1, 2016)] (K&L Gates LLP)
Lawmakers Introduce Medicare Telehealth Expansion Bill
"The legislation (S. 2484) would create a program that would waive for participating providers Medicare's requirement that telehealth services occur at a qualified site and other restrictions. The 'bridge program' would require these providers to submit annual reports to the Department of Health and Human Services on how their expanded use of telehealth and other technologies affected their bottom lines. These reports would be used to prove that telehealth technologies could reduce Medicare spending under the Merit-Based Incentive Payment System (MIPS)." (Bloomberg BNA)
Employers Focus on BMI as Health Indicator, But Should They?
"Employers are pushing workers to get in shape and become more fit through workplace wellness programs. But if employers use body mass index as a yardstick for health, then that could unfairly penalize millions of Americans ... Out of a national database of more than 40,000 people, about 70 percent of people with normal weight BMIs were in the healthy range for all the other measures. So were 47 percent of people with an overweight BMI, 30 percent of those considered obese, and 16 percent of those labeled extremely obese." (MPRnews)
[Opinion] Administration's Proposed Changes to Cadillac Tax Deserve Serious Look
"The President's 2017 budget will recommend improvements in the 'Cadillac tax' -- the excise tax on high-cost health insurance plans. While some suggest repealing the tax, reforming it to preserve most of its revenues and its ability to slow health care cost growth makes far more sense." (Center on Budget and Policy Priorities)
Are Your Benefits Management Decisions Under-Informed?
"Employers have typically drawn from three main sources of information to help them plan their benefits programs.... Third-Party Consultants ... Employee Surveys ... Industry Surveys ... [T]here's a fourth method that employers can now add to their toolkit for even greater perspective: real-time, big data aggregation.... Just as Amazon and Netflix guide their users' decisions by showing them what similar users have done, revealing actual benefits enrollment activity can promote a new level of clarity in program planning." (Benefitfocus)
Regulatory Attempts to Control 'Surprise' Medical Bills
"New York's surprise medical bill law is ground-breaking, as much for its approach to resolving payment disputes between insurers and physicians as for its protection of patients. Pennsylvania's insurance commissioner recently proposed a similar approach. A proposed federal regulation would ... [protect] patients in plans offered in the ACA's marketplaces from higher out-of-network cost sharing, but not from balance billing. By excluding protection from balance billing, the federal proposal avoids having to enter the thicket of setting standards for how much out-of-network physicians should be paid." (JAMA Forum)
[Opinion] The ACA and Its Employment Effects
"[Recent] studies provide useful new information, but they do not mean, as some reporting on them seems to suggest, that there is nothing to worry about with respect to the ACA's effects on labor markets. Given the structure of the ACA, it would be hard to conclude the law would not eventually reduce hours worked or total compensation, although the magnitude of the resulting changes may be hard to detect in the U.S.'s large and complex labor markets." (Health Affairs)
[Opinion] Claims That the ACA Would Be a Job Killer Are Not Substantiated by Research
"Contrary to predictions that the ACA would reduce employment, [the authors] find that the employment-to-population ratio is 0.9 percentage points higher than expected in 2015 after accounting for trends and demographic factors. The actual employment-to-population ratio exceeds its expected value by a larger amount (1.9 percentage points) among adults with a high school education or less who are likely to have been more affected by the ACA's health insurance coverage expansions." (Health Affairs)
Small-Group Employers: Are You Facing Community Rating?
"Perhaps the biggest Healthcare Reform change is a further fine-tuning to the definition of 'small group.' For some employers this may mean an introduction to community rating.... Healthier businesses, those whose claim experience has been good in the past, will now receive higher than expected rate increases, because they are now being pooled with the less healthy employer plans." (Corporate Synergies)
Look to the Community to Build a Results-Oriented Wellness Program
"Networking with the community can help a company's wellness efforts gain momentum. Using external resources beyond workplace walls can also help companies change their views of their culture and their efforts." (The Alliance)
New York, Minnesota Opt for Low-Cost 'Basic Health Plans' to Help Some Residents Afford Coverage
"[W]hy aren't more states putting a basic health program in place? ... New York and Minnesota ... were already providing Medicaid coverage to many people now eligible for the basic health plan. For those states, and a handful of others with more comprehensive Medicaid coverage, moving residents from the Medicaid program, where the state pays about 50 percent of the cost of coverage, to the basic health program, where the state pays just 5 percent, could be an attractive proposition." (Kaiser Health News)
Healthcare -- For Here or To Go? Rising Investment in On-Demand Health Services Reflects an Appetite for Change (PDF)
"Health represents the second fastest growing on-demand segment. The number of on-demand health service companies has spiked from four in 2010, to 42 in 2014 ... Imagine the clinical benefits when diabetics or heart disease patients have low-sodium, low-fat or vitamin-rich foods delivered to their door. By combining Auto & Transportation and Household Chores, consumers can successfully 'age in place.' Even more, those in urban settings can take advantage of convenient Health services, such as in-home visits delivered to patients at home or at the office." (Accenture)
Talk to Your Participants About Using HSAs to Fund Their Retirement
"HSA contributions made pre-tax and when balances are used to pay qualified health care expenses, they come out of HSA accounts tax-free. There are no other employee benefits that work this way.... The key to building an account balance that can carry over into retirement is maxing out contributions each year and investing unused contributions so account balances can grow. If your HSAs don't offer investment funds, think about adding them in 2016." (Lawton Retirement Plan Consultants)
Healthcare Transparency: What Is It and How Do You Get It?
"It's critical that your transparency vendor provides robust pricing data across multiple markets that will offer participants a true representation of what they'll actually pay, regardless of where they live.... Look for a vendor with a simple interface ... An independent transparency tool can help eliminate consumer distrust.... Avoid transparency tools that push the concept of doctor shopping.... The only path to effective patient care is credible, risk-adjusted, measurable quality metrics sourced from a large data set ... Look for a vendor that can support your communications needs[.]" (Benefitfocus)
Google Wants to Be a Payer
"[T]here's a huge amount of interplay between patients, providers and payers. That, coupled with Google's multiple data-generating partnerships with the life sciences industry, and it's not a far cry to imagine Google having all the moving pieces under its purview to take on the role of payer." (MedCity News)
Small Groups Have Options: Professional Employer Organizations
"Professional Employer Organizations (PEOs) are a potent weapon for small groups facing costly premiums, limited networks, very high deductibles and plans with no out-of-network benefits.... Employers will soon be able to move in and out of the PEO market and change PEOs mid-year without duplicating FICA and unemployment taxes which would have had to be reset with every payroll change." (Frenkel Benefits)
[Opinion] Deferring the Cadillac Tax Kills It
"The Cadillac tax is a decidedly modest reform compared to the real solution for the underlying problem -- namely, making all health insurance premiums taxable income to the employees covered by such premiums. Nevertheless, the tax was an initial step in the right direction.... The delay of the Cadillac tax reflects an unfortunate reality: On a bipartisan basis, our elected officials denounce high healthcare costs but are in practice unwilling to take the painful steps necessary to actually control such costs." (Prof. Edward Zelinsky, OUPblog)
[Guidance Overview] IRS Complicates Health Plan Waivers of Coverage
"If an employer is currently using an 'unconditional' waiver of coverage, should it modify that practice to require an employee to show evidence of other coverage? Certainly, doing so will help to insulate the employer from some level of potential tax liability under IRC Section 4980H(b). However, if the actual amount of tax risk is minimal, the employer may want to consider whether it is worthwhile amending its policies and practices to require proof of other coverage." (Squire Patton Boggs)
Behind Fidelity's Move Into Private Exchanges
"Fidelity is taking on the role of insurance broker along with its private health exchange, while Liazon works closely with outside insurance brokers to make sure they have access to a whole host of products and services to offer the small and midsized market.... What makes Fidelity's offering a benefit to clients is that it is integrated with NetBenefits, the 401(k) side of the Fidelity business and what the plan sponsors and their employees already have access to[.]" (Employee Benefit News)
[Opinion] Health Insurance Shifts Toward Business-to-Consumer Model
"One of the biggest changes [that will be] taking place over the next few years, resulting from dramatic changes in payers' customer base, will be the shift in how payers engage and interact with their customers to protect their market share. Employers and healthcare provider organizations alike should be aware of this shift in payer strategy, as they will be affected by the consequences of those changes." (Daniel Tranotti and Nilesh Chandra, for Healthcare Financial Management Association [HFMA])
Consumer Cost-Sharing in Marketplace vs. Employer Health Insurance Plans, 2015
"[C]ost-sharing under marketplace plans remained essentially unchanged from 2014 to 2015.... [F]or people without cost-sharing reductions, average copayments, deductibles, and out-of-pocket limits under catastrophic, bronze, and silver plans are considerably higher than under employer-based plans on average, while cost-sharing under gold plans is similar employer-based plans on average. Marketplace plans are far more likely than employer-based plans to require enrollees to meet deductibles before they receive coverage for prescription drugs." (The Commonwealth Fund)
[Guidance Overview] CMS Webinar: Qualified Health Plan Updates to the AV Calculator (PDF)
33 presentation slides; dated Jan. 26, 2016.Topics include: [1] AV Calculator Updates: MOOP, Enrollment Data, Algorithms, Claims Data and Trend Factor, and User Interface; [2] AV Calculator Name Fields; [3] Plan and Benefits Template: [4] AV Calculator Macro; [5] Saving AV Calculator Screenshot; and [5] Moving Additional Benefit Design Options. (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
Study Finds 'Mortality Gap' Among Middle-Aged Whites
"From 1999 to 2014, death rates in the U.S. rose for non-Hispanic white adults between the ages of 22 and 56, peaking at about age 30 and age 50 ... Deaths from suicide and substance abuse explain about 40 percent of the 'mortality gap,' while 60 percent is tied to death rates failing to drop as expected for nearly all of the top-ranked causes of death of middle-aged whites ... 'For working-age whites -- especially 45-to-54-year-olds -- we are witnessing regression that has little precedent in the industrialized world over the past half century,' the report said." (Kaiser Health News)
Employers Are Sticking with Health Plans
"In 2013, 21% of employers with 50-499 employees said they were likely to drop their plans within the next five years; this number fell to 15% in 2014 and to just 7% this past year. Among employers with 500 or more employees, just 5% say they are likely to drop their plans, essentially unchanged from 4% in 2014." (Mercer/Signal)
Do You Have Compliance Anxiety? Understanding 'Wellness Law' Can Help
"It's crucial for an employer to know whether their wellness plan is part of a group health plan.... HIPAA nondiscrimination rules prohibit discrimination by group health plans based on 'health factors,' but make an exception for wellness programs if they follow specific rules.... [T]he issues and rules involved in wellness law are wide-ranging and still evolving." (The Alliance)
[Opinion] Fidelity Enters the Benefits Business: Why Many Others Will Follow
"Employer desire to simplify.... Demand for more and better outsourced services.... Advance of Defined Contribution Plans (aka Private Exchanges) ... Financial wellness in the workplace ... The broker commission is in play." (Joe Markland)
Health Care Surcharge for Smokers Leads to Decreased Smoking in the Workplace
"Forty-five percent of employers who have health care surcharges in place for smokers say employee smoking in the workplace decreased since the policy was implemented, according to a Society for Human Resource Management (SHRM) survey. Approximately one-fifth of survey respondents (18 percent) impose smoking surcharges, which result in higher health care premiums for smokers. In addition, about one-half of respondents (54 percent) are providing smokers with wellness information on the benefits of a smoke-free lifestyle." (Wolters Kluwer Law & Business)
The Implications of a Finding for the Plaintiffs in House v. Burwell (PDF)
"In 2016, the case House v. Burwell will be decided in the United States district court of the District of Columbia.... [T]he House of Representatives claims that the cost-sharing reductions the Obama administration paid to low-income enrollees ... in Marketplace coverage were inappropriate because Congress had not made a specific line-item appropriation to do so.... [If the plaintiffs are successful,] premiums for silver Marketplace plans would increase $1,040 per person on average. This premium increase would, on average, make silver plan premiums higher than those of gold plans ... [and] lead to higher federal payments for Marketplace tax credits because such payments are tied to the second-lowest-cost silver plan premium.... Marketplace enrollment would decrease by 1.0 million people because enrollees ineligible for tax credits could find less expensive coverage elsewhere, and federal government costs would increase $3.6 billion in 2016 ($47 billion over 10 years).... [T]he change would also reduce the number of people uninsured by approximately 400,000." (Urban Institute)
Drug Costs, Risk Adjustment Drive 2016 Q2 Health Insurance Rate Increases
"Most insurers said they were unable to exercise any control on manufacturers' prices, and that their premiums had to take continued cost growth into account. Specialty drugs were a particular area of concern.... Many carriers cited the ACA risk adjustment requirement as a cost driver. The testimony identified pay-outs under this formula as affecting premium rate setting, contributing to a competitive disadvantage for small insurers, and generally affecting the ability to set accurate prices because of the variability in risk adjustment pay-outs/pay-ins each year." (Mintz Levin)
Task Force Urges Doctors to Screen All Adults for Depression
"All adults, including pregnant women and new mothers, should be screened for depression as a routine part of health care, a government advisory group recommended Tuesday.... The second part of the recommendation from the U.S. Preventive Services Task Force is more difficult -- ensuring systems are in place to properly diagnose and treat people identified through screening." (The Washington Post; subscription may be required)
CBO Report: Obamacare Will Enroll 40% Fewer Than It Predicted Last Year
"[B]uried deep inside [a new CBO report] was the revelation that the best, least partisan experts available were off by nearly half in their evaluation of PPACA's ability to cover the uninsured.... The CBO further projects that the number of people receiving taxpayer handouts to buy Obamacare plans will be higher than expected. Roughly 11 million people are expected to receive subsidies this year, compared to about 8 million people last year." (Benefit Revolution)
[Opinion] ERISA Industry Committee Engages EEOC on Proposed GINA Regs
"ERIC appreciates and supports the Commission's efforts to clarify how its rules will affect employer-sponsored wellness programs and is especially encouraged by its attempts to align the GINA Title II permissible reward limits with those of the Affordable Care Act (ACA). However, ERIC members continue to have serious concerns with respect to where these rules diverge." (The ERISA Industry Committee [ERIC])

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