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Four Years Into a Commercial ACO for CalPERS: Substantial Savings and Lessons Learned
"In 2007, Blue Shield of California, along with provider and employer partner organizations, began exploring development of one of the first ACO-like programs in the country to serve Commercial patients. It launched in 2010 ... Of particular note has been overall cost of health care savings reported at gross savings of more than $105 million, with net savings of $95 million to CalPERS members, since 2010. [In this article] the partners illuminate the ACO's future directions and offer lessons for other organizations considering development of an ACO delivery system for the Commercial market." (Glenn Melnick and Lois Green in Health Affairs Blog)
Update on the Basic Health Program
"Currently, only a few states have shown an interest in implementing a Basic Health Program. Some states have studied the option, and seven states -- California, Massachusetts, Minnesota, New York, Oregon, Rhode Island, and Washington -- and the District of Columbia are part of a discussion group sponsored by CMS on topics related to the Basic Health Program, including funding, eligibility, and enrollment. In the final rule, CMS estimated that a total of three states would create a Basic Health Program over the next five years." (Health Affairs Blog)
Characteristics of the Population with Consumer Driven and High Deductible Health Plans, 2005-2013
"The population of adults within consumer-driven (CDHPs), high-deductible (HDHP) and traditional health plans was split about 50-50 between men and women in 2013. The CDHP population was more likely than traditional-plan enrollees to be in households with $150,000 or more in income in every year except 2006, 2009 and 2010. They were also more likely to be in households with $100,000-$149,999 in income in most years. CDHP enrollees were roughly twice as likely as individuals with traditional coverage to have college or post-graduate educations in nearly all years of the survey." (Employee Benefit Research Institute [EBRI])
Obamacare and the Early Retiree: Health Law Offers Relief
"The system was designed to make health-care costs comprehensive and affordable at all income levels. Right or wrong, by ignoring assets as a criteria, the system can also provide benefits for those who are relatively affluent. Whether or not the early retiree is eligible for subsidies or prefers to shop outside the exchanges, advisors now have better tools for predicting future health-care costs than in the past." (Morningstar Advisor)
Report and Recommendations for Price Transparency in Health Care
24 pages. Excerpt: "Transparency tools for insured patients should include some essential elements of price information, including: [1] The total estimated price of the service; [2] A clear indication of whether a particular provider is in the health plan's network and information on where the patient can try to locate a network provider; [3] A clear statement of the patient's estimated out-of-pocket payment responsibility; [and] [4] Other relevant information related to the provider or the specific service sought (e.g., clinical outcomes, patient safety, or patient satisfaction scores)." (Healthcare Financial Management Association [HFMA])
California Makes It Harder for Insurers to Deny Autism Treatment
"In tightening its rules on covering behavioral intervention for children with autism, California is tackling a problem encountered by numerous states seeking to improve access to therapies for children with autism ... The new rules make it clear that insurers must cover behavioral interventions for children with autism at the same level that they cover visits to a medical doctor[.]" (Reuters)
Provider Sponsored Health Plans: Five Necessities for Launching a Successful Plan
"[H]ospitals are discovering [that] serving as both provider and insurer often gives them the best chance to lower the cost of care, prevent unnecessary hospitalizations through patient tracking, unearth new market share potentials, and truly create a healthier community. What's more, they know that if done properly such a strategy will allow them to capture and retain dollars that otherwise would end up in the pockets of the insurance companies with whom they have historically contracted and often battled." (Advance Healthcare Network)
[Guidance Overview] Same-Sex Marriage Developments: Recent Guidance from CMS and HHS (PDF)
"This FAQ addresses a requirement for issuers of health insurance, not employer group health plans or employers. Employers are free to control the terms and conditions of the group health plan. The FAQ reiterates that [the ACA's guaranteed availability requirement] does not direct the definition of spouse and the terms of eligibility for group health plans. If a group health plan chooses to offer coverage to same-sex spouses, this FAQ clarifies that an issuer may not decline to cover that same-sex spouse on the same terms and conditions as opposite-sex spouses." (Buck Consultants)
Analysis of Enrollment, Premiums and MLR by Product (Individual, Small Group and Large Group) and by State for Every Health Plan
199 pages. Excerpt: "[The] industry still lost 2.0 million risk lives in 2012, as commercial risk enrollment fell from 80.5 million to 78.5 million, a drop of 2.5%. The drop reflects the significant attraction many employers have for non-risk products....[S]ince 2002, risk enrollment at the publicly traded plans has fallen by over 14 million lives on an organic basis ... [L]osing 2 million risk lives hurts revenue by $8 billion, while the enrollment decline hurts potential commercial risk earnings by an estimated $400 million ... Despite losing 2 million lives, commercial risk premiums still increased in 2012, albeit by only 0.2%, to $317 billion." (CitiResearch)
New York Court Guts a Unique Health Care Fund for Taxi Drivers
"In 2012, the city's Taxi and Limousine Commission had voted to take six cents on every fare for a fund that would ... [provide] upwards of $300 per week in assistance as soon as a driver could produce a doctor's note.... [T]he approach of creating a communal benefits pool to supplement commercial plans by levying independent workers in a regulated industry is actually unique, and an example of how alternative labor groups can provide services for people who aren't represented by traditional unions.... The court decision is a serious blow, and makes several assumptions." (The Washington Post; subscription may be required)
What's Going on With Employer-Sponsored Health Insurance?
"RAND's survey results don't match up to what almost anyone expected, but unlike the CBO, which is crunching outside data to make a projection, RAND is relying on their own measurements taken on the ground. If RAND is right, though, then Obamacare's effects will look quite different from what anyone assumed, and the exchanges will be much less of a factor than the law's designers planned." (
Accountable Care Organizations, Explained
"While ACOs are touted as a way to help fix an inefficient payment system that rewards more, not better, care, some economists warn they could lead to greater consolidation in the health care industry, which could allow some providers to charge more if they're the only game in town.... As hospitals position themselves to become integrated systems, many are joining forces and purchasing physician practices, leaving fewer independent hospitals and doctors. Greater market share gives these health systems more leverage in negotiations with insurers, which can drive up health costs and limit patient choice." (Kaiser Health News)
Survey Results: The Effect of the ACA on Small Businesses and Health Reform
"In general, the percentage of employers offering health insurance grew as firm size increased. In all five states, about half of the smallest firms -- those with 3 to 9 employees -- offered coverage, compared with more than 90 percent of those with 50 to 100 employees. The relationship between firm size and the likelihood of offering coverage varied across the states, however. In Alabama and New York, this likelihood was significantly greater among firms with 10 to 24 staff compared to those with fewer staff, whereas in Colorado and Oregon, the biggest difference was between firms with 10 to 24 staff and those with 25 to 49 staff. In Minnesota, there was a steady increase from the smallest to the biggest firm." (Mathematica Policy Research)
Survey Results: What Kinds of Health Insurance Do Small Businesses Offer?
"Alabama and Minnesota were the two outliers in terms of offering high-deductible plans -- only 8 percent of the small businesses in Alabama offered them, whereas almost half of those in Minnesota did. The majority of high-deductible plans offered had savings account features associated with them.... Only a minority (37 percent) of the small businesses in Minnesota that offered coverage offered some form of managed care plan (HMO, EPO, PPO, or POS). In the other four states, it was the most common type of coverage offered. The share of businesses offering one or more types of managed care plans ranged from 72 percent in Oregon to 91 percent in Colorado[.]" (Mathematica Policy Research)
State Health Insurance Marketplaces Look to More Standardized Plans for 2015
"Employers who want to control their expense allocation for health plans and want to promote consumer-driven plans are enthusiastic about buying plans on marketplaces, [Kevin Counihan, chief executive officer of Access Health CT,] said. 'But it's a minority of the market ... It's a passionate minority, but it remains the minority,' he said. The Connecticut SHOP marketplace only has 39 accounts with an average size of 3.3 subscribers[.]" (Bloomberg BNA)
Reference Pricing for Health Care Services: A New Twist on the Defined Contribution Concept in Employer-Sponsored Health Plans (PDF)
16 pages. Excerpt: "Potential aggregate savings could reach $9.4 billion if all employers adopted reference pricing for the health care services examined in this paper. The $9.4 billion represents 1.6 percent of all spending on health care services among the 156 million people under age 65 with employment-based health benefits in 2010. Savings from reference pricing materializes through the combination of [1] patients choosing providers at the reference price, [2] patients paying the difference between the reference price and the allowed charge through cost sharing, and [3] providers reducing their prices to the reference price. Any increase in prices among providers below the reference price would reduce the potential for savings." (Employee Benefit Research Institute [EBRI])
CBO Projects Lower ACA Costs, Greater Coverage
"The CBO projects that employer-based coverage will continue to increase over the next ten years, but that the number covered through their employer will be 7 to 8 million less than would have been covered absent the ACA.... For 2014, CBO has increased its projection of active employees covered under the ACA by 1 million, but decreased its estimate of the number of covered retirees by 2 million, resulting in a slight drop in employer coverage." (Timothy Jost in Health Affairs Blog)
UnitedHealthcare's Reversal on Drug Copay Coupons
"Last month, UnitedHealthcare went out on a limb with its decision to prohibit the use of copay coupons at retail settings for its commercial book of business ... Now, it appears the limb broke, and the company has essentially decided to backtrack.... Employers may have ... cried foul. They're footing the bill, after all, and they may fear member disruption and backlash.... UnitedHealthcare is not afraid to rock the boat, so this issue will not go away." (HealthLeaders InterStudy)
Retiree Health Benefits at the Crossroads
"A marked and growing interest in shifting to a defined contribution approach for both pre-65 and post-65 retiree coverage is fueled by the employers' desire to manage future costs. Increasing interest in moving from group coverage to non-group coverage is a trend that is particularly strong with respect to Medicare-eligible retirees for whom employers can facilitate access to non-group coverage through private exchanges.... [T]hese trends suggest that employer-sponsored supplemental coverage is likely to be structured differently and play a smaller macro role in retirement security than it has in the past and than it does today." (Kaiser Family Foundation)
Growing Shift in the Health Plan Cost Burden from Employers to Employees
"Two-thirds of 2014 medical plans have individual, in-network out-of-pocket maximums of $2,500 or more. This is up from 58 percent of plans in 2013, and 49 percent in 2012. 42 percent of plans charge coinsurance for office visits, up from 35 percent in 2013. Emergency room (ER) visit co-pays have increased by roughly $3 per year since 2009, with a 2014 average of $113 per visit. The percentage of plans with high deductibles grew by 2 percent in 2014 from 23 percent to 25 percent." (HighRoads)
Odd-Hour Workers Face Loss of Employer Health Plans
"Thousands of these so-called variable-hour employees -- many of whom work on college campuses that don't operate during summer months -- could lose their benefits as employers use new formulas to classify workers as full time or part time. The distinction determines which employees are entitled to company-sponsored health coverage.... About 68% of U.S. employers have variable-hour workers ... with most of them in the hospitality, retail and education industries." (The Wall Street Journal; subscription may be required)
Health Care Reform Spurs Move to Defined Contribution Model
"Employers say the top two reasons for contemplating a switch to DC benefit models are to lower health care costs and to offer their employees more choice in the allocation of their benefit dollars (59% and 40%, respectively). Employees report they would allot 75% of their benefit dollars to health, dental, and vision coverage, leaving 25% for other coverages such as voluntary life, disability, accident, and critical illness insurance. Even with this allocation by employees, 42% of brokers feel the shift to DC plans will lead to an uptick in sales for voluntary products." (Prudential)
[Official Guidance] Key Priorities for Compliance Reviews of Issuers and Plans on Federally-facilitated Marketplaces for the 2014 Benefit Year (PDF)
"CMS will perform compliance reviews of issuers offering Qualified Health Plans (QHPs) in the Federally-facilitated Marketplaces (FFM). For purposes of this document, QHPs include stand-alone dental plans, unless otherwise indicated.... CMS will review data at both the issuer and the QHP level. Policies, procedures and any other applicable documentation may be requested, as part of the compliance review process, to show compliance with issuer standards. As additional final regulations and operational guidance are published, those standards may be included as part of the compliance reviews ... [T]his list should not be construed as a comprehensive listing of all standards applicable to QHP issuers in the FFMs, nor a limitation on CMS' authority or ability to review compliance with standards not appearing on this list." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services)
Middle Market Employers See Twofold Increase in Wellness Programs in 2013
"The highest percentage of plans offering wellness programs came from employers with 1,000 or more employees (58.2%), however, middle market employers with 100 to199 employees increased their wellness offerings by approximately 12.5% in 2013 -- double that of any other employer size subset. Surprisingly, employers with 1,000-plus employees decreased their wellness offerings by 0.7%." (United Benefit Advisors)
[Opinion] The Twilight of the British Public Health System? (PDF)
"The NHS -- like all health care systems -- is, and always has been, imperfect. Yet replacing it with a semi-privatized, commercialized, corporatized, and fragmented body -- still funded by general taxation but otherwise a pale reflection of its former self -- will only exacerbate its weaknesses, while hollowing out its universal, moral core." (Andrew Gaffney, in Dissent)
[Opinion] Flaws in Bobby Jindal's Health Reform Proposal
"Like the Republican Study Committee's plan, Jindal's proposal replaces the current exclusion of employer-based tax benefits with a standard tax deduction. The problems: It is regressive, giving more tax relief, the higher your income tax bracket. It is not helpful to the half of the population that does not pay income tax." (John Goodman's Health Policy Blog)
Top 10 Ways Companies Cut Healthcare Costs
"The most implemented strategies of top performers last year: Procured a pharmacy benefit manager in an attempt to tamp down pharmaceutical costs; Provided employees with healthcare cost transparency ... Contributed funds to employees' health savings accounts ... The most popular strategies for 2014: Make plan design changes after analyzing how they'll impact other parts of employee compensation -- like retirement contributions and salary ... Increase employee contributions in tiers with dependent coverage at a higher rate than individual coverage ... Adopt payment methods that hold healthcare providers more accountable for the quality and cost of care; Offer telemedicine programs[.]" (HR Benefits Alert)
CMS Identifies Key Priorities for 2014 Compliance Reviews of Qualified Health Plans in the Federally Facilitated Marketplace
"These key priority areas include, among others: [1] ongoing compliance with issuer participation standards, [2] not employing marketing practice or benefit designs that will have the effect of discouraging enrollment of those with significant health needs, [3] executing appropriate delegation agreements with delegated and downstream entities, [4] ensuring compliance of appointed agents/brokers, [5] making sure that the provider network is sufficient so that services are accessible without unreasonable delay, and [6] ensuring that the qualified health plan (QHP) makes health plan applications and notices accessible to individuals in accordance with the Americans with Disabilities Act and for individuals with limited English proficiency." [Source document: Key Priorities for FFM Compliance Reviews for the 2014 Benefit Year.] (Epstein Becker Green)
Alternative Health Spending Scenarios: Implications for Employers and Working Households
"Scenarios for low or high rates of health spending growth have important implications for employers that provide coverage (or are on the margin for doing so) and the employee households that benefit from it. For small employers, whether or not coverage is offered is sensitive to premiums, with smaller effects for larger employers.... Innovation in benefit designs, network designs and policies on employer contributions appear to be making it easier for employers to quickly shift unexpectedly high rates of premium increases to employees." (The Brookings Institution)
Should We Have Expected This Week's Big Surprise on Employer Health Insurance?
"There's one Obamacare number that stands out above the rest this week -- 8.2 million. That's how many people have taken up employer-sponsored insurance since September, and most of them were previously uninsured ... The [RAND] survey ... attributes the drop in the uninsured rate over the past six months mostly to gains in employer coverage. For all the predictions of employers dumping coverage for health insurance exchanges, this was a pretty surprising finding. Obamacare was actually driving millions of uninsured Americans to sign up for employer insurance." (The Washington Post; subscription may be required)
Five Employer Characteristics for Private Exchange Implementation
"The clearest distinction in a private exchange is the ability to offer a myriad of plans and networks as well as ancillary products.... Private exchanges can offer a unique consumer experience, initially during enrollment and then ultimately in supporting employees and their families to manage their health and healthcare needs.... Early experience is showing that consumers that are given a pool of money will tend to spend the money more prudently consistent with their needs and values." (Healthcare Trends Institute)
[Guidance Overview] Final Regs Issued Implementing the Mental Health Parity and Addiction Equity Act of 2008
"[T]he final regulations include some surprises that will require issuers and plan sponsors to review plan designs that may have been compliant under the interim final regulations with fresh eyes in light of the final regulations such as benefit exclusions for certain types of mental health facilities, such as residential treatment facilities." (Groom Law Group)
Comments on Provider Nondiscrimination Requirements requested by IRS, EBSA and CMS
"Section 2706 of the Public Health Service Act ... provides that a group health plan shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider's license or certification under applicable state law.... [M]any group health plans have ignored this requirement, feeling that it was really an issue for their third party administrators who are responsible for maintaining the networks and handling provider issues. However, in a curious turn of events, the Agencies are now asking for public comments on this issue." (Kilpatrick Townsend)
The Assault on the ACA Continues in the Federal Appeals Courts
"In response to questions from Justices Samuel Alito and Antonin Scalia concerning why the government contends that [the Religious Freedom Restoration Act (RFRA)] does not cover for-profit corporations, the government countered that the operative phrase for the court to interpret is 'exercise of religion.' ... The government argued that ... the court has never granted an exemption to a for-profit corporation based on the free exercise clause.... On the same day, premium tax credits ... came under a revived attack. After winning at the district court level in federal trial courts in the District of Columbia and Virginia, the government appeared to be an underdog in the oral arguments in Halbig v. Sebelius held before the U.S. Court of Appeals for the District of Columbia Circuit." (McDermott Will & Emery)
[Guidance Overview] Final 2015 Letter to Issuers in the Federally-Facilitated Marketplace: Access and Non-Discrimination Considerations
"The final letter indicates that CMS will conduct reasonable access reviews, but depending on whether actual network membership does or does not have to be submitted, it is not clear how these reviews will proceed or the standards that the agency will use.... CMS clarifies in the final letter that the agency will limit its oversight to cost sharing design aspects of qualified health plans sold in the exchange Marketplace and will not consider limitations and exclusions, discriminatory benefit definitions, or discriminatory definitions of key over-arching terminology such as the plan's medical necessity definition[.]" (Health Reform GPS)
Early Drug Claims Suggest Exchange Plan Enrollees Are Sicker Than Average
"[An] analysis of the first two months of claims data shows the new enrollees are more likely to use expensive specialty drugs to treat conditions like HIV/AIDS and hepatitis C than those with job-based insurance. The sample of claims data -- considered a preliminary look at whether new enrollees are sicker-than-average -- also found that prescriptions for treating pain, seizures and depression are also proportionally higher in exchange plans[.]" (Kaiser Health News)
Aging Workforce Requires New Strategies for Employee Retention
"In a case study of the state of Missouri's Deferred Retirement Option Provision (BackDROP), [Angela Curl, assistant professor in the University of Missouri School of Social Work] concluded that states may need to restructure deferred retirement incentives to encourage more employees to remain on the job longer and minimize the disruption to government operations." (News Bureau, University of Missouri)
Group Benefits and the Defined Contribution Model (PDF)
"More companies are moving toward a defined contribution (DC) benefits model in the wake of health care reform ... Employees would allocate over half of their benefits dollars to health insurance... Brokers believe employees will spend more on health care benefits, while at the same time employers will add voluntary coverage." (Prudential Group Insurance)
The ACA: Some Unpleasant Welfare Arithmetic
"Under the [ACA], between six and eleven million workers would increase their disposable income by cutting their weekly work hours. About half of them would primarily do so by making themselves eligible for the ACA's federal assistance with health insurance premiums and out-of-pocket health costs, despite the fact that subsidized workers are not able to pay health premiums with pre-tax dollars. The remainder would do so primarily by relieving their employers from penalties, or the threat of penalties, pursuant to the ACA's employer mandate." (National Bureau of Economic Research [NBER])
How Health Plans Are Becoming More Patient Centric
"Health plans have helped pave the way for consumer-driven healthcare by offering coverage solutions that engage people in the management of their healthcare -- HSA Programs, for example -- as well as providing members with resources to make informed healthcare decisions. Their shift toward patient-centric healthcare, in contrast, has less to do with an insured's role as a healthcare consumer but rather their position at the center of their healthcare delivery. As major payers and care coordinators, health plans will be an increasingly important part of this system." (Healthcare Trends Institute)
Toxic Workplaces May Override Wellness Efforts
"When determining well-being and longevity of workforces, [Jeffrey Pfeffer, a professor of organizational behavior at Stanford University's graduate school of business] said that most company wellness programs ... do fall short of really instituting change. Indicators such as work-family conflict, lack of job control, perceived fairness at work, as well as layoffs and economic insecurity, all play a huge role in workforce health[.]" (Employee Benefit News)
Uninsured Rate in U.S. Is Lowest Since 2008
"The uninsured rate has been falling since the fourth quarter of 2013, after hitting an all-time high of 18.0% in the third quarter -- a sign that the Affordable Care Act, commonly referred to as 'Obamacare,' appears to be accomplishing its goal of increasing the percentage of Americans with health insurance coverage. Even within this year's first quarter, the uninsured rate fell consistently, from 16.2% in January to 15.6% in February to 15.0% in March. And within March, the rate dropped more than a point, from 15.8% in the first half of the month to 14.7% in the second half -- indicating that enrollment through the healthcare exchanges increased as the March 31 deadline approached." (Gallup)
Ezekiel Emanuel Further Explains His Prediction That Employers Will Drop Health Insurance
"[T]he assumption, behind my claim is that the exchanges are going to get better, that they're going to be desirable shopping places, the options are going to be highly desirable, there's going to be more choice for people. If the products available on the exchange are not equivalent to what responsible large private employers are doing, they're not going to send their workers there. It's just that simple." (The New York Times; free registration required)
House Approves 40-Hour Definition of Full-Time Employee
"The House has approved legislation to define a full-time employee under the [ACA] as an employee who works, on average, 40 hours per week. The Save American Workers Act (H.R. 2575 ) was approved by a vote of 248-179. Senate action on the bill is unclear, and the White House has issued a veto warning." (Towers Watson)
Even the Healthy Locked Out of 2014 Policies Now
"With limited exceptions, insurance companies have stopped selling until next year the sorts of individual plans that used to be available year-round. That locks out many of the young and healthy as well as the sick and injured, even those who can afford to buy without government subsidies.... The next wide-open chance to sign up comes in November, when enrollment for 2015 begins in the government-run insurance marketplaces created by the health care law. Companies are following that schedule even for the plans they sell outside the federal and state exchanges." (Associated Press)
Surprise Medical Bills Lead to Patient Protection Laws in New York
"New York this week extended patient protection laws to restrict out-of-network providers from 'balance-billing' consumers for emergency care or when patients can't choose their doctors. Balance-billing occurs when health workers who don't accept a patient's insurance try to collect the difference between their charge and the insurer's reimbursement.... Patients most often receive these surprise bills in emergency cases, when they can't choose the doctors who treat them." (Bloomberg)
Employer-Sponsored Benefits Extended to Domestic Partners: Beyond the Numbers
"In March 2013, 72 percent of civilian workers had access to employment-based health benefits, and nearly all had such benefits extended to married spouses and children.... 32 percent of workers had access to health benefits that could be extended to unmarried same-sex partners and 26 percent had access that could be extended to opposite-sex partners.... In March 2013, 28 percent of civilian workers had access to a defined-benefit pension plan. All of these workers could extend survivor benefits to a spouse. In contrast, 15 percent of workers had access to a defined-benefit plan that allowed the employee to designate a same-sex domestic partner as the beneficiary of survivor benefits. Similarly, 14 percent of workers had access to a plan that provided survivor benefits to opposite-sex unmarried employees." (U.S. Bureau of Labor Statistics)
CalPERS Shift in Contracting Strategy Reveals Kaiser Permanente Weakness
"CalPERS will save $21.3 million after most of its members moved into lower-cost health plans during open enrollment. Members had more plan choices because CalPERS added Anthem Blue Cross, Health Net, Sharp Health Plan and UnitedHealthcare to its list of HMO options. Previously, the CalPERs contract had exclusively been held by Blue Shield of California and Kaiser Permanente. The purchasing coalition decided to expand competition based on a member survey that showed many were price sensitive." (HealthLeaders InterStudy)
[Opinion] Employer-Sponsored Health Insurance: 'Job Lock' Is Not the Problem -- 'Insurance Lock' Is
"We get our health benefits from our employer because they are non-taxable. If employees bought health insurance on our own, we would pay premiums with after-tax dollars.... But while there may be some job lock due to employer-based benefits, the problem has become way overblown in public discourse ... The real problem with our employer-based health benefits is 'insurance lock'. Until recently, and even now only for very large employers, an employee could only get his health-insurance policy from one insurer: The one chosen by his employer." (John Goodman's Health Policy Blog)
Bringing Mental Health Care Coverage Into Balance
"Critics have argued that parity legislation alone is not enough to fix other underlying problems in how our health system provides access to treatment of mental health and substance use disorders.... Much of the debate in implementing parity is around determining equivalence of services between mental health/substance use benefits and medical/surgical benefits.... While the ACA expanded the reach of the [Mental Health Parity and Addiction Equity Act (MHPAEA)] both by direct application to the individual market and to issuers in the individual and small-employer market through the EHB requirement, some plans and benefits are still excluded." (Robert Wood Johnson Foundation)
Law Removes Deductible Limits for Small Group Plans
"[By] law, HSAs can only be offered to those whose health plans have a minimum deductible of $1,250 (individual) or $2,500 (family) in 2014. While those requirements could be satisfied under the ACA's (now repealed) deductible limits on small-group plans, advocates of consumer-directed health care contended that allowing higher deductibles provides greater flexibility to tailor health insurance with account-based plans, opting for lower premiums with higher deductibles, for instance." (Society for Human Resource Management [SHRM])
The Willis Health and Productivity Survey Report 2014 (PDF)
"68% have some type of wellness program.... 54% are implementing a high deductible health plan in an effort to address rising health care costs. 64% provide employees with tools and resources to become better consumers.... 44% use third-party wellness vendors. 78% of organizations with a wellness program said that they used some sort of incentive to drive participation. 49% of those with a wellness program reported a measurable improvement in either medical costs or health risks." (Willis)
Success Stories of the Self-Insured
"As the Obama administration mulls whether to place restrictions on stop-loss insurance, a move that critics say will discourage self-insurance, three examples of how companies saved money through self-insurance point to alternatives to increasing health costs.... Proponents of self-insurance acknowledge the strategy isn't for everybody. When it works, however, employers and employees come out ahead[.]" (
Congress Repeals ACA Cap on Deductibles for Small Group Health Plans
"The impact of this legislation should be pretty significant for small employers. Many [small employers] had long used high deductible plans paired with HRAs and HSAs to keep premiums at a minimum while taking on a small amount of claims risk or employer contributions. This legislation should allow significantly more flexibility in design and contributions once again." (Kushner & Company)
New Law Eliminates Deductible Limits for Small Employer Market Health Plans (PDF)
"The [Protecting Access to Medicare Act of 2014], which prevents double digit cuts in Medicare reimbursement to doctors from taking effect this year ... eliminates deductible limits imposed under the ACA for the small employer market health plans. Section 1302(c)(2) of the ACA currently limits deductible amounts offered by small employer plans to $2,000 for individuals and $4,000 for families.... The new law goes into effect April 1, 2014." (Employers Council on Flexible Compensation)
High Deductible Plans: Going Back to the Future
"High deductible plans with a $1,000/$2,000 or $1,500/$3,000 deductible are gaining momentum. Plans that include a $500 deductible are an introduction to the deductible environment. They provide employers with some savings to the co-pay plans. These plans also introduce the employees to what the providers are charging." (William Gallagher Associates)
[Opinion] Can Obamacare Be Fixed? Part II
"The reason we have so many problems in health care is that almost everywhere we look, people face perverse incentives -- patients, doctors, employers, employees, etc. When they respond to those incentives they do things that make costs higher, quality lower, and access to care more difficult than otherwise would have been the case.... In a well-run insurance marketplace, people will pay the full cost and reap the full benefits of every change they make. That leaves them with an undistorted economic incentive to buy insurance and to choose the insurance that best meets their individual and family needs." (John Goodman's Health Policy Blog)
NLRB Classification of Athletes as Employees Highlights a Health Care Reform Land Mine
"Let's consider a hypothetical: on January 1, 2016, the IRS reclassifies enough students and independent contractors as 'full-time employees' so as to cause the University to miss the 95% mark, and at least one employee used a premium credit to purchase coverage on an exchange. It appears that after paying all the health care plan costs, the University could also be liable for a penalty in the neighborhood of $20 million, per year.... Given the high stakes involved with a failure to satisfy the 95% test, employers need to consider their margin for error, and give serious consideration to the circumstances involving anyone who is performing services but is not being treated as an employee." (Porter Wright Morris & Arthur LLP)
[Guidance Overview] Is Your Health Plan Premium Affordable Under the ACA?
"A large employer subject to the employer mandate in 2015 (i.e., an employer that employed at least 100 full-time employees and/or full-time equivalent employees during 2014) that intends to minimize exposure to ACA penalties should review the safe harbors and determine which safe harbor, or combination of safe harbors, works best for its full-time workforce.... Form W-2 Wages Safe Harbor.... Rate of Pay Safe Harbor.... Federal Poverty Line Safe Harbor." (Bond, Schoeneck & King)
[Guidance Overview] 90-Day Maximum Health Plan Waiting Period: Final Regs Give Some Relief
"[E]mployers may wait until the end of an 'orientation period' to begin counting the 90 days, and proposed rules issued in tandem with the final regulations tell us that such an orientation period can last no more than one calendar month (less one day). This may allow employers to re-instate past practices of enrolling new hires on the first of the month after 90 days of service, rather than enrolling employees mid-month or shortening the waiting period to 60 days in order to allow first-of-month enrollments and still comply with the 90-day maximum." (Frost Brown Todd)

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