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Health plans - design

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[Opinion] A Healthy Side of Health Insurer Mega-Mergers
"Anthem's proposed merger with Cigna following Aetna's acquisition of Humana has set off alarms about lack of competition in the health-insurance industry. But policy makers should consider the potential benefits of industry consolidation. The greater efficiency and market power of larger insurance plans could lower prices for consumers by offsetting the bargaining power of health-care providers." (The Wall Street Journal; subscription may be required)
Weighing the Cost of Health Care & Value-Based Choices
"The first step in becoming an informed healthcare consumer is planning ahead. When patients understand their benefit plan, payment responsibilities, and the healthcare options available to them at work and in their community, they are well on their way to being a savvy decision-maker and proactive manager of their health." (Marathon Health)
Increasing Employee Cost-Sharing (PDF)
"Since the dawn of consumerism, however, opponents have been concerned that employees may decide not to seek care at all. Ultimately, if a participant does not get necessary care, the result can be more costly care down the road because of complications from untreated conditions. Studies to date do indicate that as cost-sharing is introduced, utilization is decreased. Unfortunately, these studies do not indicate whether participants are reducing necessary or unnecessary care." (Marsh & McLennan Agency LLC)
Blue Cross and Blue Shield of New Mexico Will Not Offer Individual Products on the New Mexico Health Insurance Exchange in 2016
"According to the insurer, the premium rates BCBSNM charged for individual insurance products in 2014 and 2015 did not cover the claims costs the insurer incurred -- ultimately resulting in a $19.2 million loss.... The decision comes after the Office of the Superintendent of Insurance (OSI) formally denied the insurer's 51.6 percent premium rate increase earlier this month." (The Business Journals)
Effects of Financial Incentives on Workplace Wellness Program Participation and Utilization of Health Care Services and Spending (PDF)
"Participation in health risk assessments (HRAs) increased by 50 percentage points among members of unions that bargained in the incentive ... Participation in the biometric screening program increased 55 percentage points when financial incentives were provided. Biometric screenings led to an average increase of 0.31 annual prescription drug fills, with related spending higher by $56 per member per year. Otherwise, no significant effects of participation in HRAs or biometric screenings on utilization of health care services and spending were found." (Employee Benefit Research Institute [EBRI])
Obamacare Is Facing Another Big Threat: Accounting
"The creation of ACA health exchanges may be the final nail in the coffin for retiree health-care benefits. The exchanges make it easier for states to phase out health-care plans because pre-Medicare retirees now have other, affordable options.... About 70% of governments offer health benefits to retirees. That suggests it's likely the state retiree population could be large enough -- even 1 million could make a significant difference -- to skew the exchange population older (and likely sicker) and increase premiums." (Quartz)
The Future of Employee Premium Assistance Through Waivers Under the ACA
"For states that seek to protect and expand the [employer-sponsored health insurance] market, combining public dollars with employee and employer contributions is an attractive alternative. Using a State Innovation Waiver ... a state could create a [Health Insurance Premium Payment Program] that ... would take some of the money currently spent on tax credits and reduced cost sharing in a state-based exchange or the federally facilitated marketplace and redirect it to pay a portion of the employee premium cost and underwrite some of the out-of-pocket expenses." (Health Affairs)
Millions in the Red, Nevada Obamacare Insurer Has Failed
"Nevada Health CO-OP, which launched in 2012 with two federal loans totaling $65.9 million, will shutter its operation and will not offer coverage for 2016. Coverage for all current plans will remain good until Dec. 31, and members will be able to sign up with other carriers for Jan. 1 coverage when open enrollment begins in November." (Las Vegas Review-Journal)
ACA 'Premium Stabilization' Program Hits CO-OPs, Small Plans
"[At] least for 2014 assessments, a 'risk adjustment' program set up under the law appears to be having an unintended consequence -- new consumer-oriented 'co-ops' also created under the ACA with government funding; small, low-cost plans that employ narrow provider networks; Medicaid managed care plans; and hospital-sponsored plans are among those being hit with big payments they must make to other insurers. BlueCross BlueShield plans, which often dominate state markets, appear to be the winning recipients in many cases." (Bloomberg BNA)
The Excise Tax on High-Cost Employer-Sponsored Health Coverage: A Background and Economic Analysis (PDF)
"This report gives a brief description of the Cadillac tax. It discusses the legislative origins of the tax and provides an analysis of the revenue effects of the tax. It then analyzes health insurance premium data to provide insights in to what share of health insurance plans could exceed the Cadillac tax threshold and how the threshold could affect more health plans over time. This report also analyzes the Cadillac tax using standard economic criteria of efficiency, equity, and administrative simplicity." [Report No. R44160, dated Aug. 20, 2015.] (Congressional Research Service [CRS])
Obamacare 'Cadillac Tax' May Lead Employers to Cut FSAs
"FSAs can dramatically raise a company's exposure to the Cadillac tax.... [One] analysis, which assumed annual premium increases of 5 percent, found that just 16 percent of employers would have at least one health plan hitting the $10,200 Cadillac tax threshold for single-only coverage in 2018 if health FSAs were not considered. But 26 percent of employers would exceed that threshold that year if FSAs are included in the analysis. In 2023, when the threshold rises to $11,800 for single-only plans, 22 percent of employers would hit the threshold if FSAs were not factored into the calculation, but 30 percent of employers would if FSAs are considered." (NBC News)
U.S. Attitudes Toward Health Insurance and Healthcare Reform (PDF)
11 pages. "While 38% of respondents receive their insurance through their employer, this is a noticeable drop from 59%, when the survey was initially conducted in 2013. Those very satisfied or somewhat satisfied with their current health insurer were very similar for 2013 and 2015. Respondent's overall satisfaction with their payor, regardless of the source, remained consistent as well between 2013 (79%) and 2015 (73%)." (Valence Health)
[Opinion] How Many Employers Could be Affected by the Cadillac Tax?
"The important policy issue is not the tax, it is the decision to control spending by erecting financial barriers to [health] care through the design of the insurance product ... This prevents patients from getting care that they should have while exposing them to financial hardship." (Physicians for a National Health Program [PNHP])
Mental Health Parity Ruling Called 'Watershed Case'
"Robert Rachal, a senior counsel at Proskauer Rose in New Orleans ... said the decision 'will make it easier for participants and medical providers with valid assignments to enforce claims for benefits.' However, Rachal cautioned, 'I think it is too soon to tell whether associations will be able to bring systematic claims seeking to change how insurers process mental health benefits.' ... 'The key thing to understand is the incredible power that the third-party administrators have in the market here,' [said Jason S. Cowart, a partner at Zuckerman Spaeder]. 'They have all the discretion when it comes to approving or denying benefit claims.' " (Bloomberg BNA)
How Many Employers Could Be Affected by the Cadillac Tax?
"Looking first at the expected costs for just plan premiums plus employer contribution to HSAs and HRAs, we estimate that about 16 percent of employers offering health benefits would have at least one health plan that would exceed the $10,200 HCPT self-only threshold in 2018, the first year that plans are subject to the tax. The percentage would increase to 22 percent in 2023 and to 36 percent in 2028.... These percentages rise significantly when we consider the impact that FSA options can have: up to 26 percent in 2018, 30 percent in 2023 and 42 percent in 2028[.]" (Henry J. Kaiser Family Foundation)
Private Exchanges Leading to Both a 'Buy-Down' and a 'Buy-Up' Effect
"One interesting result of the advent of private exchange technology combined with a defined contribution is that when individuals are given [1] money to spend on benefit purchases and [2] a shopping experience that they can navigate, they behave like consumers. In this environment, they typically purchase less medical coverage (sometimes called the 'buy-down' effect), leaving money available to purchase other benefit options (the 'buy-up' of voluntary benefits).... As a result of this change in buying habits ... the Willis Private Exchange experience has demonstrated savings of almost $700 per employee per year." (The Institute for HealthCare Consumerism [IHCC])
[Guidance Overview] Retiree HRAs and the ACA: Doing It Right (PDF)
"[E]mployers may want to transition their pre-Medicare retirees to marketplace coverage -- and provide them with financial assistance to help pay for the coverage or to offset some of the cost-sharing burden. Not only may this approach reduce ongoing costs, but it may also help mitigate or eliminate the Cadillac tax on retiree coverage. Employers that want to provide financial assistance through health reimbursement arrangements will need to proceed carefully to avoid potentially unwelcome consequences." (Buck Consultants at Xerox)
[Opinion] What Can Go Wrong with a Private Health Insurance Exchange?
"Like the Obamacare exchanges, health plans in private exchanges don't add to their bottom line by becoming good at cancer care, diabetic care or at any other expensive-to-treat disease.... So what can be done? ... [H]ave all the health plans be offered by a single insurer, say, Blue Cross.... [M]anaged competition only works when health plans are prevented from doing what is in their self-interest to do.... [E]mployer risk adjustment.... [H]ave the risk adjustment be administered by the health plans themselves." (John Goodman, in Forbes)
The Startups That Give You a Second Opinion on Costly Surgery
"Second-opinion services allow employers to take a softer approach than enforcing strict rules requiring workers to get permission before seeking costly treatments. Most companies that offer services ... make them voluntary, and though there may be incentives to get a medical decision reviewed, workers can usually skip the second opinion or ignore it if they disagree. That makes the services seem less coercive than restrictive HMO rules. It also means companies sometimes struggle to get workers to use them." (Bloomberg)
Waking Up to the Opportunity of Self-Funded Employee Health Benefits
"Some of the benefits that can be realized by developing a self-funded health benefit plan include: [1] Plan design flexibility; [2] Premium and healthcare cost savings; [3] Cost transparency; and importantly, [4] the availability of detailed analytics, which provide information on fees, expenses, and costs not usually able to be provided by fully insured plans." (American Journal of Managed Care)
Insurance Exchanges Need to Better Support Patient Decision Making
"Only 3 states had out-of-pocket cost estimators that added together their premium and expected costs based on consumers' predicted use while most sites only allowed consumers to sort or filter plans by premium and deductible amounts. Most states using the premium amount as their default plan order, which may cause consumers' to be overly influenced by the premium amount while not paying enough attention to other potential out-of-pocket expenses, such as meeting a high deductible[.]" (American Journal of Managed Care)
Blue Cross May Snarl Anthem-Cigna Mega-Deal
"For Anthem to remain eligible to use the Blue Cross and Blue Shield names and symbols, the Indianapolis-based insurer must make sure it derives at least two-thirds of its health care revenue across the country from its Blue-branded businesses. In addition, in each of the 14 states where Anthem operates a Blue Cross health plan, it must derive 80 percent of its health care revenue from that plan. But buying Cigna will put Anthem out of compliance with those rules ... So Anthem must convert some of Cigna's health insurance business to the Blue Cross and Blue Shield brand names. And it might have to assuage the fears of other Blue Cross insurance plans -- possibly by offering them a few concessions." (
Federal District Court Won't Overturn HHS Determination That Self-Insured Supplemental Prescription Drug Fund Is Not Excepted Benefit Coverage
"A court has rejected a union's request to overturn an HHS determination that the union's self-insured benefit fund is subject to health care reform's prohibition on annual and lifetime limits (and cannot impose a $10,000 annual limit on prescription drug reimbursements) because it is not an excepted benefit.... The union [had argued] ... that the fund ... is supplemental to its members' employer-provided health coverage and, as such, is a 'supplemental excepted benefit' or a 'non-coordinated excepted benefit' even though it is not offered under a 'separate policy, certificate, or contract of insurance.' " [Seabrook v. Obama, No. 14-Civ-4431 (S.D.N.Y. Aug. 4, 2015)] (Thomson Reuters / EBIA)
Text of Second Circuit Opinion Allowing Mental Health Parity Claims Against Claims Administrator
23 pages. "[UnitedHealth Group (United)] argues that it cannot be held liable under [ERISA] section 502(a)(3) for violations of the Parity Act because it is the claims administrator of a self funded plan.... United argues that the Parity Act does not apply directly to it, because it is not a 'group health plan' and did not offer health insurance coverage to [plaintiff Jonathan Denbo, an individual who was a participant in the plan].... Denbo responds that United's Parity Act obligation is imposed on it not by the Parity Act itself, but rather by section 502(a)(3).... [The court finds that] section 502(a)(3) may impose a fiduciary duty arising indirectly from the Parity Act even if the Parity Act does not directly impose such a duty. For that reason, and because 'section 502(a)(3) admits of no limit . . . on the universe of possible defendants' ..., we hold that United is a proper defendant for Denbo's Parity Act claim under Section 502(a)(3)." [N.Y. State Psychiatric Ass'n v. UnitedHealth Grp., No. 14-20-cv (2d Cir. Aug. 20, 2015)] (U.S. Court of Appeals for the Second Circuit)
D.C. Health Link Launches New Physician Directory to Make Finding a Doctor Easier
"Called the Universal Doctor Directory 1.0, the new tool available on D.C. Health Link allows consumers to search individual and family plans to figure out which doctors participate in particular plans. The directory also allows consumers to find a new doctor by ZIP code, last name or specialty and then see which marketplace insurance plans the doctor accepts." (The Business Journals)
[Guidance Overview] The Scoop on MOOP
"[FAQ XXVII] stated, 'the self-only maximum annual limitation on cost sharing applies to an individual who is enrolled in family coverage or other coverage that is not self-only coverage under a group health plan.' The FAQ also stated that the departments would apply the clarification only for plan or policy years beginning in or after 2016.... The chairmen [of the House Ways and Means, Education and the Workforce and Energy and Commerce committees] have asked [HHS to provide] ... [1] the source of the statutory authority to enable the Administration to make this change in the [maximum out-of-pocket (MOOP)] limits; [2] any analyses that the Administration has conducted on the impact of the change on employers and employees; and [3] an explanation of the basis for HHS's justification for making the policy change in a preamble and not in regulations." (McGuireWoods LLP)
Big Data: A New Paradigm for Health Plan Oversight and Consumer Protection?
"In this issue brief, [the authors] discuss how insurance regulators (primarily state DOIs and the federal Center for Consumer Information and Insurance Oversight, or CCIIO) and third parties are currently using data collection and how it could change under the ACA to improve health plan oversight and compliance. In particular, [they] discuss how the new ACA requirements could prompt a sea change in regulatory oversight -- and counterintuitively -- reduce the regulatory burden on health plans." (Robert Wood Johnson Foundation)
Do Provider-Owned Health Plans Produce the Cheapest Insurance Premiums?
"The integration of insurer and provider within these provider-owned health plans holds the promise to deliver more appropriate care to patients and lower insurance costs by eliminating unnecessary tests, surgeries, and other healthcare that inflate overall costs.... Although provider-owned plans cover less than 10% of the entire privately insured market, their membership increased 4% between 2012 and 2013, a higher rate of growth than other plan types.... Contrary to expectations, the cheapest provider-owned health plans were more expensive on average than the cheapest plans not owned by providers." (HealthPocket)
Cadillac Tax Is Key in Union Worker Lockout by Steel Producer
"A provision of the Affordable Care Act, which is one reason Allegheny Technologies locked out more than 2,000 union workers last week at 12 plants in six states, also could be a stumbling block in negotiations involving two other major steel producers whose contracts covering about 30,000 union workers expire in less than two weeks.... Allegheny Technologies' final contract proposal was a four-year deal that included a provision requiring new negotiations during the life of the agreement if the company projected escalating premiums would trigger the tax." (Pittsburgh Post-Gazette)
Controversial Narrow Networks May Help Lower Healthcare Costs
"With the health insurance industry shifting toward a more consumer-centric mindset, providing shoppers with choices is imperative so they can make informed decisions about their care. And while narrow networks may impede consumer choice, they could also provide benefits[.]" (FierceHealthPayer)
[Guidance Overview] Rules for QHP Transparency Soon Will Apply to Employers
"Insurers and plan sponsors soon will have to report to the government (and list on a web page) their policies on: out-of-network liability and balance billing; enrollee claim submission; claims and denials; recoupment of overpayments; medical necessity; prior authorization; drug exception timeframes; explanations of benefits; and coordination of benefits.... Although the QHP requirements take effect for 2016 policies, very similar rules soon (after an official rulemaking process) will apply to employer plan sponsors and group policy issuers selling outside of exchanges." (Thompson SmartHR Manager)
[Opinion] ERIC Urges Flexibility as Colorado Medical Board Considers Telehealth Policies
"ERIC recommends the Board adopt regulations that take into account a wide variety of technological solutions, minimize additional requirements on providers, allow enough flexibility so that patients can access medical services without having to visit specific locations, and make rules patient-centric, giving patients expanded access to care through telehealth visits and remote monitoring of their health conditions." (The ERISA Industry Committee [ERIC])
Comparing Individual Health Coverage on and Off the ACA Insurance Exchanges
"Initial concerns that insurers might seek to enroll lower-risk customers outside the exchanges have not been realized. Instead, more-generous benefit plans, which appeal to people with health problems, constitute a greater portion of plans sold off-exchange than those sold on-exchange." (The Commonwealth Fund)
The ACA at 5 (PDF)
66 pages. "The following essays will review several technical aspects of the ACA, examining how the intent of the regulations compares to reality, and what we can expect to see in the next five years. We expect that actuaries will continue to play a key role in the implementation of the ACA as it evolves and adapts in the future, and to continue thinking and writing about the systemic changes that may still be needed." (Society of Actuaries)
Among 23 Health Insurance CO-OPs, Maine Stands Out for Its Success
"The co-ops are particularly important today because five of the largest health insurers could soon be reduced to three if Anthem acquires Cigna and Aetna merges with Humana. In practice, however, co-ops have struggled. Only a co-op in Maine, Community Health Options, has turned a profit. What's the secret to CHO's success? There are several." (Association of Health Care Journalists)
House Calls: An Insurer's New Tool in Managing Risk
"In the past, it may have been possible to get away with skipping a doctor visit or failing to renew prescriptions with little more than nagging by your significant other (and your conscious). However, health insurers are now starting to take an interesting role in reminding members of the need to continue medical and drug treatments: free in-home health exams. Aetna has begun offering these exams -- conducted by a doctor or nurse practitioner -- to members of individual and small group health plans in 2015." (Frenkel Benefits)
[Guidance Overview] Cadillac Tax Still on the Assembly Line
"[E]mployers (yes, employers) are required to determine the cost of the coverage, regardless of who the provider is. The IRS does recognize that some time will be needed to process run-out claims after the end of the year for the employer to be able to calculate the cost of coverage. However, the timing of the tax may influence how long of a run out period a plan is able to have.... Note that the cost is actually determined on a monthly basis. So what does this mean for FSAs, HRAs, or HSAs that receive a bulk contribution from the employer at the beginning of the year?" (Benefits Bryan Cave)
[Guidance Overview] New Final Regs and FAQs Provide Guidance on Preventive Services Coverage
"What employers should do: [1] Ensure that their plans and summary plan descriptions do not contain provisions that contradict the FAQ or final regulation ... [2] Review preventive services coverage annually to ensure that preventive services remain covered throughout the full policy or plan year, unless the service is downgraded to a 'D' rating or is recalled for safety reasons (or is deemed a significant safety risk); and [3] Analyze plan administration procedures and communicate with outside administrators to confirm that all claims administration and communications with plan participants are consistent with the FAQ and final regulation guidance." (Proskauer's ERISA Practice Center)
Is King v. Burwell the Last Piece of the Obamacare Puzzle?
"Setting aside some of Justice Scalia's histrionics, the case itself isn't all that interesting for its legal reasoning and conclusions. But its consequences are far-reaching.... There are signs that the business sector is becoming skeptical about the replace-and-repeal campaign speeches and is ready to get to work.... And then there are some of those fixes needed by the ACA.... Employer mandate.... Employer reporting.... Automatic enrollment.... Tax on rich plans.... Defined contribution health plans." (Dorsey & Whitney, via Bench & Bar of Minnesota)
[Guidance Overview] Essential Health Benefits Overview
"[This article] offers an EHB overview in anticipation of HHS' posting of the benchmark plan list and public comment period.... This publication focuses on EHBs as they apply to the private market. The EHB requirement applies to non-grandfathered health plans offered in the individual and small group markets (both inside and outside the Marketplace). Self-insured group health plans, large group market plans, and grandfathered health plans are not required to provide EHBs." (National Health Law Program [NHeLP])
Dental Benefits Could Take the Bite Out of the Cadillac Tax
"Employers in the West offer more generous dental benefits. They are more likely to coverage adult orthodontia (51%, compared to 34% in the Northeast) and implants (66%, compared to 59% in the Northeast). Fewer require a deductible for restorative care. And while the benefits are richer, the employee contribution requirements are lower.... Dental benefits are well utilized and highly valued -- but the cost of freestanding dental plan doesn't count toward the excise tax cost threshold. If you have to cut back on the medical benefit, considering sweetening the dental benefit." (Mercer/Signal)
Reports of the Death of Employer-Sponsored Health Insurance Are Greatly Exaggerated
"[As] of late 2014, very few companies had moved to drop or narrow health coverage. The shifts from ESHI to public exchanges that have occurred have been concentrated among smaller businesses and early retirees. The economic incentive for dropping ESHI is much stronger for companies whose average wage is low." (Forbes)
HHS OIG Finds Most Health Insurance CO-OPs Are Losing Money
"Most federal insurance cooperatives created under the Affordable Care Act are losing money and could have difficulty repaying millions of dollars in federal loans, an internal government audit has found, prompting the Obama administration to step up supervision of the carriers.... [T]he inspector general at [HHS], said that most of the insurance co-ops enrolled fewer people than they had predicted, and that 22 of the 23 co-ops lost money last year." (The New York Times; subscription may be required)
San Francisco Boosts Employer Health Care Spending Mandate for 2016
"Beginning on Jan. 1, 2016, employers with 100 or more employees in San Francisco will be required to spend $2.53 per hour per covered employee on health care, up from $2.48 in 2015 ... Employers with between 20 and 99 employees will have to spend at least $1.68 per hour, up from $1.65 per hour. Employers with fewer than 20 employees are exempt from the requirement." (Business Insurance; free registration required)
Combining HSAs with High-Deductible Health Plans: A Cost Control Strategy
"While about half of large employers offered an HDHP in 2009, nearly three out of four did so in 2014. In addition to saving on health care costs, HSA-HDHPs may help employers avoid triggering the so-called 'Cadillac Tax.' ... To achieve significant savings, an employer may need to completely replace its health plan options with an HSA-HDHP.... Employees may adapt to the change more easily if it is phased in over several years." (Marsh Consulting Group)
The Ramifications of Repealing the Individual Mandate
"[The authors] explore the effects of eliminating the mandate on health insurance enrollment and individual-market premiums. [They] find that repealing the requirement would significantly reduce health insurance enrollment and cause individual market premiums to rise." (The Commonwealth Fund)
Wellness Programs Can't Be a Ruse to Ask About Pregnancy
"Workers in small companies seem especially concerned, because an employer with only a handful of employees is far more likely to connect responses with an individual worker than a human resources office responsible for thousands of employees. Major insurers who run wellness programs on behalf of employers insist the data are aggregated and employees have nothing to fear, but advocates say women aren't so sure." (American Journal of Managed Care)
Teladoc's Sales Show Virtual Doctor Care Is No Passing Fad
"Health plans see a way for patients to get high quality care from a physician and the potential to avoid a more expensive trip to a hospital emergency room. Teladoc executives also said they are seeing growth in mental health, dermatology and potentially, smoking cessation programs. 'We saw growth in the employer segment as well as the health plan segment,' Jason Gorevic, Teladoc's chief executive officer [said], adding that health insurers are rolling out coverage 'more aggressively.' " (Forbes)
Achieving Mental Health Parity: Slow Going Even in the 'Pace Car' State
"[The California Department of Managed Health Care] last year began requiring insurers under its watch to show -- at least on paper -- that they were complying with federal parity law. The results were not encouraging: Of 26 managed care insurers, from Aetna to Western Health Advantage, zero were able to prove that they were fully in compliance. Most filed incomplete or flawed documents, state officials said." (Kaiser Health News)
What You Can Learn from Millennials Can Improve Your Workplace Wellness Program
"Because their habits tend to be significantly healthier than those of the Baby Boomers (born between 1946 and 1964) and Generation X (born between the Baby Boomers and Millennials) who together dominate the workplace and will for some time to come, Millennials warrant a close look. This article explores what sets this generation apart and what organizations can learn from them that will improve the health of the entire workforce." (Sibson Consulting)
Employees Underutilizing Employee Assistance Programs
"[O]bstacles to using EAP services include stigma associated with seeking help with mental health issues, as well as fear of repercussions for missing work. However, employers... can help employees by identifying the sources of stress for employees, developing an action plan, embracing technology, and adequately communicating the program so employees are aware of what it offers.... [T]here are three areas poised to improve the use of EAP services: Digital/mobile access ... Telemedicine ... Wellness/wellbeing programs." (OneExchange from Towers Watson)
Lessons from the Small Business Health Options Program: The SHOP Experience in California and Colorado
"For business owners, employee choice was the most important reason cited for considering SHOP, with ease of administration a distant second.... [B]usiness owners consider insurance brokers to be an important source of enrollment assistance. Those in the insurance and policy communities perceived small-business owners to be poorly informed about available tax credits; business owners disagreed, saying the credits were simply not key to their decision to elect SHOP." (The Commonwealth Fund)
Essential Health Benefits Provided by Each State's Benchmark Plan
"States had some discretion in choosing their benchmark plans and the benefits within these plans can vary greatly from state to state. [This] dataset contains data on a selection of EHBs offered by the states including private duty nursing, hospice care, adult dental and vision care, provisions for generic drugs, organ transplants, dialysis, emergency transport and ER services, x-rays, and infertility treatments." (Robert Wood Johnson Foundation)
[Opinion] A Response to the New York Times Editorial on the Cadillac Tax
"[The editorial's] reasoning for tweaks to the law, rather than outright repeal of the tax, was based on many inaccurate assumptions.... [T]he shift of premium expenses for maintaining the same plan does nothing to reduce the tax. Under IRC Section 4980I, the tax is based upon the total premium cost of the plan, regardless of the percentages paid by the employer or employee.... The overall conclusion of the editorial may actually have it right, despite all of its inaccuracies." (Kushner & Company)
Health Plan Cost Increases to Hold Steady in 2016; Nearly Half of Large Employers Will Trigger Cadillac Tax in 2018
"Almost one-half of respondents (48%) expect at least one of their benefit plans will hit the excise tax threshold in 2018 if they don't take action. By 2020, almost three-quarters (72%) expect one of their plans will trigger the tax, while their plan with the greatest enrollment will only be one year behind. Employers, however, are taking action to delay the impact of the excise tax. More than three quarters of respondents (76%) are adding or expanding CDHPs and consumerism tools while 70% are expanding wellness programs." (National Business Group on Health [NBGH])
[Opinion] Keep the Cadillac Tax
"There are good reasons to retain the tax. It makes a start, albeit small, toward reducing the cost of health care by discouraging excessive spending. It would generate some $87 billion over the next decade to finance more coverage for the uninsured, a sum that would either have to be replaced with other revenues or added to the deficit. In addition, a vast majority of policyholders won't be hurt because the average family plan currently costs about $17,000, well below the tax threshold." (The New York Times; subscription may be required)
Voluntary Benefits: Filling the Deductible Gap in the ACA Landscape
"Offering a comprehensive suite of voluntary benefits can be a cost-effective way to ease the financial burden and ... [provide] an expanded 'safety net' of coverage for individuals and their families. Voluntary benefit products such as critical illness, hospital indemnity and whole life... allow employees to protect themselves and their families in time of need, helping them to cover expenses that may extend beyond the scope of their standard health plan." (Benefitfocus)
[Official Guidance] Text of Agency FAQs on ACA Implementation (Part XXVIII): Transparency Reporting Rulemaking for Non-QHP Coverage
"The Departments intend to propose transparency reporting for non-QHP issuers and non-grandfathered group health plans in the future. The proposed reporting requirements may differ from those prescribed in the [HHS proposal under section 1311(e)(3) of the ACA], and will take into account differences in markets, reporting requirements already in existence for non-QHPs (including group health plans), and other relevant factors. The Departments also intend to streamline reporting under multiple reporting provisions and reduce unnecessary duplication." (U.S. Department of Labor [DOL], U.S. Department of Health and Human Services [HHS], and Internal Revenue Service [IRS])
[Guidance Overview] New HSA and ACA Reprieves for Veterans in Latest Highway Funding Bill
"[One] new change permits veterans enrolled in a HDHP (with no other disqualifying coverage) and who have a service-connected disability to make or receive HSA contributions regardless of when they received VA benefits. In other words, veterans with a service-connected disability will not be blocked from HSA eligibility merely because they accessed VA benefits in the prior three months.... [Another change] change provides employers with a new incentive to expand their workforce by hiring veterans who will not count toward the ALE status determination." (ABD Insurance & Financial Services)
Effects of 2018 Cadillac Tax Already Being Felt, According to Benefits Survey of Hospitals in the Northeast
"13% of respondents levy a spousal surcharge, charging extra for spouses offered other coverage through their employers. 7% of respondents deny coverage to spouses who are offered coverage through their employers. 48% of respondents are aggressively steering employees to their internal pharmacies. 46% have created a separate tier for specialty drugs, and 25% have moved to 100% copays for non-formulary drugs.... 95% of respondents are tracking the number of hours worked by employees, and 65% of respondents expect to avoid all penalties from the ACA employer mandate." (Cammack Health)

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