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Health plans - design

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Six Economic Facts About Health Care and Health Insurance Markets After the ACA
"Spending on health-care resources varies widely across the country: spending for the average Medicare enrollee in Miami is nearly 70 percent greater than in Minneapolis.... Millions of households with health insurance do not have enough cash on hand to pay out-of-pocket medical expenses in the event of a major health shock.... Over the past three decades the percent of American workers enrolled in conventional health insurance plans has declined from 73 percent to less than 1 percent.... Over the past two decades, there has been a nearly 50 percent increase in the share of private sector workers who are offered a choice of health insurance plans." (The Brookings Institution)
[Guidance Overview] President Signs PACE Act Changing Small Group Market Definition (PDF)
"On October 7, 2015 President Obama signed the Protecting Affordable Coverage for Employees (PACE) Act that amends the [ACA] definition of a 'small employer' for the purpose of purchasing health insurance coverage.... The PACE Act repeals the mandatory expansion of the small group market to employers with up to 100 employees and reverts to the prior definition of up to 50 employees although the states maintain flexibility to define the small market as up to 100 employees.... Numerous questions surround the passage of this amendment to the ACA given the fact that the change has happened so late in 2015." (Cherry Bekaert Benefits Consulting, LLC)
Can the Cadillac Tax Be Made Less Regressive by Replacing It with an Exclusion Cap?
"One alternative to the Cadillac tax is an 'exclusion cap,' under which individuals enrolled in employer-sponsored plans would be able to exclude premiums from their taxable income only up to a dollar limit (i.e., the cap). This analysis uses RAND's COMPARE microsimulation model to [1] define an exclusion cap scenario that would produce the same amount of federal tax revenues as the Cadillac tax in 2020 and [2] compare the effects of the exclusion cap and the Cadillac tax on families in different income ranges. The analysis shows that there is very little difference in progressivity between the Cadillac tax and a revenue-equivalent exclusion cap." (RAND Corporation)
Risk Selection Threatens Quality of Care for Certain Patients: Lessons from Europe's Health Insurance Exchanges
"Experience in European health insurance exchanges indicates that even with the best risk-adjustment formulas, insurers have substantial incentives to engage in risk selection.... Recommended improvements to the risk-adjustment process in the United States include considering the adoption of risk adjusters used in Europe, investing in the collection of data, using a permanent form of risk sharing, and replacing the current premium 'band' restrictions with more flexible restrictions." (Health Affairs)
[Opinion] ACA Excise Tax on Expensive Health Plans Is an Unambiguous Pay Cut
"[E]ven if wages rise in response to cutbacks in employer premium contributions, the level of pre-tax pay (where pay includes both wages as well as other employer-provided benefits) won't increase at all -- instead its composition will simply shift, with employer premium payments falling and wages rising. Further, because wages are taxed and employer premium payments are not, this means that the total tax bill on the worker's overall compensation will have unambiguously increased. So, post-tax compensation is lower with the excise tax, period. It is a take-home-pay cut." (Economic Policy Institute)
Latest Round of Cadillac Tax Comments Yields More Criticism
"In its comment letter, the OPM said that as the tax currently stands, administering it would likely lead to a reduction or elimination of benefits for employees in the Federal Employees Health Benefits Program.... The question over who should be considered 'the person that administers the plan benefits' was a prominent issue in the comment letters." (Bloomberg BNA)
[Guidance Overview] EEOC Proposes Rule on Application of ADA to Employer Wellness Programs
"The [proposed regulation] requires employers to provide employees with a written notice that clearly explains [1] what medical information will be obtained, [2] how the medical information will be used, [3] who will receive the medical information, [4] restrictions on the medical information's disclosure, and [5] the methods used to prevent improper disclosure of the medical information." (Morgan Lewis)
Why You Can't Overlook Worksite Wellness
"An increasing number of U.S. employers (over 60%) find value in offering worksite wellness. In response to current business challenges, some employers have cut their wellness programs to save money. But eliminating wellness from an organization's overall health plan strategy ignores the harmful effects unhealthy employees can have on the bottom line -- they can be less productive at work and have higher health care costs." (Ascende)
[Guidance Overview] Excluding Certain Classes of Employees from Your Health Plan May Increase Risk of Penalty
"Whether you use the month-to-month method or the look-back measurement method to determine who is a full-time employee, categorical exclusions of entire classes of employees from your medical plan increase the risk that you will miss your targets, especially beginning in 2016, when you'll have much less margin for error ... [C]ategorical exclusions also increase the risk of incurring the Section 4980H(b) penalty, which applies when your organization avoids the [4980H(a)] penalty but any of your full-time workers end up purchasing health insurance on the Exchange and qualifying for the tax subsidy." (Warner Norcross & Judd LLP)
Almost Half of Obamacare Plans on Federal Marketplace Lack Out-Of-Network Coverage
"Overall, 52.6 percent of Obamacare plans on had out-of-network coverage, leaving nearly half of plans without easily accessible out-of-network coverage.... The percentage of Obamacare marketplace plans offering out-of-network coverage in each state ranged from 0 percent in South Dakota to 100 percent in Alaska, Alabama, Louisiana, Tennessee, and West Virginia.... In 13 states, less than half of plans offered out-of-network coverage." (HealthPocket)
[Guidance Overview] Entire Subset of HSAs Will No Longer Qualify as HSAs If California Governor Signs Bill
"California teeters on the edge of passing a law that will make many HSA-eligible plans illegitimate on January 1, 2016.... There is no reasonable way to interpret the requirement for an embedded out of pocket maximum (OOPM) ... that would square with all HSA-eligible plans. The standard effective date for new legislation such as this is January 1st following the enactment. This bill does not provide delayed effective dates for the embedded OOPM; only for embedded deductibles." (Benefit Revolution)
[Guidance Overview] The Long Arm of the ACA Nondiscrimination Rules
"The proposed rule does not offer any specific guidance on how a covered health insurance issuer's required compliance would apply to its services as a third party administrator for a self-funded group health plan.... This means that insurers participating in the ACA Marketplaces that also offer coverage to employers in the group market, and those who act as TPAs for self-funded plans, may need to apply these rules to their group insurance coverages and even to the plans for which they serve as TPAs. This is a potentially very broad-sweeping rule that could change what employer plans have to cover." (Benefits Bryan Cave)
The Bigger Questions about Health Insurance
"[As] regulators assess the big deals, the bigger questions about the insurance industry will likely come into focus ... What is the purpose for health insurance? ... Should it cover everything or only the most costly episodes? And should employers play a role at all? Should health insurers be required to make their data accessible and transparent to the providers, pharmacists, and hospitals they contract, and to the members, employers, and government agencies they serve? ... Should their decisions to suspend a plan, raise premiums, eliminate providers from networks for causes other than safety or quality, be subject to tighter scrutiny by state departments of insurance to which they're accountable?" (Paul Keckley)
[Opinion] Risk Corridor Stabilization Fund: Another ACA Failure
"[T]he stabilization fund is able to cover only about 13% of of the losses above the upper margin of the corridor.... Congress has created barriers to using funds other than the user fees authorized by the risk corridor stabilization program.... Risk corridors, risk adjustment, and reinsurance are not for the benefit of patients, rather they are to protect the insurers. Not only do they add to our profound administrative waste, they also open up opportunities for insurers to profit even more through chicanery and gamesmanship." (Physicians for a National Health Program [PNHP])
House Approves Bill Redefining Small Group Plans
"[A recent CBO analysis said] H.R. 1624 would result in a net reduction in premiums for health insurance purchased by some firms with between 51 and 100 employees in the near term. Premiums would be lower because some firms would choose to offer insurance that does not meet the standards required under current law, the CBO said.... The American Academy of Actuaries has estimated that expanding the definition of small employer to include companies with as many as 100 employees could affect more than 150,000 establishments with more than 3 million workers, and would likely lead to decreased plan design flexibility, adverse selection and higher premiums." (Bloomberg BNA)
[Guidance Overview] Frequently Recurring Questions Regarding the Impact of the ACA on Employers (PDF)
Topics include: [1] Permissibility of Offering Employees a Health FSA Without a Major Medical Plan; [2] Permissibility of Offering Employees an HRA Without a Major Medical Plan; [3] Permissibility of Reducing Employees' Hours Below the 30 Hours/Weeks Threshold; and [4] IRS Health Care Coverage Reporting Requirement. (Hinkle Law Firm LLC)
Workplace Wellness Programs: Early Alarm for Workers' Health, or a Recipe for Over-Testing?
"Asking employees about smoking or checking their blood pressure is not controversial among medical experts, but there is less agreement about some of the other tests included in many wellness programs. That's mainly because most require a package that is one size fits all, not stratified based on whether a worker is 25 with no risk factors or 35 with parents who died of heart attacks in their 40s. Testing a broad cross-section of adults every year with a range of screening exams poses some risks, medical and policy experts say." (Kaiser Health News)
[Opinion] Selling Health Insurance Across State Lines
"[S]uch a reform has no effect. Back in 2010, Georgia sacrificed its sovereignty to regulate health insurance, but premiums didn't change. The reason is that if a health plan wants to offer coverage in a state, it already can easily do so. Health insurers enter and exit markets all the time.... By far the largest determinant of insurance premiums isn't mandates, it's the provider network tied to a health plan.... [If] we owned our own health insurance, states would quickly harmonize their laws to facilitate a national market. Which brings us to a legitimate recommendation for Congress: Stop the tax code's discrimination against individually owned health insurance." (National Center for Policy Analysis Health Policy Blog)
Seven Questions to Ask Your Boss About Wellness Privacy
"[1] What information will my employer see? ... [2] Is the program covered under the HIPAA privacy law? ... [3] Did I give up my HIPAA rights when I filled out my health assessment on the wellness site? ... [4] My employer says it sees only group results. Does that guarantee privacy? ... [5] How many other companies see my wellness data? ... [6] What privacy policies do subcontractors and other third parties have to follow? ... [7] Could somebody try to identify individuals in the group results shared by my wellness plan?" (National Public Radio)
Congress Votes to Repeal Small Group Market Expansion
"The PACE legislation would maintain the current definition of a small group market as one to 50 employees and give individual states the flexibility to expand the group size if they feel the market conditions in their state necessitate the change.... [S]mall group market plans must: [1] Cover 10 essential health benefits. [2] Fit into the actuarial value levels (platinum, gold, silver and bronze) defined by the ACA. [3] Participate in the risk adjustment program and be part of a single risk pool for setting premiums. [4] Only consider age, geographic location, family composition and tobacco use in setting rates. Large group plans are not bound by any of these requirements." (Society for Human Resource Management [SHRM])
[Guidance Overview] IRS Health Care Tax Tip 2015-61: Understanding Minimum Essential Coverage
"The Affordable Care Act requires any person or organization that provides minimum essential coverage, including employers that provide self-insured group health plans, to report this coverage to the IRS and furnish statements to the covered individuals." (Internal Revenue Service [IRS])
Whither Health Insurance Exchanges Under the ACA? Active Purchasing Versus Passive Marketplaces
"Two models have dominated the policy literature on health insurance exchanges, with many hybrids borrowing elements of each. At one end of the policy spectrum, the insurance exchange can serve as a 'marketplace' or 'clearinghouse' where buyers and sellers transact with minimal regulation of the product features and prices.... At the other end of the policy spectrum, the exchange serves as an 'active purchaser' of health insurance on behalf of its clients, the individual consumers. In effect, the exchange seeks to move insurance from a let-the-buyer-beware retail market to a two-stage wholesale and retail market." (Health Affairs)
Repeal of ACA Expansion for Small Groups Is Approved by Senate, Heads to President for Signature
"The Senate passed legislation on Thursday intended to protect small and midsize businesses from increases in health insurance premiums, clearing the bill for President Obama's expected signature.... The bill ... eliminates a provision of the law that would have imposed tough, potentially costly new requirements on businesses with 51 to 100 employees. A White House spokeswoman confirmed that Mr. Obama would sign the bill, but she declined to discuss its substance. Recent comments by administration officials suggested that they did not particularly like the legislation but could not stop the growing wave of bipartisan support for it." (The New York Times; subscription may be required)
Two Sides to the Debate Over Obamacare's 'Cadillac Tax'
"On the one hand, the current tax preference for employer-provided health benefits costs the federal government more than $300 billion per year and represents an open-ended subsidy that benefits high-wage workers more than low-wage workers while leading to more generous insurance than would otherwise be the case.... On the other hand, this is not the only possible approach to constraining health spending, and the Cadillac tax would hit low-income workers and the chronically ill hardest by encouraging employers to increase deductibles and co-pays." (The Wall Street Journal; subscription may be required)
[Opinion] Business Roundtable Comment Letter to IRS on Notice 2015-52: Excise Tax on High Cost Employer-Sponsored Health Coverage
"We are increasingly concerned about the broad interpretation of the 40 percent tax. We ask that you reevaluate the positions taken in both of the proposed guidance documents and instead design the implementation of the tax in a way that does not discourage employers from continuing to innovate, demand marketplace improvements and sponsor plans that promote value in the use of important health care services." (Business Roundtable [BRT])
[Opinion] Excise Tax on High-Cost Plans Will Help to Control Rising Costs
"The Cadillac tax will help curtail the growth of private health insurance premiums by encouraging employers to limit the costs of plans to the tax-free amount. The excise tax will discourage the provision of insurance that covers such a large proportion of health care spending that consumers have little incentive to insist on cost-effective care and providers have little incentive to provide it." (101 health policy experts, via Center on Budget and Policy Priorities)
Charges Billed by Out-of-Network Providers: Implications for Affordability
"[This] study identified a pattern of average billed charges submitted by out-of-network providers that far exceeded Medicare reimbursement for the same service performed in the same geographic area.... There was wide variation in out-of-network charges from different providers for the same procedure.... For many procedures, [the authors] found regional patterns in the ratio of out-of-network charges to average Medicare fee at the state level." (America's Health Insurance Plans [AHIP])
[Guidance Overview] Health and Welfare Benefits Monthly Update (PDF)
55 presentation slides covering: [1] 6056 Reporting and Disclosure Rules: Practical Applications, and [2] Forms 1095-C Examples. (Alston & Bird LLP)
60% of Employers Say Their Plans Are Likely Trigger the Cadillac Tax -- and Soon
"[N]early nine in ten employers have calculated whether their health plan will trigger the Cadillac tax, and 60% say that without any future changes, their plan will face the tax.... Of those that are on track to trigger the tax, 62% say they will likely face the tax right away in 2018. An additional 10% say they will hit the tax in 2019, 12% in 2020, and 11% in 2021 or later." (International Foundation of Employee Benefit Plans [IFEBP])
[Opinion] NHeLP Comment Letter to CMS on Proposed 2017 Essential Health Benefits Benchmark Plans
13 pages. "There is a clear directive in the [ACA] requiring the Secretary of HHS to define the [essential health benefits (EHBs)], and as a legal matter, HHS has no authority to delegate defining the EHBs to states or issuers.... HHS should clarify in written guidance to states that they may supplement when there is insufficient or inadequate coverage of an EHB category.... We urge HHS to eliminate any provision allowing issuer flexibility to substitute benefits." (National Health Law Program [NHeLP])
[Guidance Overview] Hawaii Posts Nation's First State Innovation Waiver Proposal
"On September 9 Hawaii became the first state to post a draft 1332 waiver proposal for public comment. While Hawaii's waiver proposal is focused on the state's unique 40-year-old employer mandate, the 40-page proposal illuminates the procedural and substantive issues that other states will have to address in moving forward with 1332 waiver proposals. Section 1332 of the [ACA] authorizes states to request waivers from the [HHS] and Treasury of key components of the ACA's coverage provisions, including those related to benefits and subsidies, the Marketplaces, and the individual and employer mandates." (Manatt, Phelps & Phillips)
Privacy Advocates Urge Stronger Protection of Employee Health Data
" 'A $40 a month penalty is not enough for me to want to tell my employer what I'm doing with my health,' said [one employee].... Advocates [say the EEOC] proposal includes a large loophole: It allows employers to get individual data provided to the wellness programs if needed to administer their health plans.... [P]rivacy advocates [also] say HIPAA's rules don't apply directly to employers. In addition, wellness programs run entirely by the employer, rather than as part of the employer's group health insurance plan, are also outside of HIPAA's purview." (Kaiser Health News)
Provider Groups Come Out Swinging Against Insurance Company Mergers
"[Tom Nickels, executive vice president of the American Hospital Association (AHA), criticized the insurance companies'] oft-cited argument that all healthcare is local, noting that in their arguments for the deals 'they cite national statistics on the number of competitors instead of the actual competition in local markets.' ... [Andrew W. Gurman, M.D., president-elect of the American Medical Association,] argued that consolidation in the health insurance industry also compromises the ability of physicians to advocate for their patients, especially when doctors are forced to negotiate with a 'mega-merged conglomerate.' " (FierceHealthPayer)
[Opinion] ERISA Industry Committee Comment Letter to IRS on Notice 2015-52, ACA 40% Excise Tax (PDF)
12 pages. "[E]mployers and their administrators and their insurance carriers need to assess and avoid the risk of Code section 4980I excise taxes in advance, and the entire excise tax process should be designed to support these advance determinations. Plan sponsors need to know the excise tax threshold amounts and the value of their health plan coverage before the applicable taxable period, not after. Plan sponsors need to have time to adjust their plan designs, and to reduce extraneous excise tax 'costs' before the applicable taxable period, not after. If a plan sponsor has excise tax risk exposure, the amount of that risk should be known with reasonable accuracy before the applicable taxable period, not after." (The ERISA Industry Committee [ERIC])
Forces Join to Fight the Cadillac Tax
"[By] the mid-2020s, virtually all plans will be over the cost limit, according to various analyses. Why? Because after 2018, annual increases in the thresholds are indexed to the Consumer Price Index rather than to medical-cost inflation, which has been significantly outpacing CPI for many years and presumably will continue doing so.... An NBGH survey of 140 member organizations asked how long they think they'll be able to make plan changes that delay the impact of the tax. Most respondents said it would only be two or three years." (CFO)
After-Tax HSAs May Help Employers Avoid Cadillac Tax
"Shifting premiums to employees cannot reduce Cadillac taxable plan costs because the tax is levied on the sum of the employee and employer contributions.... HRA, and HSA and health FSA contributions on a pre-tax basis will be counted when calculating the Cadillac tax.... But employee contributions made on a post-tax basis into those accounts will not be counted. And limited-scope dental and vision coverage will not be counted either. Of these, employee payments to HSAs are the most advantageous because individuals can get tax exemptions for those." (Thompson SmartHR Manager)
Post-ACA Trends in Health Coverage for Small Businesses: Views from the Market (PDF)
"Some states are not closely monitoring enrollment in small-group markets ... The SHOP continues to have a minimal enrollment ... In some states, a significant proportion of small-group employers remain in non-ACA-compliant plans ... Some small employers are dropping health coverage with an expectation that employees will shift to the individual marketplace ... In some states, small employers appear to be shifting away from association health plans, while other types of group purchasing arrangements may be gaining a foothold for future growth." [5-page executive summary; 14-page full report is also available.] (Robert Wood Johnson Foundation)
How to Add a Master Health Plan to Your Professional Employer Organization's Menu of Services (PDF)
"[H]ealthcare, though important to employees, has always been relatively complicated and expensive for small businesses to provide. Accessing this key benefit through a [professional employer organization (PEO)] gives employers a simple turnkey solution.... This article will explain the different options available to PEOs and outline the steps to take when adding a master health plan as a benefit for your clients and their employees." (Milliman via PEO Insider)
[Guidance Overview] Recent IRS Letter Rulings Shine Helpful Light on Reallocation of VEBA Assets (PDF)
"Two recent companion private letter rulings (PLR 201530022, July 24, 2015, and PLR 201532037, Aug. 7, 2015) ... suggest that employers who would like to reallocate some of their VEBA assets to fund other 'permissible benefits' should take a fresh look at the situation. While the income tax impact of the 'tax benefit' rule needs to be evaluated, the cash flow savings to the company may outweigh any tax cost as long as the reversion tax would not apply (and there are very strong arguments that it shouldn't)." (Groom Law Group)
PACE and EACH Acts Pass House of Representatives
"The CBO estimated that the PACE Act would reduce the deficit by $400 million over ten years because it would reduce premiums in the mid-size employer market, thus increasing taxable income of employees. It is thus one of the few potential amendments to the ACA that does not increase the deficit ... The EACH Act extends the ACA's religious conscience exemption from the individual mandate to purchase health insurance ... Parallel legislation to both the PACE and EACH act is pending in the Senate." (Timothy Jost, in Health Affairs)
House Votes to Protect Employees from Rising Health Care Costs, Cancelled Plans
"The House of Representatives [on Sept. 28] approved H.R. 1624, the Protecting Affordable Coverage for Employees Act, authored by Energy and Commerce Health Subcommittee Vice Chairman Brett Guthrie (R-KY). This bipartisan, commonsense legislation will help protect employees from cancelled health plans and rising health care premiums." (Energy & Commerce Committee, U.S. House of Representatives)
Description of Budget Reconciliation Legislative Recommendations Relating to Repeal of Certain ACA Excise Taxes (PDF)
The bill includes provisions repealing the individual mandate, the employer mandate, the medical device excise tax, the 'Cadillac' tax on high-cost health coverage, and the requirement to report the cost of health coverage on Form W-2. Excerpt: "The House Committee on Ways and Means has scheduled a committee markup of Budget Reconciliation Legislative Recommendations Relating to Repeal of Certain Excise Taxes Enacted in the Patient Protection and Affordable Care Act on September 29, 2015. This document, prepared by the staff of the Joint Committee on Taxation, provides a description of the bill." (Joint Committee on Taxation [JCT], U.S. Congress)
Narrow Networks Face Fresh Scrutiny: Can They Pass the Adequacy Test?
"Narrow networks mean lower premiums. Now, state insurance commissioners are wrestling with how they should be regulated so that insurers stay solvent and consumers are protected.... The [Network Adequacy Subgroup of the National Association of Insurance Commissioners (NAIC)] is working out the details, word by painful word, of a new model network adequacy law. The effort updates a 1996 version that has become badly outdated as insurance products have evolved and the narrow network has become increasingly common." (Managed Care)
House Votes Unanimously to Repeal Scheduled ACA Expansion for Small Groups
"In a unanimous vote, the House passed legislation [on Sept. 28] that would rescind the Affordable Care Act's expanded definition of a small employer. The bipartisan bill has had strong support from employers and benefit industry insiders who feared the expansion could lead to premium increases and jeopardize the ability for small and mid-sized businesses to compete in today's market.... The ACA proposes that effective Jan. 1, 2016, the definition of a small group employer increases from 1-50 employees to 1-100 employees. The Protecting Affordable Coverage for Employees Act (PACE) would maintain the current definition of a small group market as 1-50 employees and give states the flexibility to expand the group size if they feel the market conditions in their state necessitate the change." (Employee Benefit News)
[Opinion] Repealing Employer Mandate Would Weaken Job-Based Coverage, Increase Uninsured
"A just-released survey finds that in 2015, 21 percent of employers with 100 or more FTEs expanded eligibility to include more workers and 5 percent now offer more comprehensive benefits to some workers who had received only limited benefits.... [CBO] -- which estimated in 2013 that delaying the employer responsibility requirement by one year would leave 1 million fewer people with employer coverage (about 500,000 of whom would end up uninsured) -- warned that repealing the requirement would likely cause even more people to become uninsured, relative to current law." (Center on Budget and Policy Priorities)
Republican-Controlled States Bolstered Their Health Insurance Rate Review Programs Using Incentives from the ACA
"[Of] states that did not meet CMS's criteria when the ACA was enacted, most made changes to meet those criteria ... However, Republican-controlled states were less likely than non-Republican-controlled states to increase their anticipated loss ratio requirements to align with the federal retrospective medical loss ratio requirement, expand Medicaid, and establish state-based exchanges ... [F]ederal incentives for states to strengthen their health insurance rate review programs were more effective than the incentives for states to adopt other insurance-related policy goals of the ACA." (SAGE Inquiry)
Startups Use Tech and Data to Challenge the Health Insurance Industry Status Quo
"[T]he individual market created by the Affordable Care Act and the rise of consumerism have spawned a slew of startup companies trying to elbow their way into the health insurance space. Some function as online brokers, using data to help consumers choose the right plan. Another tries to compete head-to-head with the industry's biggest names, offering an alternative to a young and tech-savvy crowd. Still others blur the lines between provider and payer, seeking to turn healthcare's business model on its head." (FierceHealthPayer)
Access to Specific Provisions of Employer-Provided Benefits: New Estimates
"[This] article describes the prevalence with which people working for private employers in the United States are given the opportunity to enroll in health and retirement plans with various provisions -- the extent to which they have access to those provisions.... The analysis that follows explores this dynamic by presenting participation and takeup rates for plan provisions alongside the access rates." (U.S. Bureau of Labor Statistics [BLS])
Court Enjoins Enforcement of HHS Regulation Requiring Individuals Purchasing Fixed Indemnity Policies to Have Minimum Essential Coverage
"Excepted benefit status is crucial for fixed indemnity policies because they are not designed to comply with health care reform, and insurers want to be able to sell those policies to individuals who have no other coverage. HHS, by contrast, is concerned that individuals may purchase fixed indemnity coverage in lieu of major medical, mistakenly thinking that this coverage satisfies the individual mandate or provides equivalent protection to major medical coverage.... Given these competing interests, we probably have not seen the last of this issue." [Central United Life, Inc. v. Burwell, No. 14-1954 (D.D.C. Sept. 11, 2015)] (Thomson Reuters / EBIA)
National Compensation Survey: Employee Benefits in the U.S., March 2015 (PDF)
572 pages. "The National Compensation Survey (NCS) provides comprehensive measures of compensation cost trends, the incidence of benefits, and detailed benefit provisions. This bulletin presents estimates of the incidence and key provisions of selected employee benefit plans. Estimates presented are on benefits for civilian workers -- workers in private industry and in state and local government -- by various employee and employer characteristics. For the purposes of the NCS, the Federal Government, agricultural, and household workers, and workers who are self-employed, are excluded." [Bulletin 2782, Sept. 2015] (U.S. Bureau of Labor Statistics [BLS])
Onslaught of Bills to Repeal Cadillac Tax Continues
"The American Worker Health Care Tax Relief Act of 2015 (no bill number available), introduced Sept. 24 by Sen. Sherrod Brown (D-Ohio), joins several other bills that have been introduced this year by both Democrats and Republicans to fully repeal the unpopular tax that many call the Cadillac tax. Brown's bill has nine co-sponsors, including Democratic presidential candidate Sen. Bernie Sanders (I-Vt.)." (Bloomberg BNA)
High Deductibles More Common in Exchanges Than in Employer Plans
"Roughly half of all workers in employer plans have an annual deductible of at least $1,000, and the average deductible has grown at almost seven times faster than wages.... Roughly 60% of those with ACA plans either paid no monthly premium or less than $125, compared with 55% of people with employer plans. Employers subsidize the vast majority of their workers' health insurance premiums, and the government offers subsidies for the millions of Americans now enrolled in coverage through the exchanges." (Modern Healthcare)
Cadillac Tax Is Hated, But It Might Be Working
"[The UAW recently] proposed an unusual level of labor-management collaboration to tackle rising health costs. The draft agreement calls for labor and the Big Three domestic automakers to pool resources in a co-op 'to explore innovative ways of improving the delivery of negotiated health care benefits in a manner that increases quality, lowers cost, produces less waste and provides better patient care.' If the new contract is ratified by Chrysler workers, the UAW will take the same proposal into contract negotiations with Ford and General Motors. Does that mean the Cadillac tax is working as intended? Perhaps. It's definitely bringing new urgency to efforts to control costs." (Real Clear Politics)
Blue Cross Blue Shield Association Launches Nationwide Database on Healthcare Quality and Cost
"The database provides two primary advantages, BCBSA CIO Doug Porter [said] ... For consumers, they are better informed with this data at their fingertips. And for health plan account decision-makers, 'they now have fuller visibility and transparency' to guide employees to seek out the best point of service for their care ... [P]roviders can benefit by using the data to benchmark care delivery patterns, which allows them to drive more coordinated, patient-centered care[.]" (FierceHealthPayer)
Top 11 Health Plans in 2015
"The National Committee for Quality Assurance has released its newest rankings for health plans in the United States based on clinical and satisfaction scores. The organization used combined HEDIS, CAHPS and NCQA Accreditation standards scores as of June 30, 2015. [An] infographic shows the top 11 health plans, based on the scores." (Healthcare Payer News)
After-Tax HSAs: A Strategy for Avoiding the Cadillac Tax
"Most employers do not facilitate after-tax contributions to health savings accounts (HSAs), but they should consider it as a potential strategy to avoid the ACA excise tax on high-cost health plans." (PLANSPONSOR)
ACA Compliance: What's Ahead for Employers?
"Phased implementation of the ACA requirements has kept employers consistently busy over the last few years, but there is still more to come. Throughout the end of 2015 and into the first half of 2016, employers will continue to focus on the employer shared responsibility provisions of the ACA, tackle the new reporting requirements (not an easy feat, to say the least), and begin planning for the 'Cadillac' plan tax. Here is [a] 'simplified' cheat sheet and some tips for what's ahead." (Ogletree Deakins)
Oscar and the Changing Health Insurance Landscape
"One indicator regulators use to determine whether a business combination will reduce competition is whether there are significant barriers to entry in the industry. If there are, new competitors will not exploit openings created by incumbents' consolidation. During the hearing, the CEOs of Anthem and Aetna each (independently) pointed to Oscar, a new health insurer with highly pedigreed investors, as evidence that health insurance is an easy business to enter." (National Center for Policy Analysis Health Policy Blog)
[Opinion] This Is Your Brain on Wellness
"There are three reasons I hope my competitors undertake these programs. First, their healthcare expenses will rise.... Second, their productivity will decline.... And that raises the third point ... Their corporate morale will suffer." (The Health Care Blog)
Three Ways to Prevent Health Risk Assessment Fatigue
"In the anatomy of a corporate wellness program, the health risk assessment with biometric screening is equivalent to the heart. However, many employers who have offered this important health-status indicator are beginning to question its long-term value. A well-executed and outcomes-based [health risk assessment (HRA)] keeps the program running smoothly and effectively because all other elements depend upon its accurate assessment and ongoing data. When employers do not experience positive results, including long-term cost savings, positive health outcomes and/or improved productivity promised from the HRA, the result is HRA fatigue." (Employee Benefit News)

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