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Health plans - design


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Text of EBSA Revised Notice of ERISA Advisory Council Meeting on November 3-4, 2014
"[T]he 174th open meeting of the Advisory Council on Employee Welfare and Pension Benefit Plans (also known as the ERISA Advisory Council) will be held on November 3-4, 2014. No votes will occur until November 4. Despite our efforts to get this meeting notice published early, we were unable to do so. The Advisory Council meeting notice appeared on the public inspection desk of the Federal Register on October 20, 2014. This revised notice clarifies that final votes on the Council's recommendations to the Secretary will occur on November 4, 2014 ... The Council recommendations will be on the following issues: [1] Issues and Considerations around Facilitating Lifetime Plan Participation, [2] PBM Compensation and Fee Disclosure, and [3] Outsourcing Employee Benefit Plan Services." (Employee Benefits Security Administration [EBSA], U.S. Department of Labor)
Retirement Plan's Venue Selection Clause Held Enforceable and Applied to Dismiss Participant's Benefit Claims
"The Federal courts ... have repeatedly held that adherence to the written terms of a plan in enforcing ERISA rights and obligations is of paramount importance. These decisions often demonstrate the extent to which the courts will enforce a plan sponsor's design choices provided they fit within ERISA's statutory and regulatory boundaries. Those boundaries are not endlessly elastic, but [this case] shows that they may be broader than some participants expected." [Smith v. Aegon Companies Pension Plan, No.13-5492 (6th Cir. Oct. 14, 2014)] (Williams Mullen)
[Guidance Overview] Federal Agencies Issue Final Guidance on Excepted Benefit Standards
"The final regulations give employers more flexibility in their EAPs and stand-alone limited-scope dental and vision programs. The criteria for EAPs to qualify as excepted benefits are largely the same as in the proposed regulations. The final guidance does not address limited wraparound coverage; the departments intend to publish regulations in the future on such coverage, 'taking into account the extensive comments received on this issue.'" (Towers Watson)
[Guidance Overview] Five Hot Topics in the Health Plan World
"[1] Mental Health Parity rules require immediate attention.... [2] HPID? OMG! ... [3] Whose employees are they? Temporary workers and the employer shared responsibility.... [4] Reinsurance fee deadlines looming.... [5] Reference-based pricing and MOOP limits." (Quarles & Brady LLP)
32% of Employers Delayed Health Plan Renewal Date to December 2014 to Avoid Rate Increases
"The number of employers delaying their health plan renewal dates until December 1 increased 322 percent from 2013 to 2014, with 32 percent of all employers postponing their renewal date, according to ... [this] survey of nearly 10,000 employers. Of the 32 percent, 94 percent were small businesses in the under 100-employee market. Based on current renewal rates coming in from carriers, in the states that did not allow renewal of pre-PPACA plans, many small employers are facing rate increases of 30 percent to 160 percent[.]" (United Benefit Advisors)
[Guidance Overview] Final Regs Clarify When Dental and Vision Benefits and Employee Assistance Programs Are Not Subject to the ACA
"Benefits that meet these tests are not subject to group health plan mandates under the [ACA], including the ban on annual or lifetime dollar limits. Nor would the pediatric dental or vision benefits offered under these limited-scope arrangements have to count toward the out-of-pocket limit applicable to non-grandfathered plans ($6,600 single/$13,200 family in 2015). In addition, to the extent these benefits are not already exempt, they will also be exempt from certain fees, such as the comparative effectiveness research fees7 and the transitional reinsurance fees. Treating these benefits as excepted benefits may also assist the plan to avoid the excise tax on high-cost health plans." (Segal Consulting)
Checklist for Evaluating Private Exchanges
"Important considerations include: What are my company's benefit plan objectives and does it make sense to move to a private exchange based on these objectives? Is moving to an exchange cost effective for my organization and my employees? What does moving to a private exchange entail? What are the options for both insured and self-funded arrangements? How will offering benefits through an exchange impact my company's health management strategy? What additional fees and commissions are built into the rates under a private exchange?" (Findley Davies)
As Virus Spreads, Insurers Exclude Ebola from New Policies
"As fear of Ebola infections spreads to developed economies, U.S. and British insurance companies have begun writing Ebola exclusions into standard policies to cover hospitals, event organizers and other businesses vulnerable to local disruptions. As a result, new policies and renewals will become costlier for companies opting to insure business travel to West Africa or to cover the risk of losses from quarantine shutdowns at home[.]" (Reuters, via The Baltimore Sun)
Open Enrollment: Insights from Medicare for Health Insurance Marketplaces
"Health insurance plans often change from one year to the next, and some of these changes could have a real impact on costs and coverage, including changes in premiums, cost-sharing, benefits, formularies and choice of doctors and hospitals. Consumers are advised to review their options carefully before deciding whether to renew their current plan or enroll in a new one. But will they?" (Henry J. Kaiser Family Foundation)
[Guidance Overview] Can Dependents Trigger an ACA Employer Penalty Under Section 4980H(a) or 4980H(b)?
"The final regulations make it clear to utilize the 95 percent rule, a full-time employee's dependents must be offered coverage along with the full-time employee. Therefore, an employer not offering a full-time employee's dependents coverage would not have the protection of the 95 percent rule." (Health Care Attorneys P.C.)
ACA Issues in Mergers and Acquisitions: New Guidance from IRS
"[In] a stock deal, Buyer will assume any unpaid ACA penalties owed by Target. Although this is generally true for any taxes or other liabilities assumed in a stock deal ... the ACA penalties are not due until the Service issues a notice and demand. Thus, for cash basis taxpayers, the ACA penalty will not be reflected on Target's financial statements ... Second, whether or not Target is acquired in a stock sale or asset sale, if Buyer hires Target's employees, any such acquired employees who are 'full-time' must be offered health insurance that provides minimum value and is affordable if Buyer wants to avoid potential ACA penalties." (Saul Ewing LLP)
More States Recognize Same-Sex Marriages But No Mandate Yet for Self-Funded ERISA Plans to Extend Coverage to Same-Sex Spouses
"Although states may have insurance, domestic relations, and nondiscrimination laws that require recognition of same-sex marriages, ERISA preemption appears to invalidate those requirements as they would apply to a self-funded ERISA plan. Plan sponsors choosing an insured plan might not have a choice, because of the way these laws impact insurers." (Lockton)
Employers Looking at 'Skinny' Health Plans to Avoid ACA Penalties
"[S]ome benefits administrators are pitching somewhat-less-skinny plans that they claim protect employers against the $3,000 penalty as well -- by meeting the law's standard of covering at least 60% of the cost of health care. Yet one such 'minimum value plan' that is being sold to employers still lacked coverage for inpatient hospital treatments, procedures at ambulatory surgery centers or most maternity care[.]" (The Wall Street Journal; subscription may be required)
Proposed Bankruptcy Fairness and Employee Benefits Protection Act of 2014 Would Place Significant Restrictions on Employers in Bankruptcy
"Various changes to the Bankruptcy Code would place greater restrictions on corporations going through a bankruptcy by limiting reductions in the compensation and benefits of employees and retirees, requiring funding of retiree health benefits in excess of that approved by the bankruptcy court, increasing the amount of unpaid wages that receive priority treatment, limiting payments and bonuses to insiders, and forcing employers to continue funding pension plans after filing for bankruptcy protection." (Thompson Coburn)
71% of Obamacare Signups Traced to Expansion of Medicaid
"In the states that adopted and implemented Medicaid expansion under Obamacare, enrollment skyrocketed as an additional 5.7 million Americans signed up for coverage. In 21 states opting out of Medicaid expansion, however, enrollment was strikingly lower.... 355,674 Americans signed up for Medicaid in those states. In all, Medicaid enrollment increased by 6 million individuals for the first half of 2014." (Melissa Quinn, in The Daily Signal)
How the Supreme Court Could Still Wreak Havoc on Obamacare
"If you have Obamacare without the subsidies, it would essentially wreak major havoc on the individual insurance market ... Premiums would be 43.3 percent higher on average in the individual market in 2015, while enrollment -- on and off the exchanges -- would drop by 68 percent ... In all, 11.3 million fewer Americans would have health insurance[.]" (The Washington Post; subscription may be required)
[Official Guidance] Text of CMS Proposed Federal Funding Methodology for Basic Health Program, for Program Year 2016
"This document provides the methodology and data sources necessary to determine federal payment amounts made in program year 2016 to states that elect to establish a Basic Health Program [BHP] under the [ACA] to offer health benefits coverage to low-income individuals otherwise eligible to purchase coverage through Affordable Insurance Exchanges.... We propose that the total federal BHP payment amount would be based on multiple 'rate cells' in each state. Each 'rate cell' would represent a unique combination of age range, geographic area, coverage category ... household size, and income range as a percentage of [federal poverty level].... [We] would develop BHP payment rates that would be consistent with those states' rules on age rating. Thus, in the case of a state that does not use age as a rating factor on the Exchange, the BHP payment rates would not vary by age." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services)
[Guidance Overview] New York State Department of Health Releases Long-Awaited Proposed Regs Authorizing Formation of ACOs (PDF)
"The Commissioner of the New York State Department of Health will issue Certificates of Authority (COA) to entities that satisfy the regulatory criteria for ACOs. Among the ACO criteria are the existence of stated mechanisms for governance, accountability, and the distribution of funds. An ACO must have a plan for coordination of care to assure that all medically necessary health care services are available to and used by the patient, including evidence-based treatment initiatives and strategies for patient engagement. The regulations specify standards for the ACO's quality management improvement program, including a process for peer review." (Epstein Becker Green)
House Approves Health Care Bills Before November Elections
"During a brief September legislative session, the House of Representatives approved a bill defining a full-time employee under the Patient Protection and Affordable Care Act (PPACA) using a 40-hour-per-week standard. Another House bill would allow insurers to sell certain health plans that fail to meet PPACA requirements. Although Senate action is not expected, these provisions could reappear on the legislative agenda in 2015." (Towers Watson)
[Guidance Overview] Overview of 2015 QRS Requirements for QHP Issuers (PDF)
"QHP issuers offering family and/or adult-only health insurance coverage of any category through the Marketplaces ... must comply with QRS requirements, if they offered coverage during the previous benefit year and meet minimum enrollment criteria.... QHP issuers are required to collect and submit third-party validated QRS measure data that will be used by CMS to calculate QHP scores and ratings." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
Are Your Benefit Plans Ready for Ebola?
"Will Ebola treatment costs be covered by commercial carriers? Maybe.... [M]ost plans include an exclusion of coverage for employees who are traveling abroad on short-term assignment.... Critical illness policies need to have an infectious disease rider included (not standard), and currently, no policies specifically cover Ebola." (William Gallagher Associates)
Australia Will Raise $5 Billion by Privatizing Its Biggest Health Insurer
"[T]he sale would remove the current conflict where the government is both the regulator of the private health insurance market and owner of the largest market participant. Medibank provides cover to 3.8 million people.... Australia has been shrinking the role of government in health care. Although a national single-payer scheme was established in 1975, the federal government re-introduced private choice within a few years." (National Center for Policy Analysis Health Policy Blog)
Essential Health Benefits: 50-State Variations on a Theme
"The interim policy that defined EHBs by benchmark plans resulted in benefit packages that varied considerably across states. On one hand, chiropractic care was most frequently included (45 states). On the other hand, acupuncture was rarely included (5 states).... 19 states included infertility treatments, 26 states covered autism spectrum disorder, and 31 states covered treatments for TMJ.... For obesity, 23 states included bariatric surgery, but only 12 of them cover nutrition counseling and just three of them cover weight loss programs." (Robert Wood Johnson Foundation)
Advisory Council on Employee Welfare and Pension Benefit Plans to Meet November 3-4
"The purpose of the open meeting on November 3 and the morning of November 4 is for the Advisory Council members to finalize the recommendations they will present to the Secretary. At the November 4 afternoon session, the Council members will receive an update from the Assistant Secretary of Labor for [EBSA] and present their recommendations. The Council recommendations will be on the following issues: [1] PBM Compensation and Fee Disclosure, [2] Outsourcing Employee Benefit Plan Services, and [3] Issues and Considerations around Facilitating Lifetime Plan Participation. Descriptions of these topics are available on the Advisory Council page of the EBSA Web site[.]" (Employee Benefits Security Administration [EBSA], U.S. Department of Labor)
[Guidance Overview] Latest ACA FAQ Provides Additional Guidance on Applying Cost-Sharing Limit to Reference-Based Pricing
"The new standards preserve the flexibility to exclude certain amounts from the out-of-pocket maximum. But plan sponsors and insurers anticipating improved cost-effectiveness from a reference-based pricing design should not overlook the additional complexity these standards are likely to create for themselves or their service providers (e.g., implementing a formal exceptions process and tracking the availability of providers willing to accept the reference price for each procedure)." [FAQs About Affordable Care Act Implementation (Part XXI)] (Thomson Reuters / EBIA)
Wellness Programs Violate ADA, Claims EEOC in Lawsuits
"In the complaints, the EEOC emphasized that the wellness program requirements were not 'job related and consistent with business necessity.' This is the standard for many complaints under the ADA. However, if this becomes the standard for wellness programs, what wellness programs could possibly pass this test?" (Winston & Strawn LLP)
To Cut Healthcare Costs, Companies Emphasize Employee Wellness
"When companies can demonstrate that their wellness plan has encouraged a significant percent of employees to receive annual physicals, address potential health concerns and embrace healthier lifestyles, they often will experience lower increases in their health insurance costs, he says. Companies will have more leverage negotiating their health insurance costs when they have about 70 percent participation[.]" (Columbus CEO)
HSAs and the Coming 'Cadillac' Tax (PDF)
"Employers are waiting for clarification of whether certain items are included when determining the cost of benefits, such as the employee contributions to HSAs.... While your organization has likely already felt the pressure to slow the rate of your health care costs, this upcoming tax forces a necessary review of your strategy for the next five years. Now is the time to evaluate tactics that will provide better results over the long haul, and to consider a multi-year approach aimed at positioning your program best in the new environment." (Fidelity Investments)
Will Employers Favor Private Exchanges Over Healthcare Coverage Sponsorship?
"It remains to be seen whether private exchanges can outperform conventional self-funding arrangements over time. New data from private exchanges ... claim 5-plus percent health plan cost savings, but we don't know whether those numbers will be seen across the sector, or whether they'll be sustainable." (Health Affairs)
[Guidance Overview] New DOL Guidance Places Conditions on Employers Using Reference Pricing and Narrow Networks
"[E]mployer plans should: [1] Have procedures to ensure there are an adequate number of providers that accept the reference price ... [2] Have procedures to ensure that an adequate number of providers accepting the reference price meet reasonable quality standards; [3] Have an easily accessible exceptions process, allowing services rendered by providers that do not accept the reference price to be treated as in-network; and [4] Disclose through the plan's Summary Plan Description, or similar document, information on the pricing structure, the list of services the pricing structure applies to, and the exceptions process." (HR Policy Association)
Trends in Employment-Based Health Insurance Coverage
"Employee access to employer-provided health insurance declined from 1991 to 2000, chiefly because of relatively low rates of access among part-time workers.... From 1991 until 2012, the access rate for all workers declined from 77.3 percent to 70.2 percent. There was little change among full-time workers, whose access rates fell from 87.8 percent to 86.4 percent (although they were higher at some points during the period examined). The drop among part-time workers, however, was much steeper -- from 28.8 percent to 23.7 percent." (U.S. Bureau of Labor Statistics [BLS])
To 'SHOP' or Not: Finding the Right Exchange Path for Your Small Business
"Most smaller companies (approximately 64.8 percent) do not offer health insurance to employees, and although SHOP offers tax credits, they're only available to businesses with a high percentage of low-income workers who would likely be eligible for Medicaid or significant subsidies on the individual exchanges. In these cases, a business may be doing its employees a disservice by offering health insurance, because providing employer-sponsored insurance prevents employees from receiving subsidies on the individual exchange." (Society for Human Resource Management [SHRM])
Now That Almost Every Large Employer Has One, EEOC Targets Wellness Programs (PDF)
"According to the EEOC, wellness programs are becoming more popular, and 94 percent of employers with more than 200 workers offer one, as well as a majority of all employers.... [A]fter the initiation of the Orion suit, the EEOC reiterated that voluntary wellness programs are completely legal and encouraged, 'but they have to be actually voluntary.... Having to choose between responding to medical exams and inquiries -- which are not job-related -- in a wellness program, on the one hand, or being fired, on the other hand, is no choice at all.'" (Winston & Strawn)
Public and Union Employers Attack Upcoming 'Cadillac Plan' Excise Tax
"The truth for most employers is that the Affordable Care Act's feared excise tax is coming in 2018. In the public sector, major employers such as the City of Boston are utilizing vendor and plan management strategies, with the help of union negotiations, to control their health plan costs.... 'If you're trying to change the employer/employee contribution mix, that is not going to affect your excise tax liability,' [Kathryn L. Bakich, Segal's national health compliance practice leader] said ... That's 'because you're looking at the value of the plan -- not who pays the premiums.'" (Employee Benefit News)
Health Savings Accounts Under the ACA: Challenges and Opportunities for Consumer-Directed Health Plans
"Recent evidence suggests that high-deductible health plans in the employer market have played a significant role in moderating premium-cost increases over the last several years -- 'bending the curve' for employer health care spending. If HSA-eligible plans are structured correctly in ACA exchanges, such plans could play a similar role in the non-group market (as the number of enrollees with individual coverage grows quickly over the next few years)." (Manhattan Institute for Policy Research)
CMS Offers Some ACOs $114 Million for 'Upfront' Costs
"Administered through the CMS Innovation Center, loan eligibility targets ACOs that joined the Shared Savings Program in 2012, 2013, or 2014, and new ACOs joining the Shared Savings Program in 2016." (HealthLeaders Media)
California Health Plans on Notice: Drug Lists Will Be Standardized
"[A] new law in California ... will eventually require all plans in California to use a standard formulary.... The new law ... requires the two insurance state regulators ... to devise a standard formulary by Jan. 1, 2017. Within six months after the template is developed, all insurance plans in California, not just those on the exchange, will have to conform to that template and post regular formulary updates." (HealthLeaders InterStudy)
Administration Signals Doubts About Calculator That Allows Health Plans Without Hospital Benefits
"Treasury Department officials are preparing to reverse course on an official calculator that permits plans without hospital coverage to pass the health law's strictest standard for large employers ... HHS designed the calculator, but Treasury is charged with enforcing the minimum-value standard.... Preliminary results from a member survey by the American Staffing Association show that 46 percent of the temp and recruiting firms that responded are considering such coverage for next year[.]" (Kaiser Health News)
Majority of Companies Taking Immediate Steps to Minimize Exposure to Excise Tax on 'Cadillac' Health Plans
"Aon Hewitt's soon-to-be-released survey of 317 U.S. employers found that 40 percent expect the excise tax to affect at least one of their current health plans in 2018 and 14 percent expect it to immediately impact the majority of their current health benefit plans. Surprisingly, a quarter of employers said they still have not yet determined the impact of the tax on their health plans, and more than one-third reported that their executive leadership and finance teams have limited or no knowledge of the implications of the tax for their organizations. Of those employers that have determined the impact, 62 percent say they are making significant changes to their health plans for 2015[.]" (Aon Hewitt)
Supported State-Based Marketplace Model May Gain Traction
"The [supported state-based marketplace (SSBM)] is similar to the partnership model but allows for more state autonomy.... [A] primary point of difference between these two models is possession of final decision-making authority.... SSBM states will not be required to pay the 3.5 percent user fee for using Healthcare.gov in 2015.... SSBM states are provided full autonomy in setting the marketplace user fees and establishing a plan for sustainability, while partnership marketplaces are required to use the 3.5 percent premium assessment that is required by the FFM." (HighRoads)
Private Health Exchanges: Masquerading Cost Shifting as Savings?
"As the plan fiduciary, you have a considerable responsibility to run the plan in the interest of its participants. While it may seem daunting to uncover the details of the various exchange offerings, understanding the intricacies of the chosen plan model can arm you with the knowledge you need to make the best decision for your company and its employees.... [F]our financial areas to investigate: [1] Included services.... [2] Self-funding vs. fully insured.... [3] Defined contribution buy-down.... [4] Benefit limitations." (WorldatWork)
[Guidance Overview] Does the Section 4980H(a) Penalty Really Cap the Section 4980H(b) Penalty?
"[J]ust the minimum value requirement can trigger the discrepancy and not the affordability requirement. There is a potential planning opportunity as a result. In certain instances a minimum value plan offered at full-cost to the employee (i.e. the employee pays all of the premiums) could completely alleviate the costs of employees in a limited non-assessment period.... [O]ffering skinny plans alone is almost never a good option for an employer.... [T]his is magnified as a result of the limited non-assessment periods." (Health Care Attorneys P.C.)
D.C. Circuit Court Orders Government to Respond in Challenge to ACA Under U.S. Constitution's Origination Clause
"In a new and surprising development, the U.S. Court of Appeals for the D.C. Circuit has ordered that the Federal Government respond to their challengers' petition for an en banc hearing. This case, Sissel v. [HHS], centers on the Origination Clause and alleges that the Affordable Care Act was passed in an unconstitutional way.... Although Matt Sissel did not initially succeed at the D.C. Circuit, he has filed now for an en banc hearing ... The Court has now ordered the Federal Government to respond, indicating that judges are taking this request for a rehearing seriously." (Independent Women's Forum)
DOL Taking Hard Look at ERISA Health Plans
"The department has asked for additional funding and training programs and plans to hire additional staff. Can your plan documents pass a DOL inspection? ... DOL health plan audits will focus on: ACA compliance.... Claims denials.... Lack of fee transparency/disclosure." (International Foundation of Employee Benefit Plans [IFEBP])
[Opinion] Egg Freezing: A Unique New Benefit, or a Bad Idea?
"Earlier this year, Facebook began covering up to $20,000 for female employees to freeze and store their reproductive eggs, so they can put off pregnancy as they establish themselves during their prime career-building years. Apple has announced it will start doing the same in January 2015. Cryopreservation and egg storage could be seen as the latest advance from the tech firms that continue to blaze the trail for employee benefits that help attract and retain the best and brightest." (The Leader Board, by Human Resource Executive)
[Official Guidance] Text of CMS Accountable Care Organization Investment Model Fact Sheet
"This fact sheet provides a general description of a new ACO model being offered to support the Medicare Shared Savings Program ACOs, the ACO Investment Model.... The ACO Investment Model is a new model of pre-paid shared savings that builds on the experience with the Advance Payment Model to encourage new ACOs to form in rural and underserved areas and current Medicare Shared Savings Program ACOs to transition to arrangements with greater financial risk." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
ACA Resources for Frequently Asked Questions, Updated October 10, 2014 (PDF)
"The report provides basic consumer sources, including a glossary of health coverage terms. The next sections focus on health coverage: the individual mandate, private health insurance, and exchanges, as well as public health care programs ... It then lists sources on employer-sponsored coverage, including sources on employer penalties, small businesses, federal workers' health plans, and union health plans. It also provides sources on ACA's provisions on mental health, public health, workforce, quality, and taxes. Finally, the report lists sources on ACA costs and appropriations, legal issues, the treatment of non-citizens under ACA, and sources for obtaining the law's full text." (Congressional Research Service [CRS])
[Guidance Overview] New Regulations Issued for Dental, Vision, Long-Term Care and EAPs as Excepted Benefits under Healthcare Reform
"Many employers complained that the 2004 Regulations required them to charge a nominal fee solely to qualify for the excepted benefits status. The work required to collect the additional, nominal contribution often cost more than the contribution brought in as revenue. Employers also complained that these requirements created an unnecessary inconsistency between insured and self-insured plans. In response to these complaints, the 2014 Regulations issued by the Agencies instead provide that benefits are not an integral part of a group health plan (whether the benefits are provided through the same plan, through a separate plan or as the only plan offered to participants) if: Participants may decline coverage, whether or not there is a participant contribution required for the coverage; or Claims for the benefits are administered under a contract separate from claims administration for any other benefits under the plan." (McGuireWoods LLP)
[Guidance Overview] Updated Timeline of Highlights for Employer Group Health Plan Compliance with the ACA
"As the employer shared responsibility penalties become a reality for employers with plan years beginning on and after January 1, 2015, [the authors] have updated [their] timeline for employer group health plans to assist employers in staying current with the ACA's requirements and deadlines." (Epstein Becker Green)
Rethinking ACA Compliance Strategies Involving Reference Pricing Models and 'MVP' Arrangements
"[C]ertain applicable large employers -- principally those in industries in which coverage was not previously offered across-the-board to most, if not all, full-time employees -- have sought less expensive ways to offer coverage that is both 'affordable' and provides 'minimum value.' ... [S]ome of the emerging compliance strategies [include] the reference pricing models and 'MVP arrangements' ... Two recent developments, one in the form of a set of FAQs issued by [HHS, DOL and IRS], and the other a mere (though troubling) rumor, may cause employers to reconsider both these approaches." (Mintz Levin)
ACA Subsidy Challengers See Dire Problems Soon
"The problem of fixing the federal health care program will only grow worse if the Supreme Court does not promptly resolve the legality of subsidies to help lower-income individuals pay for insurance, the challengers to the subsidy scheme told the Justices on Tuesday. This was the formal reply to the Obama administration's argument early this month that the Court should wait to see how a federal appeals court deals with the subsidies' legality.... The filing of this brief completes the written preparation of the case for the Justices, so it can soon be sent to the Justices to set up a vote on whether to grant or deny review, or to hold the case." [King v. Burwell, No. 14-1158 (4th Cir. July 22, 2014; cert. pet. filed July 31, 2014)] (SCOTUSblog)
EEOC Files Two Lawsuits Challenging Employer Wellness Programs
"Until the EEOC provides further guidance on this issue, employers should ensure that their wellness programs are truly voluntary. Moreover, employers should make sure to avoid either significant penalties for employees who choose not to participate and/or significant rewards for employees who do participate in these programs. Finally, any medical information that employers obtain through a wellness program should be kept confidential and should not be used as a basis for making employment decisions involving the employee." (Bond Schoeneck & King)
Benefits Buyers Study 2015 Outlook: New Perspectives on Balancing Employer Costs and Employee Protection (PDF)
24 pages. "How health care reform and the economy are impacting benefits strategies; What your evolving workforce wants; Which buying trends you should watch." (Unum)
2014 Guardian Workplace Benefits Study (PDF)
"This year's study examines five key issues from both the employer and employee perspectives: [1] The early impact of the ACA on the employee benefits model; [2] An increased receptivity to outsourcing administration and enrollment functions; [3] The surprising benefits of a healthier workforce; [4] The importance of workplace benefits to the middle class; [5] How Do-It-Yourselfers, many of whom are Millennials, engage with their benefits." (Guardian)
Half of Employers Expect to Trigger Cadillac Tax on Healthcare Benefits in 2018
"73 percent of companies are very or somewhat concerned that they will trigger the tax, and 62 percent say it will have a moderate or greater impact on their health care strategy in 2015 and 2016.... The excise tax is based on both employer and employee premium contributions, not just what the employer pays for coverage. The definition of what is included for calculating the tax extends to tax-advantaged health care accounts such as health flexible spending accounts, health reimbursement accounts and pretax contributions to a health savings account." (Wolters Kluwer Law & Business)
Privately Insured in America: Opinions on Health Care Costs and Coverage (PDF)
"[A]bout 1 in 8 privately insured Americans -- or more than 16 million people -- face major financial hardships like going without food or using up all of their savings as a result of medical bills.... [In] 2007, 17 percent of the privately insured under age 65 were enrolled in a HDHP, and that proportion more than doubled by 2014. This new survey finds that the growing population covered by HDHPs is less likely than other privately insured adults to go to the doctor when sick or get recommended medical treatment, and is more likely to need to use their savings for medical care." (The Associated Press-NORC Center for Public Affairs)
From Competitors to Co-Adventurers, Seven Hospital Systems Join with Anthem Blue Cross to Shake Things Up in Southern California
"Anthem Blue Cross and seven competing hospital systems in Southern California are joining forces to establish a new health plan offering, Vivity. Operating with a combined 14 hospitals and approximately 6,000 physicians, the venture has already announced its first major customer: the State of California's pension fund manager, [CalPERS]. One of the more interesting features of the integrated delivery network is that it consists of seven separate health systems, each with its own physician strategies in place." (Sheppard Mullin)
The Benefits of Health Advocacy in Private Exchanges
"In order to ensure private exchanges are successful, it's critical that participating employees understand this new system and have access to resources to help them navigate the exchanges as well as their new coverage.... Without access to resources to help them fully understand their health care coverage, employees may not effectively utilize the benefits available to them, which can result in poor outcomes and later, higher healthcare costs for both employees and employers.... Health advocacy can serve as a safety net for employees, offering them somewhere to turn to make the private exchange experience easier and ensure the goals of the new program are met." (The Private Exchange Blog)
Supreme Court Declines to Hear Same-Sex Marriage Cases: How Does This Affect Employee Benefit Plan Administration?
"What should employers do now? [1] Account for those same-sex couples who may have been married in a state that permitted same-sex marriage ... [2] Determine if modification of benefit plan materials may be necessary; [3] Determine the appropriateness of a special enrollment opportunity to couples married in other jurisdictions prior to the Supreme Court's ruling who would not otherwise be eligible for a HIPAA special enrollment opportunity based upon the date of the wedding; and [4] Determine if modification of FMLA policy/forms is warranted based upon the changes." (Michael Best & Friedrich LLP)
[Opinion] Thanks to Obamacare, Health Costs Soared This Year
"The law reduced competition in most health-insurance markets. A limited analysis by the Kaiser Family Foundation found that in 2014, large states like California and New York were more competitive, but Connecticut and Washington were less competitive. The Heritage Foundation conducted a national analysis and found that between 2013 and 2014, the number of insurers offering coverage on the individual markets in all fifty states declined nationwide by 29 percent." (Robert Moffit, in The Daily Signal)

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