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Health plans - design

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Self-Funded ERISA Plans Subject to California Law Barring Discretionary Clauses
"[M]any states have enacted laws banning discretionary clauses in insurance policies. For insured plans, these laws have generally withstood ERISA preemption attacks. Two federal district courts in California have gone a step further and concluded that the California Insurance Code provision that bars discretionary clauses also applies to self-funded ERISA short-term disability plans." (Proskauer Rose LLP)
Employer-Sponsored Insurance Enrollment Stable in 2014
"A new study ... compared the extent to which U.S. employers dropped or added this employee benefit between 2013 and 2014.... 46.38 percent of private-sector employers offered coverage in both years, and 49.08 percent did not offer it in either year. Furthermore, just 3.45 percent of employers dropped coverage in 2014, and 1.10 percent added it[.]" (Health Affairs)
Health Benefit Cost Growth Slows to 2.4% in 2016 as Enrollment in High-Deductible Plans Climbs
"Average total health benefit cost per employee rose just 2.4% in 2016, one of the lowest increases in decades. Enrollment in account-based high-deductible consumer-directed health plans reached 29% of all covered employees, up from 25% in 2015. More employees have access to less-expensive care: 59% of large employers offer telemedicine, up sharply from 30%; and 82% include retail clinics in their plan network." (Mercer)
AARP Lawsuit Aims to Stop EEOC's New Wellness Rules
"New rules governing incentives offered as part of employee wellness programs are now the target of a lawsuit from a large advocacy group representing older Americans. AARP filed the suit against the Equal Employment Opportunity Commission (EEOC) in Federal District Court in Washington, D.C., on October 24, arguing that wellness programs can violate employees' privacy and may not be truly voluntary." (HR Daily Advisor)
2017 Obamacare Average Premiums and Average Deductibles
"[This] analysis provides a detailed overview of market conditions facing consumers who have neither premium subsidies nor subsidies for healthcare out-of-pocket costs." (HealthPocket)
[Guidance Overview] 2017 Health FSA Limit Increases to $2,600
"Keep in mind that the $2,600 limit applies only to employee salary reduction contributions. Employer contributions (including non-cashable flex credits) cannot exceed $500 per plan year for the health FSA to maintain excepted benefit status." (ABD Insurance & Financial Services)
[Official Guidance] Text of IRS Rev. Proc. 2016-55: Health and Welfare Plan Inflation-Adjusted Limits for 2017 (PDF)
30 pages. "For the taxable years beginning in 2017, the dollar limitation under Section 125(i) on voluntary employee salary reductions for contributions to health flexible spending arrangements is $2,600.... For taxable years beginning in 2017, the monthly limitation under Section 132(f)(2)(A) regarding the aggregate fringe benefit exclusion amount for transportation in a commuter highway vehicle and any transit pass is $255.... For taxable years beginning in 2017, the term 'high deductible health plan' as defined in Section 220(c)(2)(A) means, for self-only coverage, a health plan that has an annual deductible that is not less than $2,250 and not more than $3,350, and under which the annual out-of-pocket expenses required to be paid (other than for premiums) for covered benefits do not exceed $4,500.... [and] for family coverage, a health plan that has an annual deductible that is not less than $4,500 and not more than $6,750, and under which the annual out-of-pocket expenses required to be paid (other than for premiums) for covered benefits do not exceed $ 8,250." [Editor's note: retirement plan limits for 2017 are not included.] (Internal Revenue Service [IRS])
Ten Eye-Opening Stats About Employees and Their Benefits
"More than half (65%) of employees would only be able to pay less than $1,000 for out-of-pocket expenses associated with an unexpected serious illness or accident.... A third (33%) of employees are only somewhat satisfied with the benefits package offered to them at this time, and 9% are 'not very' or 'not at all' satisfied with their benefits.... More than half (60%) of employees are at least somewhat likely to take a job with slightly lower pay but better benefits.... The vast majority (81%) of employees think the medical costs they're responsible for will increase moving forward." (HR Benefits Alert)
[Guidance Overview] January 1 Is Quickly Approaching: Have You Reviewed Your Health Plan for Section 1557 Compliance?
"[T]he regulations may not directly apply to many employee health plans because neither the sponsoring employer nor the plan receives HHS funding. However, HHS has noted that it may refer discriminatory plans and employers to other government agencies (such as the EEOC), so it is a good idea for all plan sponsors to review their plans to see if any discriminatory provisions need to be amended or removed." (Jackson Lewis P.C.)
Health Plan Choice and Premiums in the 2017 Health Insurance Marketplace (PDF)
40 pages. "This brief presents analysis of Qualified Health Plan (QHP) data in the individual market Marketplace for states that use the Marketplace platform and State-Based Marketplaces where data is available. It examines plan affordability in 2017 after taking into account premium tax credits and also examines the plan choice s that new and returning consumers will have for 2017." (Assistant Secretary for Planning and Evaluation [ASPE], U.S. Department of Health and Human Services [HHS])
Datasets Published for All Health Exchange Plans from 2015 to 2016
"HIX Compare includes information on premiums, deductibles and out-of-pocket maximums, as well as cost-sharing requirements for primary care and specialist visits, prescription drugs, emergency room services and inpatient and outpatient visits for all plans across all 50 states and the District of Columbia. The previous 2016 HIX Compare files have been replaced by new, expanded data files." (Robert Wood Johnson Foundation)
[Guidance Overview] DOJ and FTC Issue Guidance on Antitrust Laws in the Employment Context
"[A]greements (whether formal or informal) among employers to limit or fix the compensation paid to employees or to refrain from soliciting or hiring each other's employees are per se violations of the antitrust laws. Also, even if competitors don't explicitly agree to limit or suppress compensation, the mere exchange of compensation information among employers may violate the antitrust laws if it has the effect of suppressing compensation." (Seyfarth Shaw LLP)
New ACA Student Health Insurance Guidance Allows College Payment of Working Students' Student Health Insurance Premiums Post-2016
"Colleges and other institutions of higher education within the meaning of the Higher Education Act of 1965 may continue until further notice to pay or subsidize student health insurance coverage premiums for students performing work-study or other services for the school as part of their financial aid package without fear of prosecution for violation of the group market reform requirements of the [ACA], according to ACA guidance jointly published by the [DOL], [HHS], and the Treasury[.]" (Solutions Law Press)
Telemedicine: A Popular New Benefit with Potential Legal Gotchas
"[Here] are some of the considerations employers should consider in determining whether to offer telemedicine services. [1] Do the scope of your telemedicine services cause the program to be a group health plan?.... [1] Is it feasible to offer telemedicine services through your existing group health plan? ... [2] Are there any legal restrictions that impact your ability to offer telemedicine services?" (Wilkins Finston Friedman Law Group LLP)
[Opinion] Rising Insurance Premiums Boost Talk of Changes to ACA
"President Barack Obama led his party's cry ... with suggestions that would further entrench the law, including the addition of a government-run health plan in parts of the country with limited competition. GOP lawmakers have continued to call for gutting the law, including proposals to waive its penalties for people who forgo coverage in areas with limited insurance options.... Next year, a new president and Congress will be under pressure to ensure that people who buy coverage on their own still have access to viable plans." (The Wall Street Journal; subscription may be required)
A Look at What's Coming: IRS Issues Guidance Priorities (PDF)
"The July 2016-June 2017 'guidance priorities' plan highlights areas of pending qualified plan guidance, with a vast majority of the 35 pension-related projects being carryovers from prior guidance plan lists. A summary of what is to come in the coming year from the project list can be found in [this] article." (Groom Law Group)
Benefits of the Tax-Preferred Status of Employer-Sponsored Health Insurance (PDF)
17 pages. "[T]he current tax treatment of health care benefits provides strong incentives to employers who purchase health care for their employees to focus on the overall health of their employees and to use their leverage to improve the quality and cost of the health care system. Furthermore, changes to the tax treatment of health care benefits may discourage employers from offering coverage to their employees.... [L]imiting or eliminating the current tax exclusion of employer-provided health care benefits could cost our system far more than any benefits it may provide." (American Health Policy Institute)
[Official Guidance] Text of DOL ACA FAQ 33: Premium Reduction Arrangements for Student Health Plan Coverage (PDF)
"Will the Departments' enforcement relief to colleges and universities for certain health care premium reduction arrangements offered in connection with student health plans be extended? Yes.... [P]ending further guidance, the Departments consider it appropriate to further extend the enforcement relief provided in the February 5, 2016 guidance and will not assert that a premium reduction arrangement offered by an institution of higher education fails to satisfy PHS Act section 2711 or 2713 if the arrangement is offered in connection with student health coverage (insured or self-insured)." (Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL])
Wellness Rules for Employers Offering Multiple Health Plans
"[W]hen wellness program participation does not require enrollment in a particular option, the maximum incentive is determined by the lowest-cost option, even if that is not the option in which the employee is actually enrolled. This interpretation, the EEOC explains, promotes consistency within the wellness program by making the incentive limit the same for all employees.... [T]he EEOC acknowledges that this approach differs from the HIPAA/ACA rule, but asserts that the end result balances a desire for consistency between the statutes with the need to ensure that incentives are 'not so high as to become coercive.' " (Corporate Synergies)
How Will the Election Impact Employee Benefits?
"In health care, the top issues employers support are: [1] More health care provider price transparency (96%); [2] Tax-favored status of employer-provided health coverage for employers (87%); [3] Small business health plans ... (85%) ... For other benefits-related topics, the top issues employers support are: [1] Tax-favored status of employer-provided retirement savings for workers (91%); [2] Tax-favored status of employer-provided retirement savings for employers (88%); [3] Tax exclusions for child-care expenses (75%)." (International Foundation of Employee Benefit Plans [IFEBP])
Enrollment in Consumer-Directed Health Plans Jumps 22 Percent Despite Increase in Plan Costs
"26.4 percent of all U.S. employees are now enrolled in CDHP plans, an increase of 21.7 percent from last year and nearly 70 percent from five years ago. Conversely, CDHP plan costs have risen 2 percent from last year ... So while they are still 3.5 percent less costly than the average plan, they offered more savings in 2015 when they were 5.6 percent less than the average plan." (United Benefit Advisors)
Enrollment in Consumer-Directed Health Plans Jumps 22 Percent Despite Increase in Plan Costs
"26.4 percent of all U.S. employees are now enrolled in CDHP plans, an increase of 21.7 percent from last year and nearly 70 percent from five years ago. Conversely, CDHP plan costs have risen 2 percent from last year ... So while they are still 3.5 percent less costly than the average plan, they offered more savings in 2015 when they were 5.6 percent less than the average plan." (United Benefit Advisors)
Workers Like Their Healthcare Coverage but Dislike the Healthcare System and Worry About the Future (PDF)
12 pages. "When asked to rate the U.S. health care system overall, many workers describe it as poor (27 percent) or fair (33 percent) and only a small minority rate it as excellent (3 percent) or very good (12 percent).... One-half of those with health insurance coverage are extremely or very satisfied with their coverage, while only 12 percent are not satisfied with their current health plan.... One-half of all workers report having experienced a health care cost increase in the past year, down from 61 percent in 2013." (Employee Benefit Research Institute [EBRI])
[Guidance Overview] Employer Obligations Under the New Nondiscrimination Rules: ACA Section 1557 (PDF)
10 pages. "Although HHS is the only agency to issue regulations so far, the scope of Section 1557 is broader, and other federal agencies could potentially issue similar regulations for programs involving federal financial assistance within their jurisdiction in the future.... Is it possible for an employer who is not otherwise subject to Section 1557 to avoid liability if the group health plan that it sponsors and maintains receives HHS assistance and violates Section 1557? Technically it would appear that such an employer could avoid liability; however, the plan would be liable for Section 1557 violations, and in such a case, the plan sponsor would ultimately be responsible for ensuring that the plan complies." (Alston & Bird LLP)
Capping Enrollment to Save Minnesota's Individual Market
"The Minnesota Department of Commerce struck a deal with five health plans in the state's individual market to prevent a market collapse.... The agreement reached included caps on health plan enrollment and significant rate increases between 50-66.8 percent.... The aggregate cap of 153,700 represents two-thirds of the 250,000 in Minnesota's individual market." (Health Affairs)
Embracing a Culture of Mental Health
"Originally, [American Express] offered a telephone-only EAP that had a utilization rate in-line with the national average of approximately 4%. By adding onsite professionals for free, face-to-face counseling sessions in regional wellness centers in the United States, and rebranding the EAP as part of the 'Healthy Living' program, covering lifestyle, safety, and disease management, utilization more than doubled." (Partnership for Workplace Mental Health)
Are Blues' Plans Benefitting Unfairly from Program to Offset Cost of Sicker Patients?
"Overall, seven of the top 10 recipients for risk-adjustment dollars were Blues' plans for 2014 and 2015, federal data show. Blue Cross Blue Shield plans are major players in most state insurance markets, so their strong performance on risk adjustment could be expected. However, a separate analysis by the Fitch Ratings agency found that some of these top recipients also have higher-than-average administrative expenses companywide." (Kaiser Health News)
[Opinion] CMS Pilot Program for Judging Breadth of Narrow Networks
"When the problem is that insurers are limiting patients' choices in their health care, CMS decides that the solution should be to merely tweak the system with more transparency while keeping it intact. The solution needed is to eliminate the restrictive provider list, allowing patient access to the entire health care delivery system." (Physicians for a National Health Program [PNHP])
2017 Obamacare Marketplace Slowdown Expected
"After two years of quick enrollment gains, Obamacare marketplaces in 2017 likely will see a 'significant slowdown' in growth ... [ACA] marketplace enrollment for 2017 is forecast to be between 10.2 million and 11.6 million ... As of March 31, about 11.1 million consumers had paid premiums for ACA marketplace coverage for 2016, and [HHS] projected enrollment of about 10 million people by the end of this year." (Bloomberg BNA)
How Narrow Is It? HHS Begins Test of Comparison Tool for Health Plan Networks
"[HHS] recently announced that the pilot project to test the network breadth tool just got a little, well, narrower.... The new tool will designate marketplace health plan networks as 'basic,' 'standard' or 'broad' based on how they compare with other health plan networks in a county. The label will reflect the availability of three types of providers: primary care, pediatricians and hospitals. Originally, network-breadth information was going to be available for the 35 states on, the federally facilitated marketplace. But in August HHS announced it would make the tool available in just six unnamed states." (Kaiser Health News)
Continuing Assaults on Surprise Out-of-Network Bills
"In September California Governor Brown signed Assembly Bill 72 requiring that policies issued on or after next July 1 provide that if an insured patient receives covered services at an in-network facility from an out-of-network provider, the patient needn't pay more than the in-network provider rate. There is an exception when the patient has specifically consented to the higher rate; that bill wouldn't be a surprise.... New York State protects patients from surprise bills not only when they are treated at an in-network facility but also when referred by an in-network physician to an out-of-network physician or service provider, including laboratory services." (Faegre Baker Daniels LLP)
The ACA's Cost-Sharing Reduction Plans: A Key to Affordable Health Coverage for Millions of U.S. Workers
"Cost-sharing amounts in silver plans with [cost-sharing reductions (CSRs)] are much less than those in non-CSR base silver plans; silver plans with CSRs generally offer far better financial protection than those without. General annual deductibles range from $246 for CSR silver plans with a platinum-level actuarial value (94%) to as much as $3,063 for non-CSR silver plans. Out-of-pocket limits vary from $6,223 in base silver plans to $1,102 in silver plans with CSRs and a platinum-level actuarial level." (The Commonwealth Fund)
Address HSA Misconceptions During Open Enrollment
"[E]mployers should use open enrollment to position the HSA program as an enhancement to the benefits package.... Send the message that employees can win financially by enrolling in an HSA ... Employees often ... mistakenly apply the 'use it or lose it' feature of health care flexible savings accounts (FSAs) to an HSA ... Employees also can take their HSAs with them when they change jobs or retire." (Society for Human Resource Management [SHRM])
Kaiser Now Interacts More with Patients Virtually Than In-Person
"52 percent of the integrated health system's 110 million physician-member interactions took place via smartphone, videoconferencing, kiosks, or other technology tools. [CEO Bernard Tyson] said that Kaiser is reversing the traditional health care delivery model that asks patients to come to providers and is instead bringing services to the patients." (The Advisory Board Company)
[Guidance Overview] Text of IRS Information Letter 2016-0051: Taxability of Contributions by Employer to Health Care Sharing Ministry (PDF)
"Your constituent asked if an employer can contribute to the premiums of employees who decline coverage in an employer group health plan and instead participate in a health care sharing ministry.... Members of a HCSM are exempt from the requirement in section 5000A of the Internal Revenue Code to keep minimum essential coverage. However, coverage by an HCSM is not minimum essential coverage. In addition, the law does not consider membership in an HCSM as health insurance and payments for participating in a HCSM are not deductible medical care. " [Dated June 22, 2016; released Sept. 30, 2016.] (Internal Revenue Service [IRS])
High Deductibles Could Backfire on Insurers, Employers
"Health plans try to encourage preventative care by making much of it covered in full regardless of the deductible, but research has shown that consumers typically have a poor understanding of their insurance policies and many are forgoing covered preventative care because they assume they will have to pay." (HealthLeaders Media)
TRICARE Lowers Mental Health Care Co-Pays, Expands Treatment Options
"TRICARE retirees, as well as non-active duty dependents and survivors, generally will pay roughly half the co-payment for outpatient mental health care and substance abuse treatment -- from $25 to $12 per visit -- effective Oct. 3. 'Co-pays and cost-shares for inpatient mental health services will also be the same as for inpatient medical/surgical care,' said a press release." (Government Executive)
Time to Reconsider Well-Being Programs
"By itself, ensuring total incentives stay below the EEOC thresholds will not help you gain the most value from your investment in employee health and well-being.... [T]ake a step back and use the guidance as an impetus to review your overall wellness program strategy and approach. As part of this broad category, ... include program structure, vendor partnerships and incentive awards." (Willis Towers Watson)
IBM Offering U.S. Employees Watson Technology to Identify Cancer Treatments
"The computing giant ... will offer its Watson artificial intelligence software to its U.S. employees to help them identify appropriate treatments and options for clinical trials. The benefit will be available beginning early next year to employees and their families who are covered under several of the company's insurance plans. The cancer-fighting service uses a mixture of artificial intelligence and human doctors." (The Wall Street Journal; subscription may be required)
Employers Shift Higher Health Care Costs to Workers
"In 2016, 83% of covered workers face a deductible for a plan covering a single person. Workers on a single coverage plan have an average deductible of $1,478, up 49% since 2011 ... This year, 29% of covered workers were enrolled in high-deductible plans that can be paired with health-savings accounts, up from 24% last year and 20% in 2014 ... About 84% of large employers will offer high-deductible health plans in 2017, and 35% of large employers will offer only high-deductible plans to their workforce, a slight increase from a year earlier[.]" (The Wall Street Journal; subscription may be required)
[Opinion] The Future of the ACA's Exchanges
"The overly restrictive federal rules for what must be covered by insurance should be substantially rolled back.... Ease the age-adjustment restrictions that increase premiums for young consumers ... [P]rovide a stronger incentive to promote insurance enrollment, and make it easy for all Americans to be enrolled ... [S]tates should be allowed to auto-enroll persons into default insurance coverage.... The rules for using premium (or tax) credits to purchase coverage should be eased substantially to allow consumers to purchase a plan outside the exchange, or through a privately run portal." (Health Affairs)
One in Three People Say Their Health Insurance Has Gotten Worse
"Thirty percent of respondents said their health insurance coverage has become worse in the past year, while just 15 percent said it had gotten better ... Fifty-five percent said they're paying more for their insurance coverage. Twenty-four percent said they have lost access to their doctors in the past year because those providers were out of network. Thirty percent said they delayed or avoided emergency medical care in the past year out of fear of costs." (Washington Examiner)
At Open Enrollment, Millennials Value Financial Security and Workplace Flexibility
"When asked how they would spend money if their employer provided them with an allowance to select among a variety of benefits, Millennials said they would allocate more than half the amount to health care and retirement plan benefits (27 percent each).... 6 in 10 Millennials (59 percent) are willing to pay a higher amount for a guaranteed retirement benefit, such as a guaranteed income stream. That figure is up from 42 percent in 2009." (Society for Human Resource Management [SHRM])
A Friendly Competition to Increase ACA Marketplace Stability: Calling All Actuaries
"In an attempt to inform decision making on the critical issue of individual market stability, the RWJF is sponsoring the Actuarial Challenge, a friendly competition in which teams of actuaries will develop and test feasible solutions to improve the performance of the individual health insurance market.... Participants can enter as a team, or individuals will be placed with others to form a team." (Health Affairs)
Consumers Continuously Enrolled in CDHPs Experience Lower Overall Health Care Costs
"After switching from a PPO to HCSC's BlueEdge CDHP, members saw a three-year average reduction in: [1] Inpatient care costs -- decreased by 16.1 percent; [2] Outpatient care costs -- decreased by 5.7 percent; [3] Professional services costs -- decreased by 10.4 percent." (Health Care Service Corporation)
EpiPen Triggers Change In Thinking About Obamacare Requirement
"Three doctors who have led a task force that evaluates preventive medical services say the group's recommendations shouldn't be tied by law to insurance coverage. The former chairmen of the U.S. Preventive Services Task Force [USPSTF] say the link between medical recommendations and insurance coverage leads to financial incentives that can corrupt the process and distort people's health care decisions. Under the [ACA], any preventive service that receives one of the USPSTF's top two ratings must be covered by insurance without any out-of-pocket cost for the patient." (National Public Radio)
Leadership, Culture and Communication Are Keys to Success of Employee Well-Being Programs (PDF)
44 pages. "More than half of respondents in 2016 (56%) have a formal strategic plan in place, compared to 44% in 2011.... [R]espondents were asked to gauge whether leaders understand the strategic importance of employee health and well-being ... About a fourth responded 'To a great extent,' whereas 20% reported that it isn't seen as connected at all to results. Among employers that have seen a substantial improvement in medical cost, 63% answered 'To a great extent,' compared to just 24% of those that have not seen savings." (HERO and Mercer)
[Guidance Overview] Some 'Elections' Do Work
"[T]here should not be a tax issue -- a constructive receipt problem -- if the employer requires employees to make a choice between accruing PTO or receiving cash in lieu of the PTO in the year before the year when the PTO will be earned.... [PLR 201601012] illustrates how this type of 'safe election' can be used to give employees somewhat greater choice and control over the use of their accumulated sick leave or PTO, without triggering current taxation." (Chang Ruthenberg & Long PC)
To Drive Real Health Care Reform, Look to What Employers Are Doing
"Private, non-government employers provide health care coverage to more than 55 percent of Americans, according to the Census Bureau. Many of these companies are already carrying out their own do-it-yourself, market-based health care reform. The formulas they use are both simple and sophisticated. Here's how it works." (STAT)
[Opinion] Is It Time for the Preventive Task Force to Inform -- But Not Determine -- Health Care Coverage?
"The [ACA] linkage of [U.S. Preventive Services Task Force (USPSTF)] decisions to insurance coverage has brought both benefit and harm. As advocates of preventive services, we are excited that many people who previously had no financial access to preventive services can now benefit from those services for which the balance of benefit and harm has been scientifically established to be favorable. But if such financial access comes at the cost of increased deductibles or copays for equally important services that are not preventive, then we must question whether the link inadvertently discourages other important care." (Annals of Internal Medicine)
[Guidance Overview] New EEOC Wellness Regs Require Re-Evaluation of Rewards
"In addition to the new restrictions on rewards, the regulations require an employer to provide a notice to participants that's easily understandable and that explains what medical information will be collected, how it will be used, who will receive it, and the restrictions on its disclosure." (Warner Norcross & Judd LLP)
[Guidance Overview] Starting in 2017, Your Plan's Opt-Out Payment and Rules May Impact ACA Affordability Penalties
"Although the proposed regulations provide a workable rule for excluding the value of payments under eligible opt-out arrangements, sponsors of such eligible arrangements will have additional administrative and record-keeping requirements with respect to reasonable evidence. Plan sponsors may want to look at whether the additional amount taken into account as employee cost would actually cause the coverage to be unaffordable." (Cheiron)
[Opinion] ERIC Comment Letter to HHS on Proposed Notice of Benefit and Payment Parameters for 2018 (PDF)
"ERIC members believe that the Exchange notices and the employer appeals process should be suspended immediately. There is no reason to perpetuate a process that is riddled with errors, that wastes employer and government resources and that produces no definitive outcome. It is an appeals process in name only, and CMS would be well served to suspend the process until such time, if any, that the process can be coordinated effectively with the IRS." (The ERISA Industry Committee [ERIC])
[Opinion] NHeLP Comment Letter to HHS on Proposed Notice of Benefit and Payment Parameters for 2018
35 pages. "[NHeLP has] concerns related to several policies related to definitions and standardized options, including high deductible health plans, cost-sharing for habilitation, and specialty drug tiering.... We support the inclusion of new standardized design options to make accommodation for states that have state cost-sharing laws.... We are concerned about the inclusion of high deductible health plans (HDHPs) to the standardized options." (National Health Law Program [NHeLP])
[Opinion] U.S. Chamber of Commerce Comment Letter to HHS' on Proposed Notice of Benefit and Payment Parameters for 2018
"To the extent that we were able to review and assess the 80-page rule in the 30 days since it was published in the Federal Register, our comments here will focus on our support for some of the proposals that will increase flexibility for carriers and create more choices and options for consumers. We also have concerns with some of the proposals which will limit choice and innovation for consumers and urge the Department to reconsider these provisions." (U.S. Chamber of Commerce)
[Guidance Overview] Untangling ACA Opt-Out Payment Rules
"This [article] focuses on the impact of opt-out payments on 'applicable large employers' subject to employer shared responsibility duties under the ACA. For such employers, reduced affordability of coverage will impact how offers of coverage are reported under ACA reporting rules (IRC Section 6056) and could trigger excise tax payments under IRC Section 4980H(b)." (E is for ERISA)
The Unintended Consequences of High Deductible Health Plans
"Notwithstanding the hope that HDHPs and HSAs would lower overall medical expenditures within the healthcare system ... a recent study ... revealed that enrollees in HDHPs were responsible for 24% of their medical costs between 2010 and 2014, compared to 14% in traditional plans. Further, while enrollees in traditional plans made over twice as many doctor visits as HDHP/HSA enrollees for non-preventive care, the study found that enrollees in high-deductible plans spent an average of $1030 in annual out-of-pocket costs, whereas enrollees in traditional plans spent an average of $687." (Sheppard Mullin)
Have We Forgotten What a Grandfathered ACA Plan Is?
"Generally, grandfathered plans are able to maintain existing coverage and don't have to amend their plans to comply with certain ACA regulations ... A plan loses its grandfathered status when any of the following changes become effective: [1] elimination of all or substantially all benefits for certain conditions; [2] increase in percentage cost-sharing requirement; [3] increase in a fixed-amount cost-sharing requirement, other than a copayment ... [4] increase in a fixed-amount copayment; [5] decrease in employers' or employee organizations' contribution rate; or [6] change in annual limits." (Bloomberg BNA)
The Enforceability of ERISA Forum Selection Clauses: Two Recent 'Against-The-Trend' Cases and an Uncertain Future (PDF)
"The majority of courts to address this issue have ruled in favor of enforcing forum selection clauses. However, going against the trend, two federal district courts recently determined that forum selection clauses are automatically invalid and unenforceable within the ERISA context ... [At] the beginning of this year, the U.S. Supreme Court declined to review a [third] case in which the Sixth Circuit Court of Appeals had ruled in favor of enforcing a plan's forum selection clause.... The [DOL] without any success thus far, has consistently filed amicus briefs in support of the view that forum selection clauses in ERISA plans are invalid and unenforceable." (Trucker Huss)
'Concierge Care' Provides a Patient-First Health Benefits Approach
"With direct primary care (DPC), individuals and/or their employer pay a monthly retainer fee that allows the patient to receive all necessary primary care without further cost or involvement by insurance carriers ... A wrap-around health care plan from an insurance carrier or a self-insured employer kicks in beyond these services. Typical DPC coverage costs an average of $77 per patient per month ... The model is therefore more adaptable for employee benefits programs." (Society for Human Resource Management [SHRM])

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