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Health plans - design


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Research Suggests L.A. Has No Cardiologists in Obamacare Networks; Chicago Has No Diagnostic Radiologists
"In seven of the nine urban areas, fewer than half of specialists sampled belonged to provider networks in Obamacare exchanges ... [One chart] indicates that some of these areas have zero physicians of one specialty in-network.... This corresponds with previous research indicating that Obamacare incentivizes health plans to design their networks (and prescription-drug formularies) to attract the healthy and shun the sick." (National Center for Policy Analysis Health Policy Blog)
Using Surveys to Measure Health Coverage Post-Reform: Lessons from Massachusetts
"Soon after the [ACA] was signed in 2010, the US Census Bureau began exploring ways of adapting surveys that measure insurance coverage to accommodate the new law, focusing on the Current Population Survey (CPS) and the American Community Survey (ACS).... [T]his brief summarizes the results of this research and outlines recommendations for measuring health insurance coverage following the introduction of marketplace plans." (Robert Wood Johnson Foundation)
Availability of Federal Survey Data to Measure the ACA's Impact on Health Insurance Coverage in 2014
"[This chart provides] an outline of the 2014 insurance coverage estimates that will be released from the American Community Survey (ACS), the Current Population Survey (CPS), and the National Health Interview Survey (NHIS)." (Robert Wood Johnson Foundation)
[Official Guidance] Text of IRS, HHS and DOL Final Regs: Amendments to Excepted Benefits
"Consistent with the 2013 proposed regulations, these final regulations eliminate the requirement under the HIPAA regulations that participants pay an additional premium or contribution for limited-scope vision or dental benefits to qualify as excepted benefits.... [It] is the Departments' view that the final regulations do not undermine the inclusion of pediatric vision or dental coverage as essential health benefits. The requirement that issuers in the small group market offer coverage of essential health benefits is not changed, and that rule does not apply to large or self-insured plans.... These final regulations clarify that limited-scope vision or dental benefits do not have to be offered in connection with a separate offer of major medical or 'primary' group health coverage under the plan, in order to meet the statutory criterion that such benefits are 'otherwise not an integral part of the plan.' ... As with the 2013 proposed regulations, these final regulations provide that, for an [employee assistance program (EAP)] to constitute excepted benefits, the EAP must satisfy four requirements.... The first requirement of the 2013 proposed regulations and these final regulations is that the EAP does not provide significant benefits in the nature of medical care.... The second requirement of these final regulations is that for an EAP to constitute excepted benefits, its benefits cannot be coordinated with the benefits under another group health plan.... The third requirement of the 2013 proposed regulations and these final regulations for EAPs to constitute excepted benefits is that no employee premiums or contributions may be required as a condition of participation in the EAP. Finally, as with the 2013 proposed regulations, the final regulations provide that an EAP that constitutes excepted benefits may not impose any cost-sharing requirements.... These final regulations apply to group health plans and group health insurance issuers for plan years beginning on or after January 1, 2015." (U.S. Department of the Treasury, U.S. Department of Labor [DOL], and U.S. Department of Health and Human Services [HHS])
Consumer Group Sues Two More California Plans Over Narrow Networks
"Insurers Cigna and Blue Shield of California misled consumers about the size of their networks of doctors and hospitals, leaving enrollees frustrated and owing large bills, according to two lawsuits filed this week in Los Angeles. Both cases allege that the insurers offered inadequate networks of doctors and hospitals and that the companies advertised lists of participating providers that were incorrect. Consumers learned their doctors were not, in fact, participating in the plans too late to switch to other insurers, the suits allege, and patients had to spend hours on customer service lines trying to get answers. Both cases seek class action status." (Kaiser Health News)
Consumers Don't Trust Insurers or Employers as Source of Health & Wellness
"Many wellness programs could be doomed to fail based on a recent survey finding that most consumers don't trust their insurers or employers as a source of health and wellness.... [J]ust 8 percent rely on their health insurers as a source of health and wellness. And just 10 percent rely on employers....Steps that insurers can take include creating a wellness platform approach that, for example, provides health itineraries informing consumers of health activities, preventative services and location-based guidance." (FierceHealthPayer)
[Guidance Overview] Demystifying the Language of the ACA
"In order to determine whether and how to comply with the employer mandate, Large Employers should evaluate the changes that may need to be made to their employer group health plan. Specifically, [1] The waiting period, does it need to be shortened? [2] The eligibility provisions, do they need to be changed? [3] The premium cost, is it affordable at all income levels? [4] The benefits offered, do they satisfy minimum value? Large Employers should also prepare a financial analysis of the impact of being compliant versus non-compliant with the employer mandate, considering both the failure to offer coverage penalty and the coverage offered penalty." (Texas CEO Magazine)
Debate Grows Over Employer Plans With No Hospital Benefits
"As companies prepare to offer medical coverage for 2015, debate has grown over government software that critics say can trap workers in inadequate plans while barring them from subsidies to buy fuller coverage on their own. At the center of contention is the calculator -- an online spreadsheet to certify whether plans meet the [ACA's] toughest standard for large employers, the 'minimum value' test for adequate benefits." (Kaiser Health News)
A Medicare Program Loses More Health Care Providers
"Four more hospital systems recently have dropped out of the Pioneer Accountable Care Organization program, a key part of the federal health law, leaving just 19 of the original 32 participants.... The 32 Pioneer ACOs had such experience and were supposed to serve as models for hundreds of other ACOs following them. But participants have complained from the start about some of its stringent rules and benchmarks. Thirteen of the Pioneers left the program last year, after failing to meet their performance targets." (The Wall Street Journal; subscription may be required)
Nearly One in Four Employers Say Private Health Insurance Exchanges Could Provide a Viable Alternative for Full-Time Active Employees in 2016
"The survey also revealed that the top three factors that would cause employers to adopt a private exchange for full-time active employees are: [1] Evidence they can deliver greater value than their current self-managed model (64%); [2] Adoption of private exchanges by other large companies in their industry (34%); [and] [3] An inability to stay below the excise tax ceiling as 2018 approaches (26%) ... [N]early all employers surveyed (99.5%) said they have no plan to exit health benefits for active employees and direct them and their families to public exchanges, with or without a financial subsidy. More than three out of four employers (77%) said they are not at all confident public exchanges will provide a viable alternative for their active full-time employees in 2015 or 2016." (Towers Watson)
[Opinion] Consumer-Directed Health Plans: One Observer's Perspective on One Employer's Experience
"Altarum's total costs per employee increased by 5.6% between 2011 and 2012 ... The estimated cost increase would have been approximately 6.5% for an indemnity plan.... [T]he price tools are at times helpful but frequently cumbersome and provide only partial information. The quality comparison tools are of little or no value, though that can vary by geographic region. Determining whether a service is covered and the expected copay or deductible remains a challenge just as before." (Altarum Institute)
41 Percent of Employees Spend Less Than 15 Minutes on Benefits Selection
"Most workers (73 percent) only sometimes, rarely, or never understand everything that is covered by their policy. More than 6 out of 10 workers (64 percent) sometimes, rarely, or never understand changes in their coverage. Sixty-four percent disagree or only somewhat agree that they are more prepared for open enrollment this year compared to last year." (Wolters Kluwer Law & Business)
How Workers and Employers Diverge on Wellness Programs
"The appeal of wellness programs has much to do with the popularity of wellness benefits among employees (and a belief that they can reduce absenteeism and improve productivity). The roughly $6 billion wellness industry aggressively sells products -- and wellness programs are a far easier cost-containment strategy to sell to employees than higher cost sharing or narrower provider networks." (The Wall Street Journal; subscription may be required)
Now May Be a Good Time to Dust Off and Update Your Section 125 Cafeteria or Flexible Benefit Plan
"As employers consider whether to amend their Section 125 plans to allow these two new change events, which are beneficial to employees, they should give thought to other plan amendments that may be needed.... [1] Amend health flexible spending accounts to reflect the $2,500 cap on salary reduction contributions.... [2] Consider allowing carryover of $500 for health FSAs.... [3] Amend Section 125 plans to reflect the federal recognition of same-sex marriages.... [4] Amend Section 125 plans to prohibit providing qualified health plans offered through a Marketplace.... [5] Amend non-calendar-year cafeteria plans to allow mid-year election changes.... [6] Amend health FSAs to require participants to have a prescription for over-the-counter medications to be eligible for reimbursement under a health FSA." (Snell & Wilmer)
Health Insurance Issuer Participation and New Entrants in the Health Insurance Marketplace (PDF)
"Based on preliminary data for 36 Federally-facilitated Marketplace (FFM) states and eight additional State-based Marketplace (SBM) states, there will be a 25 percent increase in the number of health insurance issuers offering Marketplace coverage in 2015 compared to 2014. Four of the 36 states in the FFM will have at least double the number of issuers they had in 2014. At least 67 issuers in the FFM and 10 issuers in the SBMs will be new to the Marketplaces in 2015." (Assistant Secretary for Planning and Evaluation [ASPE], U.S. Department of Health and Human Services [HHS])
Number of Marketplace Insurers to Rise 25 Percent, HHS Says
"The number of competitors on the marketplaces is considered important because it signifies the vitality of the exchange and can mean increased competition and lower prices for consumers. It also means that insurers see the health law's online marketplaces or exchanges, as a good business opportunity ... HHS officials could not elaborate on what 'tiers' of coverage the new entrants would offer or how much that coverage would cost. The report also does not say in which counties the insurers will offer coverage, a factor that would directly influence the level of competition in coverage and price." (Kaiser Health News)
Narrow Networks Are Saving Money for Health Plans
"If narrow networks are like restricting the stores where your kids are allowed to shop, reference pricing is like telling your kids they can shop anywhere. But you will only pay, say, $30 towards the cost of a pair of jeans. If they choose to spend $100 on Buffalo jeans at the mall, they must pay the $70 difference. Several years ago insurer WellPoint partnered with [CalPERS] on a reference-pricing program to encourage enrollees to patronize lower-cost hospitals. It worked -- enrollees quickly shifted to hospitals that charged less for joint replacement surgery." (National Center for Policy Analysis Health Policy Blog)
One Year In: Americans Respond to the Affordable Care Act
49 slides. "Nearly half (46 percent) of uninsured Americans are uninformed about the individual mandate provision of the ACA and 43 percent have not heard of the state exchanges where they can apply for assistance.... Among the uninsured, less than half (42 percent) could afford health insurance premiums of just $100 per month, and affordability of health insurance varies widely amongst Americans.... In general, continuously insured (insured pre-mandate and currently insured) Americans noticed few changes in their health care options .... For those continuously insured (insured pre-mandate and currently insured), an increase in costs was the most commonly experienced change as a result of the ACA." (Transamerica Center for Health Studies)
[Opinion] A 2020 Vision: Flexibility and the Future of Employee Benefits (PDF)
26 pages. "In the future, personal health and financial well-being will embrace a broader view of income protection that includes not only health coverage and retirement savings, but also incorporates life insurance, disability and long-term care coverage in a much more integrated way.... It is critically important for policymakers to acknowledge that enlightened, bipartisan tax policy has been indispensable to the success of the employer-sponsored benefits system." (American Benefits Council)
ACA Implementation: Six-State Case Study on Network Adequacy
"Researchers assessed network changes and efforts at regulatory oversight in six states: Colorado, Maryland, New York, Oregon, Rhode Island, and Virginia. Researchers found that insurers made significant changes to the provider networks of their individual market plans, both inside and outside the marketplaces, and that insurers took varying approaches to network design. Across all six states, insurers and state officials alike reported consumer and provider confusion about which plan networks included which providers, but most have received few consumer complaints about their ability to obtain in-network services[.]" (Urban Institute)
Covered California Announces Expanded Small-Business Options for 2015
"Covered California will offer the same six health plans next year in its Small Business Health Options Programs [SHOP] ... but add flexibility for employers, greater choice for employees and the option of buying adult dental coverage.... Starting Oct. 1, employers can offer workers a choice of plans in two benefit levels. Currently, business owners can offer only one benefit level, although workers can choose from a variety of plans at that level." (The Business Journals)
[Guidance Overview] IRS Notice 2014-55 Gets Employer Shared Responsibility Rules to Play Nice with Rules Governing Mid-Year Cafeteria Plan Elections
"Notice 2014-55 addresses two specific situations in which a cafeteria plan participant may wish to revoke coverage mid-year. [1] Revocation due to reduction in hours of service.... [2] Revocation due to enrollment in a Qualified Health Plan.... Importantly, due to the consistency requirement that applies to mid-year cafeteria plan election changes, an employee in a stability period who reduces hours may not drop coverage altogether. Instead, he or she must get coverage elsewhere -- i.e., either through a public exchange, coverage under a spouse's plan, or some other source." (Mintz Levin)
Risk Corridors and Reinsurance in Health Insurance Marketplaces: Insurance for Insurers
"[The authors] compare reinsurance and risk corridors in terms of insurer risk reduction and incentives for cost containment, finding that one-sided risk corridors achieve more risk reduction for a given level of cost containment incentives than both reinsurance and two-sided risk corridors. [They] find that the ACA policies being implemented in the Marketplaces (a mix of reinsurance and two-sided risk corridor policies) substantially limit insurer risk but that they are outperformed by a simpler one-sided risk corridor policy according to our measures of insurer risk and incentives." (National Bureau of Economic Research [NBER])
[Guidance Overview] No More Election-Lock for Cafeteria Plans with Non-Calendar Plan Years
"There are six important things for employer-sponsors to note: [1] The cafeteria plan is permitted to rely upon the employee's representation of intent to enroll in a Marketplace plan ... (actual proof of enrollment is not required). [2] The employer-sponsored cafeteria plan document must be amended to allow for such a mid-year election change.... [3] In no event under this guidance may a cafeteria plan allow a participant to revoke a coverage election on a retroactive basis. [4] Mid-year election changes under this guidance are permitted, but not required. [5] This guidance does not extend to health FSA elections. [6] As long as the employee is still eligible for the employer-sponsored coverage (assuming it is affordable and of minimum value), the employee will not be eligible for tax credits in the Marketplace." (Hill, Chesson & Woody)
EEOC Challenges Employer's Wellness Program under ADA
"Although the alleged facts [in this case indicate the employer's] practices might be much more aggressive than in common use by most employers, the principles argued by the EEOC ... raise potential concerns for the growing number of employers relying on health risk assessment and other wellness programs to help manage health benefit costs, employee disabilities, and other concerns.... The sponsors of these arrangements often are unaware of or discount the likelihood that the EEOC might view these and other wellness benefit arrangements as violating the ADA prohibitions against medical inquiries that are not both job related and necessary to the job or other ADA disability discrimination prohibitions." [EEOC v. Orion Energy Systems, No. 1:14-cv-1019 (E.D. Wis., filed Aug. 20, 2014)] (Solutions Law Press)
Fortune 500 Employees Can Expect to Pay More for Health Insurance
"Key findings ... include: [1] 78 percent [of the surveyed Human Resources officers] report a rise in health insurance costs (average of 7.73 percent); [2] 37 percent report a rise in labor costs (average of 5.6 percent); [3] 73 percent report having moved or will move employees to Consumer Directed Health Plans; [4] 71 percent report raising or plans to raise employee contributions to health insurance; [5] 30 percent report moving or plans to move pre-65 retirees to ACA health exchanges; [6] 27 percent report cutting back health insurance coverage eligibility[.]" (University of South Carolina)
[Opinion] Obamacare Will Devour Your Pay Raise
"To be sure, we should be grateful that CDHPs are surviving Obamacare, but they have been increasing market share for years. The real effect of Obamacare ... is eliminating pay raises.... All of our increased compensation will be in the form of health benefits, which will not be better, but merely Obamacare-compliant. Isn't it time American workers took home more of their compensation as wages, instead of paying it to health insurers?" (National Center for Policy Analysis Health Policy Blog)
Silicon Valley Start-Up Rattles Entire Healthcare Brokerage Industry
"By registering as a broker, Zenefits could collect the monthly commission that traditional brokers are now paid. In return for that fee, Zenefits would give small businesses some very good H.R. software.... This unusual model is threatening to traditional health brokerage firms. In slightly more than a year of operation in California, Zenefits became the No. 1 broker submitting new plans to Anthem Blue Cross, one of the state's largest providers, in the 'small group' market, which serves businesses with fewer than 50 employees. Zenefits has since expanded and is now licensed as a broker in 50 states and has customers in 41." (The New York Times; subscription may be required)
Health Insurance Plan Rankings by NCQA, 2014-2015
NCQA ranks health plans using the methodology they have used every year since 2005. For these 2014-2015 rankings, NCQA studied almost 1,400 health plans and ranked more than 1,000 of them based on clinical performance, member satisfaction and results from NCQA Accreditation surveys. (National Committee for Quality Assurance [NCQA])
'Relative Value Health Insurance' and 'Pay for Performance for Insurers' -- New Proposals are Complements, Not Substitutes
"A recent insurance reform proposal, known as Relative Value Health Insurance (RVHI) ... enables insurers to reduce their contractual obligation to cover 'usual and customary' care.... Less well-covered, however, are proposals to alter the very incentives of insurers to improve health, ... 'pay-for-performance-for-insurers' (P4P4I).... P4P4I proposals allow insurers to deny coverage for expensive care that provides few health benefits, but they also incentivize insurers to cover care that they suspect will improve health cheaply. P4P4I faces substantial drawbacks, however, which limit its ability to substitute for traditional health insurance or its RVHI-reformed variants." (Health Affairs)
Non-Partisan Panel Urges Overhauling Health Care at End of Life
"The country's system for handling end-of-life care is largely broken and should be overhauled at almost every level, a national panel [appointed by the Institute of Medicine, the independent research arm of the National Academy of Sciences,] concluded ... Many of the report's recommendations could be accomplished without legislation. For example, the panel urged insurers to reimburse health care providers for conversations with patients on advance care planning.... But some recommendations -- like changing the reimbursement structure so that Medicare would pay for home health services instead of emphasizing hospital care, and so that Medicaid would provide better coverage of long-term care for the frail elderly -- would require congressional action." (The New York Times; subscription may be required)
Health Care Survey of Employers: Changes Ahead in 2015
"Employers estimate that 2015 health care costs will increase by 4% after changes to medical and pharmacy plan designs, vendors, provider networks or other features. Eight in 10 companies (81%) plan to make moderate to significant changes to health benefit programs for full-time active workers. Two-thirds of CEOs and CFOs will be more directly involved in health care strategy decisions than they were three to five years ago to help control costs and reduce exposure to the 2018 excise tax." (Towers Watson)
ERISA at 40: ERISA, Nixon, and the Could-Have-Been ACA (PDF)
"This article looks at the Nixon administration's proposal to reform the US health care system, presented to Congress in 1974 -- the same year ERISA was enacted. Although it wasn't adopted, the proposal included a number of provisions that are surprisingly similar to those appearing in the Affordable Care Act." (Buck Consultants at Xerox)
Plan Selections by Zip Code in the Health Insurance Marketplace
"The dataset provides the total number of Qualified Health Plan selections by ZIP Code for the 36 states that are participating in the Federally-facilitated Marketplace, or have State Partnership Marketplaces or supported State-based Marketplaces, for the initial Marketplace open enrollment period from October 1, 2013 through March 31, 2014, including additional special enrollment period activity reported through April 19, 2014. The data represent the number of unique individuals who have been determined eligible to enroll in a Marketplace plan and had selected a plan by April 19." (Assistant Secretary for Planning and Evaluation [ASPE], U.S. Department of Health and Human Services [HHS])
ACA Is Erasing the Difference Between Hospitals and Insurers
"Most hospitals currently make more money performing a surgery than providing preventive care to avoid one, but under the Affordable Care Act they're being encouraged to change that: Instead of compensating doctors and hospitals for each service provided, the law encourages arrangements that reward hospitals for better outcomes. Some health-care providers have responded by consolidating." (Bloomberg Businessweek)
Employee Choice in the SHOP Marketplace
"To date, the majority of state-based SHOP Marketplaces have chosen to implement employee choice, but federal regulations have made implementation of employee choice voluntary until 2016.... While a majority of small businesses say they are interested in giving employees more plan choices, detractors have raised concerns that employee choice may overwhelm employees with too many choices or result in higher premiums in the SHOP if higher-risk employees can select more comprehensive plans than lower-risk employees." (Health Affairs)
An Update on the Small Business Health Options Program: Is It Working for Small Businesses?
"On Thursday, September 18, 2014, ... the Committee on Small Business Subcommittee on Health and Technology held a hearing titled, An Update on the Small Business Health Options Program: Is It Working for Small Businesses?' ... The purpose of the hearing was to examine the current state of the SHOPs and whether they are working for small businesses." [Page includes links to testimony by [1] Mayra Alvarez, Director State Exchange Group, Center for Consumer Information and Insurance Oversight, CMS; [2] Dr. Roger Stark, Health Care Policy Analyst, Washington Policy Center; [3] Adam Beck, Assistant Professor of Health Insurance, The American College of Financial Services; and [4] Jon Gabel, Senior Fellow, NORC, University of Chicago.] (Committee on Small Business, U.S. House of Representatives)
[Opinion] Reference Pricing and Network Adequacy Standards: Conflict or Concord?
"[R]ecent federal guidance ... blurs the distinction between in-network and out-of-network providers and may make it more difficult for regulators and consumers to understand the effective 'size' of a particular network. This confusion could undermine the goal of improving transparency in consumers' health care choices and make it difficult for consumers to use prices in choosing providers. More troubling, expanded use of 'reference pricing' under the guidance could leave patients paying unexpectedly large out-of-pocket amounts for services provided by ostensibly in-network providers." (Health Affairs)
[Opinion] Number of Uninsured Americans Aged 18-64 Drops by Two Percentage Points
"The number of uninsured Americans aged 18-64 has dropped by two percentage points from the first quarter of 2013 to the first quarter of this year ... [T]hat brings the proportion of uninsured down to where it was about ten years ago.... Obamacare has not managed to overcome the results of the recession that began in December 2007." (National Center for Policy Analysis Health Policy Blog)
2014 Health and Voluntary Workplace Benefits Survey: Most Workers Continue to be Satisfied With Their Own Health Plan, but Growing Number Give Low Ratings to Health Care System
"Confidence about various aspects of today' s health care system has also remained fairly level before and after the passage of PPACA.... Confidence about the health care system decreases as workers look to the future. While 47 percent of workers indicate they are extremely or very confident about their ability to get the treatments they need today, only 30 percent are confident about their ability to get needed treatments during the next 10 years, and just 19 percent are confident about this once they are eligible for Medicare[.]" (Employee Benefit Research Institute [EBRI])
Health Care Costs Follow Health Risks and Can Be Mitigated Over Time Through Incentivized Workplace Wellness Programs
"The study was designed to evaluate the impact of UPMC's health management and wellness program, MyHealth, on the health and health care costs of its own employees ... [T]here were significant improvements in health-risk status as well as increases in the use of preventive and chronic disease management services ... The findings are particularly meaningful since healthcare workers are a prime target for improving population health and mitigating rising healthcare costs." (UPMC Health Plan)
Employer Wellness Programs: Mind, Body, Spirit -- and Wallet
"All health-contingent wellness programs, whether activity-only or outcome-based, must satisfy the following criteria: Frequency of Opportunity to Qualify ... Size of Reward ... Reasonable Design ... Uniform Availability and Reasonable Alternative ... Notice of Availability of Reasonable Alternative." (von Briesen & Roper, s.c.)
[Guidance Overview] How the ACA Affects U.S. Territorial Employees (PDF)
"Employers should be pleased by the greater flexibility they have in designing benefit programs for their territorial employees. Although their plans may have to meet ACA benefit mandates, employers generally will not be adversely impacted if they fail to offer affordable, minimum value health coverage to these employees. In addition, because it is unlikely that a territorial employee would ever be considered full-time for purposes of the shared responsibility provisions, the tracking and reporting obligations of these employees should be minimal." (Buck Consultants at Xerox)
[Guidance Overview] Can a Plan That Fails to Cover Inpatient Hospitalization Services Provide Minimum Value?
"Whether these plans were 'intended,' or whether they are consistent with Obamacare, is irrelevant. Under currently applicable laws and regulations, these plans appear to work as advertised. Moreover, no employer is required to do anything more than the law requires; and any employer that does risks putting itself at a competitive disadvantage relative to those that do not. The regulators are free to change the rules. Despite a high likelihood that they are aware of these plans, however, they have not yet seen fit to act." (Mintz Levin via Lexology)
What Can Employers Do to Reduce the Cost of Obamacare?
"Surprisingly, firms that are large enough to self-insure can satisfy the mandate without covering hospitalization! They can also avoid paying for mental health care and even emergency rooms visits. Yet insurance for small firms and individuals does have to cover these things." (John Goodman, in Forbes)
Measuring Wellness: From Data to Insights
"[A recent survey explored] the extent to which employers use health-related employee data to guide the operation and outcomes measurement of US wellness programmes.... Key findings: [1] More matters than cost effectiveness: Wellness programmes can be part of a progressive HR strategy to make the organisation an employer of choice. [2] Better data collection is needed, but what to do with it? Employers struggle to interpret the data they have and they lack sufficient insights to assess key programme objectives. [3] Leading obstacles to participation in wellness programmes are insufficient time and privacy concerns, employees say." (The Economist)
[Guidance Overview] Five ACA Issues Employers Should Be Following (PDF)
"Employers have about three months to finalize their employer mandate compliance plans under the [ACA].... While most employers are in the final stages of planning, ... [other] issues that employers should be aware of as they move forward into 2015 and beyond [include]: [1] ACA-related litigation [2] Employer mandate reporting [3] Section 510 liability [4] Alternatives to traditional plan offerings [5] The looming Cadillac tax." (Epstein Becker Green)
Are Wearables a Good Fit for Your Wellness Program?
"Wearables are more expensive than the typical pedometer by $10 to $15 per participant. As a result, while some companies distribute a device to every employee, others require employees to complete an activity to earn one. For example, a large financial services firm rewarded employees with a Fitbit for completing a health assessment. And for those employees who wanted to upgrade to a more expensive version, the company subsidized the cost." (HealthFitness)
Optimizing Enrollment in Employer Health Plans: A Comparison of Enrollment Strategies in the Diabetes Health Plan
"The subjects were 5014 eligible employees from 11 self-insured employers who had purchased the Diabetes Health Plan, which offers free or discounted copayments for diabetes related medications, testing supplies, and physician visits.... Overall, the proportion of eligible members who were enrolled within the automatic enrollment strategy was 91%, compared with 35% for voluntary enrollment. Income was a significant predictor for voluntary enrollment but not for automatic enrollment. Within automatic enrollment, covered dependents, Hispanics, and persons with nondiabetes comorbidity were more likely to enroll than other subgroups." (American Journal of Managed Care)
What's Causing Healthcare Premiums to Rise?
"[1] New premiums may be an attempt to correct for errors in the previous year. If insurers set premiums higher than necessary in 2014, they may not have needed to raise them as much for 2015. [2] [HHS] has warned insurers against raising premiums by more than 10 percent, threatening to analyze any such increases. As a result, insurers have an incentive to raise premiums by smaller amounts from year to year, to avoid attracting attention from HHS. [3] Some Americans are still allowed to be in noncompliant (and therefore cheaper) plans. In 25 states, non-ACA-compliant plans are allowed to run through at least 2015." (National Center for Policy Analysis)
New Data Show Early Progress in Expanding Health Care Coverage, with More Gains to Come
"[T]he share of Americans without health insurance averaged 13.1 percent over the first quarter of 2014, down from an average of 14.4 percent during 2013, a reduction corresponding to approximately 4 million people. The 13.1 percent uninsurance rate recorded for the first quarter of 2014 is lower than any annual uninsurance rate recorded by the NHIS since it began using its current design in 1997." (The White House Blog)
Quality of Health Care After Adopting a Full-Replacement, High-Deductible Health Plan with a Health Savings Account: A Five-Year Study (PDF)
"This study reports use of health care services related to health care quality over five years ... [at] a single large employer ... that adopted an HSA-eligible health plan for all employees. It represents one of the longest observation periods reported with a full-replacement CDHP, and it is one of the few studies with a matched control group. The introduction of the HSA-eligible health plan had a negative impact on office visits for annual physicals, well-child visits, and preventive visits in the year that the plan was adopted. In the second year, office visits increased for HSA-eligible health plan enrollees, but were mostly unchanged for the comparison group. By the fourth year in the HSA-eligible health plan, office visits for annual physicals, well-child visits, and preventive visits were down slightly relative to the comparison group." (Employee Benefit Research Institute [EBRI])
Income, Poverty and Health Insurance Coverage in the United States: 2013
"The percentage of people without health insurance coverage for the entire 2013 calendar year was 13.4 percent; this amounted to 42.0 million people." (U.S. Census Bureau)
ACA Tempers New State Coverage Mandates
"To discourage states from passing mandates that go beyond essential health benefits requirements, the law requires states, not insurers, to cover the cost of mandates passed after 2011 that apply to individual and small group plans sold on or off the state health insurance marketplaces. If a mandate increases a plan's premium, states will be on the hook for the additional premium cost that's attributable to the mandate." (Kaiser Health News)
Text of GAO Report: Coverage of Non-excepted Abortion Services by Qualified Health Plans
"GAO was asked to provide a list of QHPs that do and that do not cover abortion services and for additional information on issues related to that coverage. This report describes whether non-excepted abortion services are covered by QHPs within the 28 states with no laws restricting such coverage for the 2014 benefit year and provides additional information -- such as the scope and the cost of non-excepted abortion services coverage -- for selected QHPs that cover such services." (U.S. Government Accountability Office [GAO])
Why Any Plan Sponsor Fiduciary Needs to Give HSAs Another Look
"Banks, insurance companies, and investment firms with active IRA programs may be interested in making their programs friendly for employers that want to make the HSAs widely available to employees with education as to the advantages of keeping the HSA accounts invested.... It will be critical for anyone marketing or offering these programs to be very sensitive to the conditions for exemption from ERISA. Some employers may be willing to offer HSAs as a fully ERISA-covered benefit, but most will want to stay ERISA-exempt, and for the latter category it will be necessary to keep the program simple and be very careful with the handling of investment options." (Fiduciary News)
Looking Ahead to the ACA's 'Cadillac Tax' on High-Cost Health Coverage (PDF)
"Given the potentially dramatic financial effect of the Section 4980I excise tax, some employers have determined that radical modifications to benefits may be required to avoid liability. Employers are developing strategies for limiting its negative impact, including plotting out a 'glide path,' whereby the value of employer-sponsored coverage will be reduced gradually between 2014 and 2018 to bring the cost of coverage under the Section 4980I thresholds (and employees will not see their benefits dramatically reduced between 2017 and 2018). Complicating the development of any long-term strategy, however, is the paucity of guidance related to Code Section 4980I." (Groom Law Group)
Race to the Middle? Middle and Skinny Plans Under Healthcare Reform
"A number of innovative strategies for avoiding or minimizing the impact of tax penalties under Code 4980H(a) and Code 4980H(b) exist in the marketplace. However, these strategies are not one size fits all. Even when the strategy seems to fit, the questionable compliance of these strategies with the many requirements for health plans under PPACA make for numerous cracks in the elusive glass slipper that is the cost-effective, compliant, and penalty-eliminating group health plan. [The authors review] compliance concerns with so-called 'Middle Plans' currently emerging, and highlight employer risks in implementing a Skinny Plan." (Hill, Chesson & Woody)
Early Observations Show Safety-Net ACOs Hold Promise to Achieve the Triple Aim and Promote Health Equity
"This post will outline five key observations regarding emerging safety-net ACOs and suggest broad policy implications. We are defining safety-net ACOs as collaborative entities of providers and sometimes payers that are [1] accountable for managing the health of their population, [2] assuming upside and/or downside financial risk, and [3] serving predominantly Medicaid (including dual eligibles) and uninsured patients." (Health Affairs)

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