Headlines about "Health plan admin - misc"
Gathered from the web by the editors at BenefitsLink.com.
[Official Guidance] IRS Statement on Court Ruling Prohibiting Testing of Tax Return Preparers
"In accordance with this order, tax return preparers covered by this program are not required to complete competency testing or secure continuing education. The ruling does not affect the regulatory practice requirements for CPAs, attorneys, enrolled agents, enrolled retirement plan agents or enrolled actuaries.... Fee amounts collected for scheduled registered tax return preparer test appointments canceled due to the court ordered injunction are being refunded. Additionally, fees collected from return preparers who tested on or after January 18, 2013, the date the test was enjoined, are also being refunded." (Internal Revenue Service)
[Opinion] Text of Comments to CMS on Advance Notice of Methodological Changes for Calendar Year 2014 for Medicare Advantage Capitation Rates (PDF)
"Our comments relate solely to the proposal that Part D sponsors should require their network retail and mail pharmacies to obtain patient consent to deliver new or refill prescriptions prior to each delivery.... An alternative approach that strengthens protections for both Medicare beneficiaries and the Part D program would be to develop balanced, workable guidelines that require affirmative written or electronic consent when patients opt in to an automatic refill program and the opportunity for beneficiaries to opt out of an automatic refill program entirely or for any particular medication." (American Benefits Council)
Obama Appoints Daniel Werfel as Acting Head of IRS
"President Obama on Thursday appointed senior budget adviser Daniel Werfel as the acting commissioner of the Internal Revenue Service... Werfel has served for most of the Obama administration as controller of the Office of Management and Budget, overseeing federal procurement, financial disclosure and working to fight waste. A lawyer by training who also worked as a budget official in the George W. Bush administration, Werfel has helped reduce the administration's level of improper payments to contractors and has been working to manage the mandatory budget cuts known as the sequester." (The Washington Post)
[Opinion] Testimony Before the Health Committee of the District of Columbia Council, Supporting Mandatory Use of Exchange for Purchase of Individual or Small Business Health Insurance
"Designing the best exchange for the District has been challenging because DC's health insurance market is small and highly concentrated. There are only four carriers one of which one controls more than three quarters of the individual and small group markets.... In a small market with a dominant insurer, it is essential that the exchange risk pool be as inclusive as possible, both to stabilize the exchange -- which is the only source of federal subsidies for District residents with modest incomes -- and to maximize transparency and competition." (Brookings)
Reinhart Employee Benefits Update, May 2013 (PDF)
Articles include: Summary of Description of Material Modifications for Calendar Year Plans; PBGC Issues Proposed Regulations on Reportable Events and Other Notification Requirements; IRS Provides Relief from the Anti-Cutback Requirements for Certain ESOP Amendments; FAQs on SBC Requirements and Updated SBC Template for 2014; IRS Proposes Regulations on Determining Minimum Value; Supreme Court Issues Decision in US Airways, Inc. v. McCutchen. (Reinhart Boerner Van Deuren s.c.)
California Interpreters Push State for More Trained Healthcare Interpreters
"During the next five years, with the implementation of health care reform, more than 3 million Californians will require language assistance in health care. By state and federal law, these Californians must have access to translating services. And yet, the state does not yet have a clear plan for how a rapidly growing number of patients will access the care to which they are entitled and need." (AFSCME)
[Guidance Overview] Notices Must Inform Employees About ACA Insurance Exchanges
"[T]he model Marketplace Notice describes affordability in terms of whether the cost of coverage exceeds 9.5% of the employee's wages from the employer, not the statutory threshold of 9.5% of the employee's household income. The model notice contains certain optional provisions on its last page that are intended to help ensure that employees understand their coverage options, but will require the notice to be customized for different groups of employees ... [T]hese optional provisions may not be practical at larger employers." (Vedder Price)
Plan Administrators Not Always Required to Obtain Vocational Evidence or IME Before Making Long-Term Disability Determinations
"'[A] plan administrator is not required to obtain vocational evidence where the medical evidence contained in the record provides substantial support for a finding that the claimant is not totally and permanently disabled.' ... [T]he file reviewers 'made no credibility determinations about [the claimant] and did not second-guess [the claimant's] treating physicians.' For those reasons, the [Court of Appeals for the Sixth Circuit] held that 'MetLife did not act arbitrarily or capriciously in conducting a file review.'" (Lane Powell PC)
IFEBP Survey Finds Confidence in Continued Employer-Sponsored Health Care
"[T]he vast majority of employers (90 percent) have moved beyond a 'wait and see mode' and are actively developing tactics and taking steps to deal with new rules and regulations stemming from the new health care reform law.... 69 percent of employers stated they will definitely continue to provide employer-sponsored health care when health exchanges come online in 2014 -- a 23 point increase from 2012 (46 percent). Another quarter of respondents (25 percent) stated they are very likely to continue their employer-sponsored health care offering." (International Foundation of Employee Benefit Plans)
Employer Roundtable Discussion: The Future of Health Care Benefits
"[A]bsent some needed guidance about nondiscrimination rules, it is difficult for [employers] to move forward, and options for replacing employer-sponsored coverage and paying penalties are still too immature for most employers to seriously consider for their active employee population.... Most roundtable participants had not yet considered potentially leveraging public exchanges and paying a penalty to enable employees more affordable options, but were intrigued with the idea." (PricewaterhouseCoopers)
[Opinion] Your Next IRS Political Audit: Tax Agency Gets Vast New Powers Under ACA
"To monitor compliance with these rules, the IRS and HHS are now building the largest personal information database the government has ever attempted.... Good luck in advance to anyone who gets caught in this system's gears, assuming it even works. Centralizing so much personal information in one place is another invitation for the IRS wigglers in some regional office -- or maybe higher up -- to make political decisions about enforcement." (The Wall Street Journal)
Utah Gets Approval for Unique Dual-Model Exchange
"Utah is set to become the only state in the country with a dual-model health insurance exchange, which will be split into two parts that will be run separately by Utah and federal officials.... The two exchanges will operate completely independently of each other, including providing their own navigators and certifying health plans for each online marketplace." (FierceHealthPayer)
2013 Group Health Plan Notices Calendar
"The 2013 edition of the Group Health Plan Notices Calendar features a number of important updates as a result of new requirements under Health Care Reform, including the new Model Exchange Notices required to be distributed by all employers no later than October 1, 2013." (hr360; registration required)
Marilyn Tavenner Confirmed as Medicaid and Medicare Chief
"Fierce disagreements over health policy had made confirmation difficult for any nominee for the Medicare job. Ms. Tavenner, a nurse who worked for more than two decades at the Hospital Corporation of America, will be the first Senate-confirmed administrator since Dr. Mark B. McClellan stepped down in October 2006." (The New York Times)
Subsidy Calculator: Premium Assistance for Coverage in Exchanges
"This tool illustrates health insurance premiums and subsidies for people purchasing insurance on their own in new health insurance exchanges ... created by the [ACA]. Beginning in October 2013, middle-income people under age 65, who are not eligible for coverage through their employer, Medicaid, or Medicare, can apply for tax credit subsidies available through state-based exchanges." (Kaiser Family Foundation)
[Official Guidance] IRS to Be Closed on May 24 and Four Other Days -- Filing and Payment Deadlines Unchanged (PDF)
"The Internal Revenue Service announced ... additional details about the closures planned for May 24, June 14, July 5, July 22 and Aug. 30, 2013.... [A]ll IRS operations will be closed on those days. This means that all IRS offices, including all toll-free hotlines, the Taxpayer Advocate Service and the agency's nearly 400 taxpayer assistance centers nationwide, will be closed on those days.... No tax returns will be processed and no compliance-related activities will take place." (Internal Revenue Service)
Take Me Out to the Ballgame ... and Sign Me Up for Health Insurance
"So, what's the best way to get the word out about the ACA, the exchanges, and the importance of signing up for health insurance? ... [T]he first answer is obvious to everyone -- Facebook! And, of course, it was obvious to the folks in charge, so we have Healthcare.gov on FB.... [H]ere are a few other ideas to spread the word: Celebrity tweets.... Sporting events.... School kids.... Public transportation." (Wolters Kluwer Law & Business)
[Guidance Overview] More Guidance on Health Insurance Marketplaces: Three Sets of FAQs Released by HHS
"The first set of section 1311 funding FAQs primarily summarizes earlier guidance on state activities in federally facilitated marketplace (FFM) and state partnership marketplace (SPM) states, but in some instances goes into greater detail.... The Consumer Partnership FAQ states again that section 1311 prohibits HHS from using such funding for state navigator programs.... The final ... FAQ set covers a number of topics. It begins with two questions on oversight of state-operated premium stabilization, advance payment of premium tax credits, and cost-sharing reduction payment programs." (Timothy Jost in Health Affairs)
New Obamacare Rules on Wellness Programs Deal Blow to Employers
"Employers' hopes about the majority of their wellness program incentives helping their health plans meet minimum-value and affordability requirements have effectively been crushed by the feds. Many experts in the benefits community aren't happy with the distinction the feds made between wellness programs and feel the moves adds more confusion to complying with Obamacare's many regs." (HRBenefits Alert)
[Opinion] Study of Massachusetts Health Reform Does Not Adequately Examine Obamacare
"[A recent] study of Massachusetts's experience with health care reform [has led to claims] that under Obamacare most employers will not reduce or eliminate the health coverage they currently offer. However, there are at least three aspects the study did not directly address, all of which suggest that employers will, in fact, scale back their health insurance offerings: 1) Obamacare is a federal program, not confined to one state.... 2) Obamacare contains fewer restrictions for employers who want to drop coverage.... 3) Obamacare subsidizes more individuals than the Massachusetts plan." (The Heritage Foundation)
[Official Guidance] Text of CMS FAQs on Health Insurance Marketplaces (PDF)
Ten Q&As on the following topics: [1] Oversight of Premium Stabilization Programs, Advance Payments of the Premium Tax Credit, and Cost-sharing Reductions; [2] Issuer Oversight; [3] State-based Marketplace Reporting Requirements; [4] Privacy and Security; [5] Cost-Sharing Reductions and Health Savings Accounts; [6] Eligibility and Enrollment. (Centers for Medicare & Medicaid Services)
Are Converted Individual Disability Policies Governed by ERISA?
"[A]n individual disability policy may nevertheless be governed by ERISA ... when the employees benefit from a rate structure or premium discount the employer was able to negotiate in obtaining group benefits. But does ERISA apply when the employee 'converts' a group disability policy to an individual policy? What does 'conversion' mean, anyway? Can the policy merely be a 'continued' policy, rather than a 'converted' policy? Does ERISA apply then? Maybe yes." (Lane Powell PC)
ML Strategies Health Care Reform Update, May 13, 2013 (PDF)
Update on developments in federal and state health care reform legislation and regulations, including summaries of recent announcements and regulatory activity by HHS, CCIIO, IRS and CMS. (ML Strategies, LLC)
Obamacare Brings New, Expensive Contractor Misclassification Penalty
"[W]hen classifying workers, follow the IRS' three-point checklist for determining a worker's classification: Behavioral control... .Financial control.... Type of relationship." (HRBenefits Alert)
US Airways v. McCutchen Health Plan Reimbursement Case: When Silence Is Not Golden
"[T]he Court noted that if the plan sponsor ... had wished to depart from application of equitable doctrines, it was free to draft its plan to say so. In other words, if a plan sponsor does have an intent inconsistent with certain commonplace equitable doctrines, it can avoid application of those doctrines by expressly drafting around the issue in the plan itself." (Jones Day)
Invasion of the Health Insurance Brokers
"Largely dealt out of benefit distribution by Obamacare, intermediaries are looking to work directly with your employees.... In addition to insurance carriers and brokers, the commercial players looking to pick up business directly from workers will include worksite marketers, benefit consultants, retirement-plan representatives and payroll-services providers[.]" (CFO.com)
State Health Insurance Exchange Navigators Prepare to Help Applicants
"When enrollment in the health care law's new insurance exchanges opens in October, the prospects for success will turn on a crucial element: people who actually understand health insurance coverage and can explain it in plain language to consumers.... [T]he states and [HHS] will oversee the training of what's expected to be thousands of paid health insurance experts who will be available to guide Americans through the enrollment process." (Roll Call)
Oregon's Upstart Health CO-OPs to Challenge Mainstream Insurers
"In October, [two startup health insurers offering a consumer-run experience] will go head-to-head with about a dozen established insurers to appeal to small businesses as well as more than 200,000 expected to buy their own insurance next year.... Only one state received federal funding for two co-ops: Oregon. Now the upstarts will have to sink or swim in an insurance market already ranked among the most competitive in the country." (The Oregonian)
Obamacare Application Form Isn't So Simple After All
"The much-derided 21-page application was for families. It is now down to 11 pages ... Eight pages in the longer application called for filling in information for four additional family members. The new form cuts these pages but says that if you have children, 'make a copy of Step 2: Person 2 (pages 4 and 5) and complete.' The work required of the applicant remains the same." (John Goodman's Health Policy Blog)
EEOC Settles First GINA Lawsuit
"Fabricut, Inc.... will pay $50,000 and furnish other relief to settle the suit.... The EEOC claimed that after the woman was offered a position, Fabricut sent her to a contract medical facility to complete a post-offer medical examination and drug test. When she appeared for the medical examination, she was required to complete a questionnaire that asked her to disclose the existence of various conditions in her family medical history, such as heart disease, hypertension, cancer, tuberculosis, diabetes, arthritis and 'mental disorders.'" (Thompson Hine)
Text of CCIIO Letter to Essential Community Providers (PDF)
"At this time, health insurance issuers that wish to establish QHPs may be approaching you with offers to join their provider networks. Whether or not you are currently engaged with private insurers, I encourage you to thoughtfully consider these overtures. Many of the patients whom you serve will be eligible to purchase health insurance from these QHPs." (Centers for Medicare & Medicaid Services)
[Guidance Overview] DOL Issues Model Notices on Employer Health Insurance Options
"[A]t least some of the required information and most of the optional information can only be determined by an employer if it has already determined what the status of its plan will be under the employer shared responsibility rules and how it will comply or not comply with the shared responsibility rules for its different categories of employees." (Pillsbury Winthrop Shaw Pittman LLP)
[Guidance Overview] Implementing Health Reform: Medicaid DSH Payments, Utah Exchanges and More
"The [CMS] FAQ, moreover, allows Utah to operate a SHOP navigator program in which navigators can only conduct consumer outreach and education activities and not assist with enrollment or perform other required navigator functions. CMS will operate the navigator program in the individual market, where navigators will be able to fulfill all required functions ... [I]t is disconcerting that CMS has folded on this issue in Utah." (Timothy Jost in Health Affairs)
[Guidance Overview] More Guidance on 'Minimum Value'
"[I]t appears employers could still offer a basic plan that provides minimum essential coverage but not minimum value, as long as employees may choose to decline that plan. So, for instance, an employer could offer a preventive services-only plan (which would comply with the requirement to cover first-dollar preventive care at 100%), and the employer would never be subject to the larger penalty under the employer mandate ($2,000 multiplied by all full-time employees). While the employer may still be subject to the smaller penalty ($3,000 multiplied by only those full-time employees who receive a tax credit) because they have not offered a plan that provides Minimum Value, presumably this penalty would be significantly less than the alternative." (Seyfarth Shaw LLP)
Streamlined Exchange Applications Released by HHS; Employers Will Need to Complete Employer Coverage Tool
"Employers with employees who may seek enrollment in the public Health Insurance Marketplace should become familiar with the content of the applications and with the information they will need to provide as part of the Employer Coverage Tool. The application process will be an important step in the initial determination of an applicant's eligibility for federal premium tax credits and an employer's potential liability for penalties under the play-or-pay mandate." (Towers Watson)
[Guidance Overview] Guidance Issued on Required Notice to Employees of Available Coverage on Health Insurance Exchanges (PDF)
"Employers should be embarking on their own communications efforts around the Marketplace to help manage employee concerns and minimize the need for responding to individual questions. This is also a way to underscore the value of employer-provided coverage.... Employers may want to supplement the notice with some of their own information and terminology." (PricewaterhouseCoopers)
Enroll America Will Not Be Enrolling
"Enroll America has not filed to serve as navigators and has no intention of doing so. So there you have it. The group that is supposed to be leading the charge to serve those who need it most won't be serving them much at all." (InsureBlog)
A Self-Funded Employer's Worst Nightmare
"The employer changed to a self-funded plan and purchased stop-loss that provided coverage for member claims that exceeded $75,000 up to a $1 million lifetime maximum. The employer thought that the health plan imposed a $1 million lifetime maximum on benefits.... [When the employer found itself responsible for payment of a claim that exceeded that maximum,] the employer argued that the agents had a special relationship with the employer in the design of the plan and the stop-loss coverage.... [T]he court refused to dismiss that claim. Thus, the employer will have the opportunity to show the court that there was a fiduciary relationship between the insurance agents and the employer and that the insurance agents should cover the losses not covered by the stop-loss insurance." (Leonard, Street and Deinard)
[Guidance Overview] Model 'Notice of Marketplace Coverage Options' Released: October 1 Deadline
"Employers must provide the Notice of Marketplace Coverage to current full-time and part-time employees -- regardless of their enrollment status under existing group plans -- no later than October 1, 2013 ... Thereafter employers must provide the Notice to each new employee upon hire, which the Guidance defines as within 14 days of an employee's start date. Employers wanting to provide the Notice to current employees and new hires in advance of the October 1, 2013 deadline may use the Model Notices and rely on the terms of the Technical Release in doing so." (E is for ERISA)
[Guidance Overview] DOL Issues Model Exchange Notices, Updated COBRA Election Notice and Related Guidance
"The notice [for employers who offer a health plan] includes spaces in which basic information about an employer is provided, and includes questions about the employer's coverage, including whether: The coverage is offered to all or some employees and, if the latter, which employees are eligible. Dependent coverage is provided. The coverage meets minimum value and is intended to be affordable, based on employee wages." (Practical Law Company)
Treasury and IRS Update from ABA Joint Committee on Employee Benefits
"One of the issues [discussed with IRS at a recent meeting] was whether employers can use a 'non-safe harbor approach' for some of its employees, but a safe harbor approach for other employees for purposes of the employer penalty rules.... Another issue ... was whether HRAs and individual policies can still be integrated ... Many potential arrangements are being marketed to employers that do not take into account the 4980H rules[.]" (Kilpatrick Townsend)
Obamacare Confusion Triggering Potential Scams
"Specifically in Ohio, scammers are: [1] Claiming to be authorized to help people navigate the health insurance exchange created under the ACA and say they need to verify the person's name, address and Social Security number. Tip: Health insurance exchange open enrollment does not begin until Oct. 1. The marketing of plans offering coverage through the exchange has not begun. [2] Claiming to be a Medicare representative and that because of the ACA the person's information needs verified in order to receive a new Medicare card. Tip: New Medicare cards are not being issued because of the federal health care law. [3] Claiming they need the person's Medicare number to provide them an updated medical emergency alert device. One of the brand names mentioned was Lifeline. Tip: Medicare does not cover medical alert devices." (Ohio Department of Insurance)
[Guidance Overview] The Legal Risks Behind Workplace Wellness Programs (PDF)
"Before implementing a wellness program, employers must consider the requirements of the Health Insurance Portability and Accountability Act ... the Americans With Disabilities Act ... the Genetic Information Non-Discrimination Act ... and state law. Unfortunately, this is a relatively complex area of the law in which more detailed guidance is greatly needed from administrative agencies and the courts." (Locke Lord)
Plan Administrator Abused Discretion in Denying Coverage for Air Ambulance
"The court faulted the plan administrator for disregarding the physicians' opinions and failing to provide a logical explanation for denying benefits. Concluding that the plan administrator had abused its discretion, the court ruled for the participant.... One wonders whether the plan administrator might have prevailed had it invested a little more effort to document its interpretation of the plan language and distinguish the opinions of the participant's physicians." [Couture v. Gen. Motors, LLC, 2013 WL 1693598 (D. Ariz. 2013)] (Thomson Reuters / EBIA)
[Official Guidance] Text of CMS FAQs on Small Business Health Options Program (SHOP)-Only Marketplace (PDF)
"Q1: May a State operate only a Small Business Health Options Program (SHOP) while the individual market Marketplace is operated as a Federally-facilitated Marketplace (FFM)? ... Q2: Can any State elect to operate a State-based SHOP in 2014? ... Q3: Will the requirements for a State to operate a State-based SHOP while the individual market Marketplace is operated as a FFM be different for 2015? ... Q5: [sic] If a State elects to operate a State-based SHOP only, will the State be required to operate a Navigator program for the SHOP? If so, are the requirements for the State-based SHOP-only Navigator programs the same?" (Centers for Medicare & Medicaid Services)
Proskauer ERISA Litigation Newsletter, May 2013
Articles include: [1] U.S. Supreme Court Provides Defendants With More Ammunition for Defeating Class Certification by Requiring Classwide Proof of Damages; [2] District Court Limits the Collection of Withdrawal Liability Against Private Equity Funds; [3] Monetary Damages Potentially Available For Inadequate Disclosure; [4] U.S. Supreme Court Rules That Plan Terms Trump Equitable Defense; and [5] U.S. Supreme Court Agrees To Hear Case On ERISA Statute of Limitations. (Proskauer Rose LLP)
[Guidance Overview] Agencies Issue Updated Summary of Benefits and Coverage Template, and Extend Enforcement Relief (PDF)
"It appears that any employer-sponsored health coverage, other than coverage that consists of 'HIPAA-excepted benefits' (e.g., limited-scope dental or vision coverage, if offered separately), will be considered minimum essential coverage.... While plans may continue to furnish partial SBCs if there are multiple insurers, benefits described in a partial SBC may not satisfy the 60% minimum value standard, even though the overall plan does. Additional guidance on how to handle partial SBCs would be helpful." (Buck Consultants)
Federal Agency Says It's on Track to Make Health Exchanges Work
"The federal government has met its deadlines, tested its system and collected insurance plan information critical to rolling out the 2010 health care law ... despite the rumors of train wrecks, delays and bare-bones health care exchanges rocking Washington. White House and [HHS] officials working on implementing the plan say the exchanges will be up and running for enrollment by Oct. 1. They spoke on condition of anonymity because they were not authorized to speak publicly about internal meetings." (USA TODAY)
[Guidance Overview] What Executives and Boards Need to Know About Health Care Reform
"while many leaders are waiting to make decisions, the window for communicating with employees will not be open for long. Over the next few months, leaders must engage employees in an open discussion about how potential changes may affect them, their pocketbooks and their families. So in addition to the company's decision about play or pay and workforce structure, companies should be talking to their employees about their responsibility for health insurance (the individual mandate), understanding the public and private exchanges, and Medicaid eligibility." (Towers Watson)
[Guidance Overview] Implementing Health Reform: Employer Coverage Option Notices
"Employers must provide the notice if they are subject to the FLSA. The FLSA applies generally to employers who employ one or more employees and have a volume of at least $500,000 in annual business. It also applies to specific listed types of employers. Employers must provide the notice to each employee, including part time employees." (Timothy Jost in Health Affairs)
[Guidance Overview] DOL Issues Eagerly Anticipated Guidance on Marketplace Notice Requirement (PDF)
"Unlike the Summary of Benefits and Coverage (SBC), the guidance does not include a requirement to provide the notice in alternate languages. The DOL does not indicate its intention to provide the model notice template in other languages.... It is welcome news that the model notices are not state-specific or employee-specific. Employers who offer different health plans to different groups of employees, however, may need to prepare multiple not ices and coordinate the distribution." (Buck Consultants)
Statements and Testimony at May 8 EEOC Meeting on Wellness Programs Under Federal Equal Employment Opportunity Laws
At the link appear statements and testimony submitted to the Commission, as well as video of the meeting. (Transcript to follow.) The Commission will hold open the May 8, 2013 Commission meeting record for 15 days, and invites audience members, as well as other members of the public, to submit written comments on any issues or matters discussed at the meeting." (Equal Employment Opportunity Commission)
[Guidance Overview] Staffing Agencies and Common Law Employees: Who is Responsible for Offering Health Coverage?
"Given the myriad of factors used to determine who an employee's common law employer is, it is imperative that employers currently utilizing the services of a staffing agency clarify who will be responsible for providing coverage to workers working more than 30 hours per week. With the use of the common law employer rules, many companies may have more employees than they currently realize and this could affect how they determine their size for the pay or play penalty, as well as to which employees they offer coverage if they have more than 50 full-time employees." (Hill, Chesson & Woody)
How Will Premiums Change Under the ACA? (PDF)
"Premium changes due to ACA health insurance market reform rules will vary across states and individuals and will reflect many factors, including: [1] The effectiveness of the individual mandate and premium subsidies at attracting low-cost enrollees, [2] New benefit requirements which may increase plan generosity but reduce out-of-pocket costs, [3] Employer offer decisions and the demographics and health status of any employees shifting to coverage in the individual market, [4] How each state's current issue and rating rules compare to those beginning in 2014, and [5] Each individual's demographic characteristics and health status (and income when determining premiums net of subsidies)." (American Academy of Actuaries)
House Committee Hearing on the Fee on Health Insurance: Impact on Small Businesses
"On Thursday May 9 2013 the Committee on Small Business Subcommittee on Health and Technology held a hearing titled, The Health Insurance Fee: Impact on Small Businesses.... The purpose of the hearing was to provide an opportunity to examine the economic effects of the fee on small businesses." [At the link are the Chairman's opening statement, witness lists, and testimony.] (Committee on Small Business Subcommittee on Health and Technology, U.S. House of Representatives)
California Exchange Granted Secrecy
"A California law that created an agency to oversee national health care reforms granted it sweeping authority to conceal spending on the contractors that will perform most of its functions, creating a barrier from public disclosure that stands out nationwide. The degree of secrecy afforded Covered California appears unique among states attempting to establish their own health insurance exchanges under President Barack Obama's signature health law." (Associated Press via InsuranceNewsNet.com)
Group Health Plans Ruled Primary Plans When Coordinating With Medicare Advantage Plans
"Group health plans ... should confirm they are properly coordinating benefits with Medicare Advantage organizations (MAOs) to avoid a private cause of action for double damages to recover amounts under the Medicare Secondary Payer Act (MSP Act) in light of the U.S. Supreme Court's denial of certiorari on an appeal of the Third Circuit's decision in In Re Avandia Marketing Sales Practices GlaxoSmithKline LLC v. Human Medical Plans, Inc. (Glaxo). The Supreme Court's decision ... lets stand a Third Circuit decision that the private right of action provision in the MSP Act ... gives Humana a private cause of action as a primary plan against GSK to recover the double damage award." (Solutions Law Press)
Yahoo's Sweetened Parental Leave Policy Raises Practical FMLA Certification Issues for Moms and Dads in the Workplace
"[The DOL] very clearly warns employers ... that an 'employer may not request a certification for leave to bond with a newborn child or a child placed for adoption or foster care.' ... [C]an an employer require some sort of documentation from mom or dad confirming the need for bonding leave? Yes, indeed! ... [I]f mom wants to return before [the generally recognized period of recovery from childbirth], an employer arguably can require documentation from her physician confirming that she is able to perform the essential functions of her job." (FMLA Insights)
[Guidance Overview] HHS Issues Guidance on Role of Brokers in Online Insurance Markets
"Federally facilitated marketplaces (FFMs), including state partnership marketplaces (SPMs), will not establish commission schedules or pay commissions directly to brokers and agents ... But [HHS] has established a standard for qualified health plans (QHPs) sold through the FFMs and federally facilitated Small Business Health Options Program (SHOP) marketplaces that requires issuers to pay brokers and agents the same compensation for enrolling people in similar plans sold outside of the marketplaces." (Bloomberg BNA)
Colorado Launches Ad Campaign for New Online Marketplace
"With less than five months until Colorado's new online health insurance marketplace opens for business this fall, officials are concerned that few state residents have heard of it. This week, it became the first state to launch a public awareness campaign with television, print, radio and billboard ads that will cost $2 million and run two months." (Kaiser Health News)
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