Headlines about "Health plan costs - misc"
Gathered from the web by the editors at BenefitsLink.com.
Inaugural Health Care Cost and Utilization Report Summarizes National Trends in Health Care Utilization and Cost
"Key findings from this report: Per capita health spending among people under 65 is growing moderately, up 3.3 percent from the previous year but still nearly three times the rate of general inflation. Higher spending was mostly due to price increases, rather than changes in the use of health care services: Prices for hospital admissions, outpatient care and prescription drugs all grew at a much faster rate than general inflation in 2010. Health care spending grew fastest among those who are 18 and younger." (Health Care Cost Institute)
What Could Revolutionize Health Care? This Database
"This morning a new nonprofit called the Health Care Cost Institute will roll out a database of 5 billion health insurance claims (all stripped of the individual health plan's identity, to address privacy concerns). Researchers will be able to access that data, largely using it to probe a critical question: What makes health care so expensive?" (The Washington Post; free registration required)
[Guidance Overview] Insurers Who Meet Or Exceed 2011 Medical Loss Ratio Standard Must Provide Notices Beginning July 1, 2012
"The notice is also intended to motivate insurers to spend as high a percentage of premium dollars on care and quality improvement as possible (rather than just enough to avoid paying rebates), because informing subscribers that they can view insurers' MLRs on www.HealthCare.gov increases transparency." (Employee Benefits Institute of America (EBIA))
[Opinion] Broken Promise: Why ObamaCare Will Force Americans to Lose the Health Care Coverage They Have and Like (PDF)
"[N]ew analysis of the health care costs of Fortune 100 companies indicates the Democrats' health care law threatens the stability and sustainability of the employer-based health insurance system -- even among the nation's most prosperous companies. House Ways and Means Committee Chairman Dave Camp (R-MI) asked for and received, on a confidential basis, information on the cost and coverage of the health insurance plans for the Fortune 100 companies." (U.S. House of Representatives, Committee on Ways and Means)
Genetic Test Results Do Not Trigger Increased Use of Health Services, Says Government Study
"People have increasing opportunities to participate in genetic testing that can indicate their range of risk for developing a disease. Receiving these results does not appreciably drive up or diminish test recipients' demand for potentially costly follow-up health services, according to a study performed by researchers at the National Institutes of Health and colleagues at other institutions." (U.S. Department of Health and Human Services, National Institutes on Health)
[Opinion] Text of Additional Comments by American Academy of Actuaries on Proposed Health Care Costs Calculator (PDF)
"[T]hese comments address issues related to whether the AV calculator needs to incorporate plan designs with benefit limits, whether different claim distributions should be used for plans in the individual and small group markets, how many geographic pricing tiers would be appropriate, whether induced demand should be incorporated into the calculator, and how Health Savings Account (HSA) and Health Reimbursement Arrangement (HRA) contributions should be incorporated. We also provide recommendations regarding ways to enhance the calculator's transparency." (American Academy of Actuaries)
Health Care Costs Reported in Recent Milliman Medical Index Incite Fear, Car Comparisons
"The Gaston Gazette compares the cost of healthcare in Atlanta to the cost of a Honda Civic. Forbes (which already has one car comparison on the books) compares healthcare costs to a new Chevrolet Cruze, with a caveat...." (Healthcare Town Hall)
Making Gene Mapping Part of Everyday Care
"The price to get a full genetic map currently starts at about $3,000, and many experts predict this could quickly fall to $1,000, roughly equivalent to the cost of an MRI. Insurance is expected eventually to help cover the cost of doctor-ordered tests." (The Wall Street Journal)
Health Care Savings Advice for Individuals
"Money magazine gives you strategies to cut your costs as much as 70% in six big areas -- from doctor visits to prescription drugs to dental care -- that are major sources of cash drains. This is the first of a two-part series on how to lower your medical expenses." (CNNMoney.com)
Data Trove Might Shed Light on Health Care Cost Uncertainties
"How much do hospitals and doctors actually charge insurers for their services? How much and which of those services are privately-insured patients using? And, most significantly, what drives changes in health-care use, costs, and total spending? They are among the most vexing questions in American health care. And a recently amassed trove of data from insurance companies could soon shed new light on them." (The Washington Post; free registration required)
Consumer-Directed Health Plans Shown to Be Money-Savers
"A large study of the medical spending patterns of consumer-directed health plan enrollees, published in the May Health Affairs, found that CDHP enrollees did indeed spend less on care, saving them and their employers money. But the declines were not restricted to unnecessary and redundant tests. The drop also was due to fewer preventive tests and screenings." (American Medical Association)
Health Tax Credit Could Mean Big Savings for Small Firms
"Of firms with fewer than 50 workers and that offer health benefits, 65 percent last year said they had not explored their eligibility for the tax credit, according to a national survey by ... Henry J. Kaiser Family Foundation. Of similarly sized firms that don't offer health insurance, 48 percent said they were not aware of the tax credit, the survey said. The tax break will expand to cover 50 percent of health premium costs in 2014[.]" (Crain's Chicago Business)
New York State Retiree Health Liability Rises to $72 Billion; NYC's Is $84 Billion
"Most states cover retiree health benefits on a pay-as-you go basis. They don't set aside money annually to pre-fund the obligations, as they do with pensions. Last year, New York, the third-biggest U.S. state by population, spent $3.3 billion on health care for active and retired employees as health-care spending rose 6 percent." (Bloomberg)
Individual Insurance Benefits Becoming Available Under Health Care Reform Would Have Cut Out-Of-Pocket Spending In 2001-08
"This study compared out-of-pocket spending on health care between individual and employment-related insurance, controlling for numerous characteristics such as health status. Then it simulated the impact of full implementation of provisions of the Affordable Care Act on adults who currently have individual insurance ... [Among other findings, the study determined that the] likelihood of having out-of-pocket expenditures on care exceeding $6,000 would have been reduced for all adults with individual insurance, and the likelihood of having expenditures exceeding $4,000 would have been reduced for many." (Health Affairs)
[Official Guidance] Text of CCIIO Announcement on Medical Loss Ratio Annual Reporting Form Reminding Health Insurers of June 1 Deadline (PDF)
"[The final regs require] an issuer to submit an annual report to the Secretary by June 1 of the year following the end of an MLR reporting year. The first annual report must be submitted to the Secretary by June 1, 2012.... Please refer to the Medical Loss Ratio (MLR) Annual Reporting Form Instructions at: http://www.cciio.cms.gov/resources/other/index.html#mlr for the complete set of instructions." (Centers for Medicare & Medicaid Services, Center for Consumer Information and Insurance Oversight)
[Official Guidance] Text of CCIIO Announcement on Medical Loss Ratio Rebate Notices, Reminding Health Insurers of August 1 Deadline (PDF)
"[The final regs require] an issuer to provide information in the form of a rebate notice to enrollees who are owed rebates, regardless of the form in which the rebate payment is made (e.g., check or future premium credit).... CMS has developed a standard form for the rebate notice that each issuer must send by August 1 of the following year to enrollees entitled to a rebate based upon the prior MLR reporting year. For example, notice of rebates based on the 2011 MLR reporting year must be provided by August 1, 2012.... Please refer to the Medical Loss Ratio (MLR) Rebate Notice Instructions at http://www.cciio.cms.gov/resources/other/index.html#mlr for the complete set of instructions." (Centers for Medicare & Medicaid Services, Center for Consumer Information and Insurance Oversight)
Animated U.S. Map Showing Year-by-Year Increase in Obesity Among State Populations, 1985-2010
An effective use of animation to show a trend that substantially raises the cost of providing health care. "The number of states with an obesity prevalence of 30% or more has increased to 12 states in 2010. In 2009, nine states had obesity rates of 30% or more. In 2000, no state had an obesity prevalence of 30% or more." (Centers for Disease Control and Prevention)
RAND Study of Effect of ACA on Enrollment and Premiums, Either With or Without the Individual Mandate (PDF)
The authors predict the effects of a possible Supreme Court decision invalidating the individual mandate while keeping the other parts of the law intact. They predict the effects of such a decision on health insurance coverage overall and for subgroups based on income. They also estimate where people will obtain insurance in scenarios with and without the mandate. Finally, they estimate how the elimination of the individual mandate will affect insurance premiums. (RAND)
[Guidance Overview] HHS Notice Addresses Rules for Insurers That Meet or Exceed Medical Loss Ratio Standards
"The extended notice requirement will hopefully reduce confusion that may have otherwise occurred when some individuals received rebates and others, in different insurance plans, did not. Importantly, the electronic disclosure rules for providing SBCs, which are referenced in the extended notice requirements for MLRs, were recently addressed in DOL frequently-asked-questions[.]" (Practical Law Company)
Health Care Costs for American Families in 2012 Exceed $20,000 for the First Time
"The annual Milliman Medical Index (MMI) measures the total cost of healthcare for a typical family of four covered by a preferred provider plan.... The 2012 MMI cost is $20,728, an increase of $1,335, or 6.9% over 2011. The rate of increase is not as high as in the past, but the total dollar increase was still a record." (Milliman)
Resource Page on Implementation of Health Insurance Medical Loss Ratios by the States, Updated May 11, 2012
"The N.H. insurance department released its first health insurance premium rate report in April 2012, a study mandated by legislation enacted two years ago. According to the report, premiums grew 14 percent between 2009 and 2010, driven primarily by claims costs, as well as new medical technologies and the growth in outpatient facility costs." (National Conference of State Legislatures)
[Guidance Overview] Whether or Not Constitutional, ACA Is Creating Turbulent Times for HSAs and HRAs (PDF)
At page 4. "Health savings accounts (HSAs) avoid many of the regulatory requirements under the ACA because they are not generally considered to be health plan coverage. By way of direct regulation, the ACA did increase the penalty for using HSA funds for non-medical purposes to a 20 percent excise tax (plus applicable income taxes) and requires a prescription for OTC drugs. More dramatically, however, is the potential for collateral damage to HSA viability as a result of ACA's regulation of the underlying high deductible health plan (HDHP) coverage, especially in the fully insured market. Some of this concern has been allayed recently when the agencies indicated that a portion of an employer's contribution (but not salary reductions) to an HSA could count toward the actuarial valuation requirements for the underlying HDHP plans." (Employers Council on Flexible Compensation)
[Official Guidance] Text of Official Corrections to Interim Final CMS Regs for Health Insurance Issuers Implementing Medical Loss Ratio Requirements (PDF)
8 pages; the clarifications are more than typographical errors. "This document corrects technical errors that appeared in the interim final rule published in the Federal Register on December 1, 2010, entitled 'Health Insurance Issuers Implementing Medical Loss Ratio ... Requirements under the [PPACA]' and in the correction notice published in the Federal Register on December 30, 2010, entitled 'Health Insurance Issuers Implementing Medical Loss Ratio ... Requirements Under the [PPACA]; Corrections to the Medical Loss Ratio Interim Final Rule With Request for Comments.' ... We believe that it is unnecessary to provide for a public comment period or to delay implementing these corrections, as they clarify provisions of a final rule that has been subjected to notice and comment procedures and do not make any substantive changes to it." (Centers for Medicare & Medicaid Services)
[Opinion] Health Care Reform: What Employers Should Be Considering Now
"As employers anxiously await the Supreme Court's decision on health care reform (expected by late June), there are many things employers should be thinking about now. The Supreme Court will most likely make one of four decisions on health care reform. [This article describes] how each of those possible decisions may affect employers." (Faegre Baker Daniels)
[Opinion] Techniques Used by Obamacare Could Support Proposed Taxation of Employer-Provided Health Care Benefits
"On November 4, 2011, [two Congressmen] sent a letter to the Congressional Supercommittee on federal debt reduction, urging the committee 'to oppose new taxes on employer-sponsored health benefits.' ... The letter argues that [imposing taxes on] employer-sponsored insurance ... is unfair, because it disproportionately affects those who, by virtue of being older or living in the Northeast, face higher health costs ... Obamacare's 'Cadillac tax' on high-value health plans* worked out a number of these issues. Let's go through them[.]" (Forbes)
America's Employers Controlling Health Care Costs and Improving Employee Lifestyles with Wellness Initiatives
"Seven in 10 American employers offer wellness initiatives such as flu shots, health screenings, and weight management programs ... according to the International Foundation of Employee Benefit Plans� (IFEBP) survey ... The survey suggests a definite decrease in health care costs when wellness initiatives are offered, according to the 21.6 percent who have analyzed return on investment (ROI). Of the organizations that are analyzing ROI, 83 percent indicated a positive return. For every dollar spent on wellness initiatives, most organizations see between $1 to $3 decreases in their overall health care costs." (Wolters Kluwer Law & Business / CCH)
[Opinion] Why Employer-Paid Health Insurance Drives Up Health Care Costs
"Stanford Nobelist Kenneth Arrow famously described third-party insurance as one of the principal flaws in America's health-care market. That is to say, because patients don't pay for their health care directly, they're insensitive to the cost and value of that care. But the 155 million Americans with employer-sponsored insurance in fact have fourth-party insurance. Not only do they not directly pay for their care, but they don't directly pay for their third-party insurance." (Forbes)
[Official Guidance] Agencies Revise Summary of Benefits and Coverage Template and , Sample Completed SBC, and Coverage Example Calculations
Q&A 14 in Part IX of "FAQs About ACA Implementation" explains the changes: "In the diabetes treatment scenario, the version originally posted contained a typographical error, listing the allowed amount for insulin as $11.92, rather than $119.20 -- a difference that impacts the total cost of care for diabetes in the coverage example calculations. To correct this error, the Departments have posted updated versions of the SBC template, the sample completed SBC, and the guide for coverage examples calculations - diabetes scenario. The updated SBC template and sample completed SBC also include sample taglines for obtaining translated documents ... as well as updated Sample Care Costs amounts for the diabetes coverage example, due to more accurate rounding in making these calculations. Finally, the updated versions include some appearance modifications (such as changes in bolding, underlining, shading, capitalization, margin justification, use of hyphens, and row and column sizing) to ensure the document is accessible to individuals with disabilities, consistent with section 508 of the Rehabilitation Act. Plans and issuers may use either version, or may make similar modifications to their own SBCs, without violating the appearance requirements for an SBC. The updated versions of these documents are labeled �corrected on May 11, 2012� in the lower right corner of the first page and are available at www.dol.gov/ebsa/healthreform and cciio.cms.gov. These three documents replace the prior versions issued contemporaneously with the final regulations in February 2012." (Employee Benefits Security Administration)
[Official Guidance] Text of Final CMS Regs for Medical Loss Ratio Requirements (PDF)
"[T]his final rule establishes a simple, straightforward notice requirement for health insurance issuers that meet or exceed the [Medical Loss Ratio, or 'MLR'] standards established by the Affordable Care Act, but only requires the notice for the 2011 MLR reporting year, the first year that the MLR rules are in effect, and does not require issuers to include information about the current or prior year MLR. The notice will direct enrollees to the HHS Web site for specific information about issuers' MLRs." (Centers for Medicare & Medicaid Services)
Massachusetts Politicians Taking Different Tacks Pursuing Containment of Health Care Costs
Provides an interesting list of proposed programs, technologies, expenditures and tax relief. "The current legislative session's policy focus has been health care payment reform, and the Massachusetts Senate, House of Representatives and governor have each proposed their own unique approach to transition the market away from fee-for-service and to contain cost growth." (ML Strategies)
Illinois House Votes to Require Former State Employees to Pay Part of Health Care Premiums for First Time
"The measure ... takes aim at an $876 million annual subsidy that had been one of the most lucrative perks of public employment. 'Not only are these benefits unaffordable given today's fiscal situation, but they are far more generous than those provided by other governments to their employees and those provided by the private sector,' said [the Illinois] House Speaker[.]" (Chicago Sun-Times)
Wellness Programs Credited with Keeping Eau Claire City Employee Insurance Costs Down
"Since the city began a wellness program through Group Health Cooperative of Eau Claire about five years ago, those on the city's insurance program have lost 2,243 pounds.... After two years of no cost increases to the city, Group Health offered a renewal with a 3.5 percent increase." (insurancenewsnet.com)
The ACA Small Business Tax Credit Makes Good Business Sense
"[This analysis finds] that more than 3.2 million small businesses, employing 19.3 million workers across the nation, will be eligible for this tax credit when they file their 2011 taxes. In total, these small businesses are eligible for more than $15.4 billion in credits for the 2011 tax year alone, an average of $800 per employee." (FamiliesUSA)
[Guidance Overview] Proposed IRS Regs Address the PPACA Comparative Effectiveness Fee (PDF)
"The proposed regulations provide very practical alternatives for determining the number of covered lives for the purpose of determining the [Patient-Centered Outcomes Research Institute] fee. Plan sponsors should review the options available for determining the fee to determine the most effective approach for their plans." (Buck Consultants)
[Opinion] Time to Control Runaway Military Personnel Costs
"[W]hile the military's retirement program serves only a small minority of the force, it provides an exceedingly generous benefit, often providing 40 years of pension payments in return for 20 years of service. As a result, the program now costs taxpayers more than $100 billion per year, an exceedingly steep price tag for a program hampered by serious flaws. This number is projected to double by 2034." (Tuscon Sentinel)
The ABCs of Beating Obesity: Schools Called 'Focal Point' for Prevention by Advisory Body
"The report by the Institute of Medicine, an influential independent body that advises the federal government on health policy, recommended requiring at least 60 minutes of physical activity a day in schools and considering excise taxes on sugar-sweetened beverages. It urged food companies to improve nutritional standards for foods marketed to people under 18[.]" (The Wall Street Journal)
[Opinion] Innoculate the Budget Deficit from Health Care Reform
"As we work to restrain health care cost growth, we must, at the same time, inoculate the future deficit from the inevitable failures of health reform. We can do this by choosing a federal health care spending level and stipulating that any spending above that amount must be financed on a current basis with a tax. For example, if federal health care spending were allowed to grow at the rate of GDP plus 0.5 percent (a rate proposed by both President Obama and Rep. Ryan), any health spending in excess of that growth rate would be financed with tax revenues in the next year." (Brookings)
Washington State's 1993 Experiment with Health Insurance Reforms (PDF)
"In 1993, Washington adopted one of the most extensive health care reforms ever enacted by a state. The law promised the grail of near-universal coverage while controlling costs. But the law was not implemented as intended, and as Washington residents soon discovered, unless [reforms such as premium caps] are paired with an effective personal coverage requirement, real problems emerge for employers, families and individuals." (America's Health Insurance Plans)
Essential Health Benefit Packages Under Health Care Reform Have Employers Wary
"Employers and consumer groups are tracking state efforts to craft insurance benefit packages for individuals and small businesses as required under the federal health care reform law.... Large and small employers have banded together to form the Essential Health Benefits Coalition to voice concerns in Washington and statehouses across the country on the issue.... 'Employers want to make sure the benefits aren�t so expensive that they can�t cover the cost,' [said a spokesman] for the Essential Health Benefits Coalition. " (Workforce)
Nearly Half of Soon-to-Be-Retired, High-Net-Worth Americans 'Terrified' of Health Care Costs in Retirement
"While 45 percent expect health care to be their biggest expense throughout retirement, when asked to estimate how much they anticipate spending each year on health care, they said, on average, $5,621. This represents a drastic underestimation based on a 2010 study that estimates out-of-pocket health care expenses for a 65-year-old couple retiring today and living for 20 years to range from $250,000 to $430,000. That could mean as much as $10,750 a year per person in out-of-pocket health care expenses." (Nationwide Financial)
[Guidance Overview] IRS Notice Requests Comments on Minimum Value and Reporting Requirements for Group Health Plans
"The [IRS is requesting comments on] three potential approaches to determining minimum value under consideration: 1. Use of an actuarial value calculator (for insured small group plans) or minimum value calculator (for self-insured and insured large group plans) created by [HHS] and the Treasury ... 2. Creation of various design-based safe harbor checklists describing deductibles, co-pays, coinsurance, out-of-pocket maximums and other cost-sharing attributes for the four core categories of benefits and services [and] 3. For non-standard plan designs, determination by a certified actuary that the plan provides minimum value." (McDermott Will & Emery)
[Guidance Overview] IRS Guidance Addresses Upcoming Research Fees on Many Health Plans and Insurers
"These research fees are scheduled to start with the first plan or policy year ending on or after October 1, 2012, and will affect the health plans of many employers. Although the regulations currently are in proposed form, health insurance issuers and plan sponsors may rely on the proposed regulations for guidance pending the issuance of final regulations." (Bond, Schoeneck & King)
Massachusetts Lawmakers Unveil Ambitious Plan to Cut Health Care Costs
"[State lawmakers announced a new proposal to control rising medical costs], including new ways to pay doctors and hospitals, a specific cap on health-care spending tethered to economic growth and a tax on the state's most expensive hospitals if they can't justify their prices." (Kaiser Health News)
DOL Reports to Congress on Self-Insured Health Plans; Agencies Seek Information on Stop-Loss Coverage
"Will health care reform's insurance mandates (which indirectly burden plan sponsors ... prompt more employers to consider self-insurance? It's too soon to tell -- particularly from a report based on 2009 data. But employers considering a change to a self-insured plan should understand both the risks and the advantages." (Thomson Reuters/EBIA)
[Guidance Overview] Minnesota State Agency to Pay Damages Plus Insurance Coverage to Resolve Case of 'Age 55 Cliff' Discriminatory Early Retirement Plans
"This decree ... resolves the last in a series of cases brought by the EEOC against Minnesota state agencies regarding early retirement incentive plans contained in collective bargaining agreements for certain employees. The incentive plans provided that the employee had to retire by age 55 to obtain the incentive, and would lose it if he or she worked longer, according to an EEOC statement. For an employee who did retire by age 55, the employer continued to pay the employer's share of the insurance premiums which generally ranged from 85 percent to 100 percent of the total amount of the premium -- and continued to do so until the retiree reached age 65. For an employee who retired after age 55, the employer paid nothing, and the cost of retiree insurance fell entirely on the retired employee." (Wolters Kluwer Law & Business / CCH)
Public Opinion on Gender Rating for Health Insurance Premiums
"While relatively few Americans are aware that the ACA [already includes a provision prohibiting gender rating in health insurance beginning in 2014], many Americans like the idea of leveling the playing field for health insurance premiums. Overall, six in ten (61 percent) have a favorable view of this provision, a number that rises to seven in ten (69 percent) among women as a group, and about three-quarters among women under age 50 (73 percent of whom back it)." (The Henry J. Kaiser Family Foundation)
[Guidance Overview] IRS Proposed Regs Address Comparative Effectiveness Research Fee on Group Health Plans
"Insurers and plan sponsors must report and pay these fees annually on IRS Form 720, which will be due by July 31 of each year. The first due date is July 31, 2013. A return will generally cover policy or plan years that end during the preceding calendar year. In other words, fees for a plan year are due by July 31 of the calendar year following the calendar year containing the plan year end. Form 720 may be filed electronically. The IRS has not yet updated Form 720 to reflect the reporting of these fees." (Proskauer)
[Guidance Overview] Proposed IRS Regs Address Fees to Be Paid by Health Insurers and Sponsors of Self-Insured Health Plans
"If the Supreme Court agrees that the individual mandate is unconstitutional and cannot be severed from the rest of the Act, the Section 4375 and 4376 fees [on health insurers and plan sponsors for the Patient-Centered Outcomes Research Trust Fund] would be invalidated along with the PCORI. The Court's decision is expected this June." (McGuireWoods)
[Opinion] Text of Comments by American Academy of Actuaries to CMS on Revised MLR Annual Reporting Form (PDF)
"The Medical Loss Ratio Work Group sent a letter to CMS offering comments on the revised annual reporting form, specifically on the definition of premiums, contract reserves, and the definition of pre-tax underwriting gain/(loss)." (American Academy of Actuaries)
Is the Fact that I Am a Woman Considered a Pre-Existing Condition?
"When they buy their own health insurance in the individual market, women must lay out an extra $1 billion a year, simply because they are women. Some argue that this is fair: after all, a woman could become pregnant, and labor and delivery are costly. But the truth is that, even when maternity benefits are excluded, one-third of all health plans charge women at least 30 percent more, according to a report released just last month by the National Women's Law Center." (The Health Care Blog)
Health Care Law Creates Financial Incentives for Employers to Drop Health Coverage
"More than 70 percent of America's Fortune 100 companies detailed their health care costs for the Committee, providing the ability to analyze how those self-reported costs would compare to ending employer-sponsored insurance and paying the employer mandate penalty. Based on an aggregation of the data received, if the 71 Fortune 100 companies that replied to the survey ceased to offer health care coverage and paid the employer mandate penalty, they could save a total of: $28.6 billion in 2014 (an average savings of over $400 million per company) and $422.4 billion from 2014-2023 (an average savings of nearly $6 billion per company)." (U.S. House of Representatives, Committee on Ways and Means)
[Guidance Overview] CMS Guidance Addresses Medical Loss Ratio Requirement
"In response to [a] question about whether 'premium holidays' are permissible in lieu of providing rebates if an issuer finds that its MLR is lower than the standard required, the guidance explains that this is a state regulatory issue not addressed by the MLR regulations." (Littler)
[Guidance Overview] IRS Proposes Methods for Valuing Employer Health Coverage
"The IRS has just issued three notices concerning key aspects of the 2010 Affordable Care Act ('ACA'). Notice 2012-31 proposes three different methods by which sponsors of self-funded health plans could value the coverage they provide to plan participants and their dependents. Notice 2012-32 and Notice 2012-33 then solicit comments on two related employer reporting requirements.... All three of these Notices solicit comments. Unfortunately, the deadline for submitting those comments is June 11, 2012. This is likely to be before the Supreme Court has issued its ruling on the constitutionality of the individual mandate - and perhaps the entire ACA." (Spencer Fane)
[Guidance Overview] Employers Sponsoring Health Plans Must Pay New Annual Health Plan Fee
"Plan sponsors of self-insured group health plans covering individuals residing in the U.S. must pay the fee. Governmental entities, including federally-recognized Indian tribal governments, must also pay the fee unless they operate certain exempt governmental programs." (McKenna Long & Aldridge LLP)
[Guidance Overview] Research Fees to Be Imposed on Self-Insured Health Plans Beginning October 2012
"New proposed regulations identify the plans and policies that are subject to the fee, specify how the fees will be calculated, and prescribe the filing and payment requirements. The proposed regulations explicitly provide that plan sponsors and issuers are entitled to rely on their terms until final regulations are issued." (Deloitte)
California State Officials Launch 'Health Happens in the Workplace' Program
"The health and wellness program evolved from a study ... of health care expenditures for state employees by the Urban Institute, in partnership with CalPERS, the largest purchaser of public employee health benefits in California. The study found that 22.4 percent of CalPERS' medical expenditures in 2008 were spent treating chronic diseases that could be prevented through changes in diet and increased physical activity." (The California Endowment)
Michigan Senate Bill Would Raise Lawmakers' Share of Retiree Health Contribution to 20% of Total Premium
"The Michigan Senate is currently debating legislation that would require retired public school, community college and university employees to shoulder 20 percent of [the total cost of] health insurance premiums. The requirement mirrors a new law requiring existing public employees to contribute 20 percent of health insurance premiums from their paychecks. The [Detroit News reported May 1, 2012,] that just seven months ago the Legislature and Gov. Rick Snyder approved a new law ensuring all but two of the 38 senators would get lifetime health insurance at age 55 at a cost of 10 percent." (The Detroit News)
[Guidance Overview] IRS Mulls Meaning of 'Minimum Value' Coverage
"[M]ost large employers that don't provide plans offering 'minimum value' (thereby sending their employees to an Exchange to seek coverage) may be liable for a penalty payment under Code Sec. 4980H. So, for the IRS to determine which individuals are eligible for the tax credit or not, and which employers will get socked with the penalty, it must get a handle on what it means under the ACA to provide minimum value." (Wolters Kluwer Law & Business / CCH)
[Guidance Overview] IRS Requests Comments on Calculation of 'Minimum Value' and Associated Reporting Requirements
"On April 26, 2012, the [IRS] issued three notices in connection with health care reform employer penalty and reporting requirements. Notices 2012-31, 2012-32 and 2012-33 invite comments on potential approaches to determining whether an employer-sponsored plan provides minimum value, and reporting requirements under [IRC] Sections 6055 and 6056." (Practical Law Company)
Deloitte Health Care Reform Memo, April 30, 2012
Describes recent developments in various health plan and health insurance matters at the federal and state levels. This issue includes a discussion of health policy and costs. (Deloitte)
[Guidance Overview] Insurers Who Meet Or Exceed 2011 Medical Loss Ratio Standard Must Provide Notices Beginning July 1, 2012
"The notice is also intended to motivate insurers to spend as high a percentage of premium dollars on care and quality improvement as possible (rather than just enough to avoid paying rebates), because informing subscribers that they can view insurers' MLRs on www.HealthCare.gov increases transparency." (Employee Benefits Institute of America (EBIA))
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