Headlines about "Health plans - design"
Gathered from the web by the editors at BenefitsLink.com.
What Determines Movement Across Health Care Plans?
Excerpt: "In sum, the authors find that adverse selection is more important than adverse retention in explaining insurance plan dynamics for this pool. However, these effects are modest relative to the impact of changing the mix of employer and employee premiums. If the relative price of a FFS plan were increased considerably, the authors suggest that it is 'entirely possible that an adverse selection death spiral would set in, and the generous FFS plan would ultimately no longer be available.' Pointing to the importance of demographics such as age and sex in explaining both spending differentials and plan mobility decisions, the authors end on 'a note of optimism about the ability to have a competitive choice process for health insurance,' since insurers can easily observe these characteristics and price insurance plans accordingly." (National Bureau of Economic Research; paid subscription or individual purchase required to retrieve fulltext)
[Guidance Overview] Clinical Evidence Protocols Rejected Under ERISA Plan's Medical Necessity Standard
Excerpt: "This unpublished opinion from the Second Circuit is instructive in showing that evidence-based protocols, e.g., clinical studies, may exceed what is required to show medical necessity, even under an abuse of discretion standard of review. In this case, the claimant, Richard Durgin, challenged Blue Cross' denial of coverage for a 'standing component' on his motorized wheelchair under BCBS's 'Vermont Freedom Plan'." (Roy Harmon III via Health Plan Law)
[Guidance Overview] EEOC Revision of 'Equal Employment Opportunity Is the Law' Poster to Address ADA Amendments and GINA
Excerpt: "EBIA Comment: Employers should update their EEOC posters right away in accordance with the applicable options, keeping in mind that special rules apply about where to post such notices. As a practical matter, we recommend using the November 2009 poster, which contains a full description of the current rules and would be less confusing for employees. Note that many of the employment nondiscrimination laws in the EEOC posters provide protections relating to fringe benefits (including group health plans) provided by employers." (Employee Benefits Institute of America)
[Guidance Overview] Sixth Circuit Holds Plaintiff's Attorney Liable to ERISA Plan for Disbursed Settlement Funds
Excerpt: "The Sixth Circuit handed down a momentous ERISA health plan subrogation (reimbursement) case in Longaberger v. Kolt. Building on a foundation crafted from an excerpt from Sereboff and a form shaped by a recent Seventh Circuit recoupment decision, the Sixth Circuit all but eliminated any defense based upon commingling of funds." (Roy Harmon III via Health Plan Law)
What Are Immediate Reforms for Employment-Based Health Insurance Plans?
Excerpt: "At first glance, employers appear to be off the hook from the changes in the House-passed Affordable Health Care for America Act until 2018. Employer-based health plans that are in effect at the end of 2012 have an additional five years to meet the requirements for a qualified health benefits plan, including the essential benefit package requirement, as noted in an earlier post." (Wolters Kluwer)
Employee Benefits 2009 Year-End Checklist, Year in Review, and Planning Ahead for 2010 (PDF)
9 pages. Excerpt: "In addition to the items on the legislative agenda, both the Department of Labor and the Internal Revenue Service have important guidance projects still awaiting release, some or all of which may be issued in 2010. Employers should stay tuned for news about the following items in particular: Pending Department of Labor guidance requiring enhanced disclosure to plan participants about benefit plan administrative costs and investment expenses, and enhanced disclosureobligations from plan service providers to plan fiduciaries. Department of Labor regulations governing the provision of investment advice to retirement plan participants. Congress is also considering legislation in this regard. IRS regulations governing cafeteria plans and flexible spending accounts, particularly with respect to compliance with non-discrimination rules." (Harter Secrest & Emery LLP)
[Guidance Overview] ERISA TPA That Is Not a Fiduciary Must Face State-Law Breach of Contract Claims by Plan Sponsor
Excerpt: "EBIA Comment: This well-written decision (collecting numerous other cases) is recommended reading for employers and TPAs alike, as it reviews and summarizes many of the most important contractual provisions and legal principles governing the TPA relationship. One lesson to be learned: In the event of contract disputes, TPAs that successfully argue they are not ERISA fiduciaries should be prepared to face alternative claims under state law." (Employee Benefits Institute of America)
[Opinion] Protect Hawaii Health Care from ERISA
Excerpt: "The health care reform package approved by the U.S. House last week may bear little similarity to the Senate version, if one emerges. In its final form, a reform measure should expand Hawaii's health care system, but separate federal and state legislation may be needed to prevent Hawaii's system from being dismantled as a result. Three years after Hawaii's Prepaid Health Care Act was enacted in 1974, Standard Oil won a court ruling that invalidated the act as a violation of the federal Employment Retirement Income Security Act. Hawaii's congressional delegation saved the day by securing an exemption from ERISA through legislation." (starbulletin.com)
Both Workers and Companies Will Be Paying Higher Health Insurance Premiums in 2010 (PDF)
Excerpt: "This article from BusinessWeek discusses the shifting burden of rising health care costs from employers to employees, and what interventions employers can take to avoid cutting coverage." (BusinessWeek via Towers Perrin)
Republicans Halt Abortion Coverage for Their Workers
Excerpt: "It's tough to argue against coverage of abortion in any health overhaul, when your own insurance policy would pay for it. Now a 'chagrined' Republican National Committee Chairman Michael Steele, as the Associated Press puts it, has ordered a halt to coverage of elective abortions under GOP insurance provided by Cigna. Strange as it may seem, an insurance plan offered by the GOP, staunch opponent of abortion, has covered the procedure since 1991." (National Public Radio)
Path to Alternative Health Therapies Is Littered With Obstacles
Excerpt: "[M]y purpose here is to provide financial guidance for those who, like Ms. Klenke, [who was told five years ago that she had pancreatic cancer and was given three months to live,] choose to take the medical path less traveled. Besides learning the ins and outs of complementary and alternative medicine, Ms. Klenke has also become something of an expert on how to pay for these treatments. With the help of the Block center and her own research and persistence, she persuaded her insurance company to cover her entire course of treatment and the follow-up treatments that she continues to pursue, as she puts it, 'to boost my immune system and keep me cancer-free.' So-called complementary and alternative medicine -- or CAM, as it is known by practitioners and adherents -- is becoming more mainstream every day." (The New York Times; free registration required)
10 Ways to Cut Health Care Costs Right Now
Excerpt: "BusinessWeek has looked at 10 such attempts to lower health-care costs and improve patient care. These innovations cannot have the same impact as a comprehensive federal bill. Nor are the gains from private efforts assured. . . . Still, companies and hospitals are taking the initiative, and some results are in plain view. 'Three years ago, professional medical organizations were very reluctant to talk about inappropriate treatments. . . . [T]he American College of Cardiology recently published several standards of care for angioplasty and other common treatments, aimed at preventing unnecessary and costly interventions. Given that about one in six U.S. health-care dollars is currently spent on cardiovascular procedures, 'that's a big step forward,' . . . ." (Yahoo!News)
[Guidance Overview] Enforcement of Equitable Liens by ERISA Benefit Plans: A Contrast in Available Remedies
Excerpt: "Equitable liens offer avenues of relief to fiduciaries which are distinguishable from the remedy offered by a constructive trust. Read together with a recent federal district decision in a California case, Humana v. Powell provides a valuable overview of these distinctions in the context of a ERISA health plan subrogation dispute. These distinctions, while thought-provoking, may not entirely hold true in view of Sereboff's rejection of the 'parcel of equitable defenses' asserted in that case as [is pointed out in the target document]." (Roy Harmon III via Health Plan Law)
[Guidance Overview] Compliance Update for Health and Welfare Plans, November 2009 (PDF)
5 pages. Excerpt: "This Client Alert provides a broad overview of several recent statutory and regulatory changes that have a significant impact on the operation and administration of employer-provided health and welfare plans that require implementation in 2009 or 2010. Employers should examine their benefit programs closely in light of these changes and take immediate action where necessary to ensure compliance." (Paul, Hastings, Janofsky & Walker LLP)
Employer Groups Blast House Health Reform Measure
Excerpt: "Helen Darling, president of the National Business Group on Health, which represents about 280 large U.S. employers, identified 10 major items that should concern plan sponsors that provide health care benefits to their workers. According to Darling: 1) the bill lacks meaningful ways to control health care costs; 2) the bill takes us down the road to even worse deficits and crushing national debt by not getting more savings from the health system and making the coverage more affordable; 3) there is no support for strong evidence-based medicine or a way to make certain that we don't pay for treatments that are not effective; 4) there is not a strong independent Commission that could help Congress make the politically hard but obvious good decisions to eliminate wasteful and harmful treatments and spending; 5) it does nothing to correct medical liability problems and related costly defensive medical practices; 6) it doesn't expand employers' ability to help employees to actively engage in wellness activities or achieve health goals; 7) it undermines ERISA and opens ERISA plans to unacceptable burdens; 8) there are serious questions about the public plan and how it would operate; 9) an employer who provides comprehensive benefits could still be subject to an 8% payroll tax if employees decline employer coverage because it costs more 12% of the employee's income; and 10) it contains a particularly outrageous requirement that any employer still offering retiree medical coverage would have to continue it indefinitely thereby hurting employers who have done what they could to maintain benefits for retirees." (Employee Benefit News; free registration required)
Detailed Summary of Health Reform Bill Passed by the U.S. House (PDF)
10 pages. Excerpt: "?X Benefits. Outlines broad categories of covered services in the law, and creates a Health Benefits Advisory Commission, with physicians and other expert members, to help the Secretary of HHS define the essential benefit package. Cost-sharing varies by four tiers ranging in actuarial value (AV) from 70 percent to 95 percent (??basic,?? ??standard,?? ??premium,?? and ??premium plus??). In other words, in a 70 percent plan, the plan pays 70 percent of the costs and an individual would pay the other 30 percent of expenses on average. The fourth tier plan (??premium plus??) will offer additional benefits such as adult dental or vision, gym memberships, or private hospital rooms. All plans will limit annual out-of-pocket expenses for enrollees at a maximum of $5,000 for an individual and $10,000 for a family, with lower levels for lowerandmiddle-income families." (U.S. House of Representatives Committees on Ways and Means, Energy and Commerce, and Education and Labor)
[Guidance Overview] Mental Health Parity: What Employers Need to Know
Excerpt: "After more than a decade of discussion, Congress has finally enacted legislation mandating full parity for mental health and substance abuse benefits. The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) became law on Oct. 3, 2008, as part of the Emergency Economic Stabilization Act. The law, which generally becomes effective in 2010, affects insured and self-insured group health plans provided by employers. Under MHPAEA, employer group health plans may not impose steeper financial requirements or stricter treatment limitations on mental health and substance abuse benefits than on medical and surgical benefits. The act does not require employers to provide mental health/substance abuse benefits. Rather, if employers provide them, the benefits must be equivalent to medical and surgical benefits. If a plan offers two or more benefit packages, the MHPAEA applies separately to each." (Watson Wyatt Worldwide)
Federal Employees Have Fewer Health Insurance Choices This Year
Excerpt: "The Federal Employees Health Benefits Program typically includes an array of health insurance options. But this year the choices are more limited than before because 32 health insurance plans are leaving FEHBP or reducing their coverage across the country. 'It's kind of a disturbing trend,' said Dave Snell, retirement benefits service department director for the National Active and Retired Federal Employees Association. 'It cuts down on choices, for one, and the federal program is all about choice.'" (GovernmentExecutive.com)
Small Increases in Compensation Costs in September 2009
Excerpt: "Compensation costs and its components -- wages and salaries and benefits -- decelerated for private industry workers for the 12-month period ending September 2009, registering the smallest increases since each series began. The differences were not statistically different from last quarter. Wages and salaries make up about 70 percent of compensation and benefits make up the remaining 30 percent." (Bureau of Labor Statistics, U.S. Department of Labor)
Insurance Discounts for Healthy Habits Spur Debate in Washington
Excerpt: "Safeway says it's a smart incentive: charging lower premiums for people who lose weight, quit smoking or start exercising. Some medical groups say it's a new way to exclude pre-existing conditions." (Los Angeles Times)
[Guidance Overview] Economic Stimulus Package Contains New Parity Rules for Mental Health Benefits
Excerpt: "The article discusses the 'Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act,' which was part of the Economic Stimulus package enacted by Congress in October 2008. The Act increases and expands the protections for mental health benefits that were established under the 1996 Mental Health Parity Act." (Steptoe & Johnson)
[Guidance Overview] Warning to Employers: If Your Health Risk Assessment Violates GINA, You May Have to Tell the IRS (and Pay Excise Taxes)
Excerpt: "[T]he new self-reporting requirement is particularly problematic at this time with respect to the recently issued guidance under GINA because a failure to comply with the new GINA regulations will cause the employer to have to self-report the violation and pay the excise tax. There is already an open question of whether a group health plan that collected genetic information (e.g., family histories) in a health risk assessment prior to the GINA rules becoming effective is violating GINA by providing a reward in 2010. The conservative answer is that providing a reward is a violation, although we are hopeful for transition guidance that says otherwise. Now, however, the transition issue is made more difficult by the self-reporting requirement. If providing a reward in 2010 is a violation of GINA, and if a group health plan provides the reward, the employer will have to self-report the violation and pay the excise tax. In addition, if it is determined that the employer knew of the new regulations and intentionally violated the regulations by providing a reward, the amount of the tax could be unlimited." (Jones Day)
City of Tallahassee, Florida, Adds Domestic Partner Benefits
Excerpt: "City officials in Florida's capital city have extended the city's employee benefit package to employees' domestic partners. The Tallahassee Democrat reported that the policy change provides employees' same- or opposite-sex domestic partners the same benefits currently available to married employees' spouses. The city's change will allow city employees to include their partners for health, dental, vision and other benefits coverage." (PLANSPONSOR.com; free registration required)
[Guidance Overview] EEOC Updates Notice to Employees
Excerpt: "The Equal Employment Opportunity Commission (EEOC) has published a notice revising its 'Equal Employment Opportunity is the Law' poster to reflect changes required by the employment provisions (Title II) of the Genetic Information Nondiscrimination Act (GINA), which become effective on November 21, 2009. . . . The new poster can be found at http://www.eeoc.gov/posterform.html." (PLANSPONSOR.com; free registration required)
IRS Personnel Share Unofficial Comments on Compliance Issues with ABA Employee Benefits Committee
Excerpt: "IRS representatives shared their unofficial views on certain benefits issues that were presented earlier this year by the Employee Benefits Committee of the Tax Section of the American Bar Association. Although the views cited by the IRS representatives are not binding and do not represent the policy of the agency, they provide useful insight into areas of concern. Some of the notable unofficial and non-binding views shared by the IRS representatives were the following . . . ." (Deloitte via BenefitsLink.com)
[Guidance Overview] Federal Court Finds ERISA-Covered Plan May Be Comprised of Individual Rather than Group Insurance Policies
Excerpt: "This decision demonstrates that an employee welfare benefit plan may be comprised of individual, rather than group insurance policies. If the plan satisfies the statutory definition of an employee welfare benefit plan, then ERISA applies regardless of the employer's intent. In light of this, employers should evaluate the benefits they provide to employees to determine whether they are subject to ERISA." (Ford & Harrison LLP)
[Guidance Overview] GINA Interim Final Regulations: Impact on Health Risk Assessments
Excerpt: "New rules under the Genetic Information and Non-discrimination Act (GINA) restrict group health plans from offering premium reductions or other economic awards for participating in a health risk assessment (HRA) that asks for genetic information. Employers will need to update their plans to ensure that their HRAs and any associated policies and procedures comply with GINA's prohibition on using genetic information prior to or in connection with enrollment or for underwriting purposes for plan years beginning on or after December 7, 2009." (Sonnenschein Nath & Rosenthal LLP)
The 'Big Three' VEBAs and other Stand-Alone Welfare Benefit Trusts: What Is and Is Not Novel About Them
Excerpt: "The 'Big Three' automakers, Ford, General Motors and Chrysler, as well as other companies, have agreed to establish and fund voluntary employees' beneficiary associations, or 'VEBAs,' to meet their post-retirement health insurance obligations. . . . The VEBAs established most recently by the automakers, however, are different. They do not serve merely as an advance-funding vehicle by which the employer can pre-pay part of its liability under the plan. Rather, they actually assume the employer's liability for benefits under the plan, and the employer is relieved of that liability.6 Thus these trusts serve as a mechanism not merely of pre-funding, but of permanently settling, the employer's obligations under the plan. The assumption of the employer's liability is the critical distinguishing feature that makes the Big Three trusts, and other recent trusts like them, different from what had gone before." (Tax Management Inc.)
Now-Secret Medical Care Claims Denial Rates Could Tell Consumers a Lot About Their Insurance Company
Excerpt: "There is no reliable estimate of the total number of health care claims that insurers deny annually. But Mark Rieger, chief executive of National Health care Exchange Services, which collects claims data from physicians, says the number certainly is in the millions annually. Rescissions are estimated to be only in the thousands." (California Nurses Association / National Nurses Organizing Committee)
The New Health Participation and Access Data from the National Compensation Survey
Excerpt: "New data on participation in and access to health care benefits allow for the study of the correlation between health care cost and health plan participation. This article compares this correlation between two occupational groups: management, professional, and related workers and service workers. Although participation is a significant factor in determining the estimates of average employer costs for health care benefits, other factors, such as annual hours worked, mix of jobs and industries, and the percentage paid by the employer can also have substantial effects." (U.S. Bureau of Labor Statistics)
Integrate Workers Compensation to Cut Health Costs, According to Study
Excerpt: "Integrating occupational and nonoccupational treatment would produce savings between $490 billion and $560 billion during the first 10 years, according to the report by researchers at the University of California, Berkeley. 'Savings would result from the much greater efficiency with which health insurance delivers care compared to workers compensation insurance,' according to the report released late last week that was funded by a grant from the Oakland-based California HealthCare Foundation. 'Only 12% to 14% of health insurance premiums go toward administration and profit,' researchers said in the report. 'Workers compensation turns this ratio on its head, spending the majority (50-60%) of premiums on these same overhead costs,' the researchers found." (Business Insurance)
Employer-Based Insurance: Employees Are Paying More, Getting Less
Excerpt: "Changes to 2010 health benefits, which reflect the first chance employers have had to restructure their plans since the economy started tanking in September 2008, look to be even more daunting than usual. Surveys indicate that in 2010, 40% of employers will shift more premium costs onto employees and 39% will increase deductibles, co-payments, co-insurance or out-of-pocket maximums. More employers are steering workers toward catastrophic health policies with deductibles as high as $5,000 or $10,000." (Time Inc.)
Fight Erupts Over Health Insurance Rates for Businesses with More Women Employees
Excerpt: "Insurers say women under the age of 55 cost more to cover because they use more health services, and not just for maternal and infant care. But Bettinazzi, the president and CEO of Visiting Nurse Association of Indiana County, believes there's something inherently wrong in charging her company more because it hires a lot of women. 'There's a great sense of unfairness,' Bettinazzi says. 'I feel angry, and maybe betrayed would be a good word.' Gender rating is the norm today, part of a complex formula of risk factors ? including health history and age -- insurers say has been necessary to fairly price policies. But advocacy groups for women argue that charging more for women than men is discriminatory and should be illegal. The battle is playing out on Capitol Hill through the debate on health overhaul legislation." (Kaiser Family Foundation)
Righting Wrongful Denials of Health Insurance Coverage
Excerpt: "The problem starts with the 35-year-old Employee Retirement Income Security Act, a federal law that regulates the pensions, retirement savings programs and other benefits provided by private employers, guilds or unions. ERISA imposes two of the same requirements on employers' group insurance policies that Congress wants to apply to the individual insurance market: no denials of coverage and no increase in premiums for individuals with preexisting conditions. But it also exempts employers from state rules mandating which types of treatments must be covered and protects employers and their insurance partners from most damages if a policyholder's treatment is wrongfully delayed or denied. Patients can go to federal court and try to force the insurer to pay for the treatment, but, as Times staff writer Lisa Girion has pointed out, that's cold comfort for the families of those who die waiting for the dispute to be resolved." (Los Angeles Times)
[Guidance Overview] Court Decision Requiring Employer to Pay for Weight-Loss Surgery Has Raised Concerns Among Businesses
Excerpt: "The Indiana Court of Appeals has ruled that a pizza shop must pay for a lap-band weight-loss surgery for a 340-pound employee so another surgery he needs -- for a back injury he suffered at work -- can be successful. Employment experts and analysts say the decision in the case, Boston's The Gourmet Pizza vs. Adam Childers, raises concern among businesses, which are bracing for more such claims." (Human Resource Executive Online)
Large Firms That 'Self-Insure' Are Resisting New Regulations
Excerpt: "The companies want to be able 'to keep extending health insurance to their workers free of many insurance regulations, such as those governing what services must be covered by a policy and when a person can be denied coverage'" (Kaiser Family Foundation)
Pilot Program Shows Re-Engineered Health Benefit Reduces Cost
Excerpt: "A just-completed pilot project sponsored by the Boeing Company shows that re-engineering primary health care, especially for the chronically ill, can dramatically improve the quality of care and reduce cost, according to an article in the policy journal Health Affairs. A Mercer news release says that among the outcomes in the Boeing pilot project, patient-reported work days missed were 56.5% lower among participants than among a baseline control group. Cost per participating patient was reduced by 20% compared to a control group." (PLANSPONSOR.com; free registration required)
[Guidance Overview] Health Risk Assessments Face Bias Hurdle
Excerpt: "Under IRS rules associated with the Genetic Information Nondiscrimination Act, employers are prohibited from collecting genetic information -- defined as family medical history -- in health risk assessments if that information will be used for 'underwriting' purposes. That includes offering employees discounts on their monthly premium contributions or lowering deductibles for completing a health risk assessment." (Workforce Management; free registration required)
House Committee Votes to Strip Health Insurance Industry of Federal Antitrust Exemption
Excerpt: "The House Judiciary Committee Wednesday 'voted to strip the health insurance industry of its exemption from federal antitrust laws as senators announced plans to take the same step,' The Associated Press reports. The committee voted '20 to 9 to repeal a 1940s law that exempted the health insurance industry from federal controls over certain antitrust violations including price-fixing.'" (Kaiser Family Foundation)
Small Businesses Could Benefit from Insurance Exchanges, According to Hearing Testimony
Excerpt: "Supporters of health reform legislation told a Senate subcommittee Tuesday that the insurance exchanges are critical for small businesses, which pay more than large companies to cover their employees and are cutting jobs and insurance coverage to control costs. The San Francisco Chronicle reports: 'Legislation approved by the Senate Finance Committee last week would create insurance exchanges that supporters say would aid small businesses by spreading risk among a greater number of participants. The result, they said, would be lower premiums. ... Small businesses could compare the price, quality and services of a number of plans offered through the exchanges, said Karen Mills, the administrator of the U.S. Small Business Administration.'" (Kaiser Family Foundation)
[Guidance Overview] What's in Store for Health Plans? Top 10 Legal Changes for 2009 - 2010
Excerpt: "December 31, 2009, is a significant date for group health plans that are operated on a calendar year. Non-calendar year plans face the same changes but with different timing requirements. And some new requirements are already in place. [The target document] is a brief description of some major new laws and rules that require implementation in 2009 or 2010." (Warner Norcross & Judd LLP)
[Opinion] The High Cost of Small Business Health Insurance: Limited Options, Limited Coverage
Testimony at October 20, 2009, Hearing Before the Committee on Energy and Commerce Subcommittee on Oversight and Investigations United States House of Representatives. Excerpt: "Small employers and their workers face an assortment of barriers to obtaining health insurance coverage. These include high administrative costs, limited ability to spread health care risk, and a low-wage workforce. These issues have led to low rates of coverage offers by small employers and high rates of uninsurance among their workers. An insurance exchange, such as the one proposed in H.R. 3200, would spread health care risk and reduce administrative costs. The financial assistance provided to the low-income under the bill would benefit many small-firm workers. As such, the bill would significantly increase coverage among workers of small employers." (Urban Institute)
[Guidance Overview] 2010 Benefit Limits
Excerpt: "The Service has also released health and fringe benefit plan adjustments effective January 1, 2010." (Kilpatrick Stockton LLP)
Employers May Not Restore Benefits to Pre-Recession Levels
Excerpt: "'Since the downturn began, thousands of employers have cut pay, increased workers' share of health-care costs or reduced the employer contribution to retirement plans,' The Wall Street Journal reports. 'Two-thirds of big companies that cut health-care benefits don't plan to restore them to pre-recession levels, they recently told consulting firm Watson Wyatt. When the firm asked companies that have trimmed retirement benefits when they expect to restore them, fewer than half said they would do so within a year, and 8% said they didn't expect to ever.' The changes are 'reshaping unemployment in America' and 'eroding two pillars of the late-20th-century employment relationship: employer-subsidized retirement benefits and employer-paid health care.'" (Kaiser Family Foundation)
Frozen or Trimmed Benefits Budgets Spur Interest in Efficiency, Employee Health
Excerpt: "A recent study conducted by Prudential Financial revealed that employee benefits budgets have been frozen or trimmed during these difficult economic times. Fewer than half of benefit plan sponsors said that their benefits budgets increased in 2009, compared with two-thirds of those surveyed in the prior two years, according to Prudential's study, A New Day in Employee Benefits: A Companion Report to the Study of Employee Benefits: 2009 & Beyond." (Wolters Kluwer)
Health Insurance Cooperatives: An Alliance for Health Reform Toolkit (PDF)
20 pages. Excerpt: "As Congress approaches what may be the final stage of this year's health reform debates, legislators continue to search for creative solutions that will expand coverage and reduce costs with little impact on the federal budget. One proposed solution ? health insurance cooperatives ? has received increasing attention as an alternative to a new public coverage plan. Cooperatives are businesses that are owned by members. A health insurance cooperative is owned and operated by the people receiving health coverage through the organization. Since there are no shareholders, profits and savings in a health cooperative can generate reduced premiums or increased benefits for the consumer." (Alliance for Health Reform)
Health Reform Bills May Not Protect Consumers from Treatment Denials
Excerpt: "'Experts said the legislation under consideration does not significantly enhance patient protections against insurers refusing to cover requests for treatment. Most people currently have no right to challenge health insurers' treatment decisions by suing them for damages.' The Employee Retirement Income and Security Act (ERISA) 'bars suits for damages over health benefit decisions' for the 132 million people who get insurance through employers. Current health care bills do not remove the barrier (Girion, 10/19)." (Kaiser Family Foundation)
A Call for Repeal of Health Care Insurers' Antitrust Exemption
Excerpt: "Sen. Charles Schumer, D-New York, urged his colleagues Wednesday, October 14, to add an amendment to health care reform legislation that would strip health insurers of their limited antitrust exemption. Sen. Schumer, a co-sponsor of the Health Insurance Industry Antitrust Enforcement Act introduced last month, made his call one day after the Senate Finance Committee approved a health care reform bill. Insurers enjoy a limited antitrust exemption under the McCarran-Ferguson Act. The health insurance industry's 'antitrust exemption is one of the worst accidents of American history,' Sen. Schumer said in a statement. 'It deserves a lot of the blame for the huge rise in premiums that has made health insurance so unaffordable. It is time to end this special status and bring true competition to the health insurance industry.'" (Workforce Management; free registration required)
[Guidance Overview] 2010 Cost-of-Living Adjustments for Retirement, Social Security, and Health Benefits (PDF)
2 pages. (Milliman)
Legislation Would Keep Children in Federal Employee Health Benefits Program Longer
Excerpt: "Democratic leaders announced on Tuesday that the final House health care reform package will include a provision requiring all insurance plans -- including the Federal Employee Health Benefits Program -- to cover dependents up to age 27. FEHBP currently covers unmarried dependent children up to age 22." (GovernmentExecutive.com)
IRS Representatives Address Employee Benefits Issues at Meeting
Excerpt: "In a meeting on employee benefits issues raised by the American Bar Association's (ABA) employee benefits committee section on taxation, representatives of the Internal Revenue Service addressed COBRA, imputing fair-market value to self-insured employer-provided health care coverage, and one-time lump sum cash payments for irreversible waiver of retiree health benefits. Two of the COBRA situations involved the tax treatment of employer voluntarily continued coverage after COBRA ends for certain beneficiaries, and waiver of the COBRA subsidy." (Wolters Kluwer)
[Guidance Overview] Requirement that Employees Complete Health Risk Assessments in Order to Receive HRA Reimbursements Violates the ADA
Excerpt: "The broadened scope of the definition of 'disability' under recent amendments to the ADA . . . may cause more inquiries in health risk assessments to be viewed as disability-related and thus subject to scrutiny under the ADA. Formal guidance from the EEOC on the ADA's application to wellness programs is sorely needed. It also bears repeating that in addition to the ADA, wellness programs must also meet applicable HIPAA requirements and comply with GINA." (Employee Benefits Institute of America)
In Hawaii's Health System, Lessons for Health Reform
Excerpt: "Since 1974, Hawaii has required all employers to provide relatively generous health care benefits to any employee who works 20 hours a week or more. If health care legislation passes in Congress, the rest of the country may barely catch up. Lawmakers working on a national health care fix have much to learn from the past 35 years in Hawaii, President Obama's native state. Among the most important lessons is that even small steps to change the system can have lasting effects on health. Another is that, once benefits are entrenched, taking them away becomes almost impossible. There have not been any serious efforts in Hawaii to repeal the law, although cheating by employers may be on the rise." (The New York Times; free registration required)
[Guidance Overview] Does Your Wellness Program Need to Revise Its Health Risk Assessment?
Excerpt: "The new rules clarify that your health risk assessment can still seek genetic information if no reward is provided, completing the HRA is voluntary, and the HRA is not completed until after a new participant is covered under your health plan. But if your plan offers a reward, then the HRA may not directly or indirectly seek genetic information (although you could put questions seeking genetic information into a separate, voluntary HRA for which there is no reward.)" (Warner Norcross & Judd LLP)
Can VEBAs Alleviate Retiree Health Care Problems?
Excerpt: "Recent negotiations between the United Auto Workers (UAW) and Detroit automakers focused attention on an innovative response to the long-term decline in retiree health insurance in the United States. The union agreed to set up a trust called a Voluntary Employees' Beneficiary Association (VEBA) to assume responsibility for the UAW retiree medical care at the companies. An analysis of the General Motors Corporation VEBA suggests that it is a second-best option to employer-paid retiree coverage. However, absent comprehensive national health-care reform, it may be a viable alternative for those unable to fend off the elimination of retiree health elimination by an employer." (Pension Research Council; registration required to download fulltext of paper)
[Guidance Overview] GINA Regulations Require Redesign of Health Plan Wellness and Disease Management Incentives
Excerpt: "The Bulletin provides an overview of GINA's prohibitions; discusses the regulations involved in using health-risk assessments to ask questions about an individual's family medical history; and briefly outlines the action steps for sponsors of group health plans. Plan sponsors must conduct a compliance review immediately to ensure that: Health-risk assessments (including those designed by outside vendors) and any associated wellness policies and procedures comply with GINA's broad prohibition on collecting genetic information; and Wellness or disease management programs do not collect or use genetic information to screen individuals for eligibility for benefits under the plan." (The Segal Group, Inc.)
Employers' Wellness Rewards Now Come with Risks
Excerpt: "Employers seeking to promote wellness in the workplace may have to rethink their rewards programs - or run the risk of breaking new federal rules protecting individuals' genetic information. The recently issued guidelines prohibit health plans and employers from offering any financial rewards to any worker for participating in a health risk assessment that requests information about their family medical history. The rules apply to group health insurance with plan years beginning on or after Dec. 7." (The Wall Street Journal)
[Guidance Overview] Missed COBRA Qualifying Events Cause Forfeiture of Stop Loss Coverage
Excerpt: "The district court's opinion in Majestic v. Trustmark addresses numerous aspects of a controvery between an employer on the one hand and its stop loss carrier and MGU on the other. Though not dispositive of the case, the opinion does cover a broad swath of issues than can arise in the stop loss reimbursement setting . . . . In this post, I will note the facts that cost the employer stop loss coverage on several claims based upon discontinuities in the plan language and that in the stop loss policy." (Roy Harmon III via Health Plan Law)
[Guidance Overview] Group Health Plan Excise Tax Reporting Obligations Coming in 2010
Excerpt: "With the publication of final regulations on excise tax reporting, effective January 1, 2010, employers who sponsor group health plans now will be required to report and pay excise taxes for failing to satisfy certain federal group health plan mandates, unless timely corrected. In addition, excise tax reporting is required if comparable employer contribution rules are not satisfied for health savings accounts (HSAs) and Archer medical savings accounts (MSAs). Failure to file the excise tax return and pay the excise tax on or before the required due date will result, under Internal Revenue Code section 6651, in penalties and related interest unless the failure to timely file or pay is due to reasonable cause and not to willful neglect." (Groom Law Group)
Guidance on Health Insurance Coverage of Swine Flu Vaccinations
Excerpt: "The Employee Benefit Research Institute issued a Q&A fact sheet that highlights information some employers may find helpful about health insurance coverage for H1N1 and seasonal flu shots. On Monday, the Centers for Disease Control and Prevention launched a national campaign to immunize at least half the U.S. population against the new H1N1 virus." (Employee Benefit Adviser; free registration required)
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