Headlines about "Health plans - design"
Gathered from the web by the editors at BenefitsLink.com.
[Guidance Overview] Chart of State Domestic Partner and Same-Sex Marriage Laws as of May 10, 2012
Jurisdictions covered are CA, CO, CT, DC, DE, HI, IA, IL, MD, ME, MA, NH, NJ, NV, NY, OR, RI, VT and WA. Issues described in this nicely done 3-page chart include: type of relationship addressed, whether or not health insurance coverage is mandated; whether a leave law applies; scope of state tax exclusion for health coverage; scope of rights (same as opposite sex vs. limited); and recognition of out-of-state relationships. (Mercer)
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)
[Opinion] USCCB Submits Comments on Proposed HHS Rulemaking, Urges Re-Opening of Final Rule Defining Mandate, Exemption
"'We believe that this mandate is unjust and unlawful - it is bad health policy, and because it entails an element of government coercion against conscience, it creates a religious freedom problem,' wrote Anthony Picarello, USCCB associate general secretary and general counsel, and Michael Moses, associate general counsel. 'These moral and legal problems are compounded by an extremely narrow exemption that intrusively and unlawfully carves up the religious community into those that are deemed 'religious enough' for an exemption, and those that are not.'" (The Sacramento Bee)
[Official Guidance] Form W-2 Reporting of Employer-Sponsored Health Coverage: IRS Informational Page Updated May 2, 2012
"The chart ... illustrates the types of coverage that employers must report on the Form W-2. Certain items are listed as 'optional' based on transition relief provided by Notice 2012-9 (restating and clarifying Notice 2011-28)." (Internal Revenue Service)
DOL Begins Enforcing the ACA Through Plan Audits
"Generally, plan sponsors and administrators must be able to demonstrate that their plans comply with the ACA, which requires documentary evidence -- from plans, record keepers, and/or service providers. Written records of the steps taken to comply with the ACA since September 23, 2010, including detailed records of participation information and communications with participants about enrollment periods and coverage, should be retained in a readily accessible fashion. For example, plans should keep and be able to produce notices of coverage for children up to 26 years of age, and evidence of distribution. Likewise,any plan amendments or written policies that were adopted to implement the ACA mandates discussed above should be ready for production." (Proskauer Rose LLP)
Is a 'Simple Cafeteria Plan' Right for Your Company?
"[The 'Simple Cafeteria Plan'] was established by health care reform and is available for years beginning after December 31, 2010. It provides eligible employers an automatic 'pass' for many of the nondiscrimination tests that apply to cafeteria plans and their component benefits.... A Simple Cafeteria Plan is treated as automatically satisfying the three nondiscrimination requirements that apply to cafeteria plans ... The general rules for cafeteria plan eligibility apply, so self-employed individuals, partners in a partnership (this includes members in an LLC taxed as a partnership) and more-than-2% S-corporation shareholders may not participate." (McKenna Long & Aldridge LLP)
[Official Guidance] Text of General CCIIO Guidance on Federally-Facilitated Health Exchanges (PDF)
"This document outlines the [HHS] approach to implementing a Federally-facilitated Exchange (FFE) in any State where a State-based Exchange is not operating. In addition to describing [the] high-level operational approach, [the document discusses]: 1. How States can partner with HHS to implement selected functions in an FFE, 2. Key policies organized by Exchange function, and 3. How HHS will consult with a variety of stakeholders to implement an FFE. Subsequent guidance documents will include additional policy and operational details intended to inform State decision-making and preparation for Exchange participation, roles and responsibilities, and potential areas of collaboration." (Center for Consumer Information and Insurance Oversight)
More States Working to Implement Health Insurance Exchanges, HHS Announces
"[Illinois, Nevada, Oregon, South Dakota, Tennessee and Washington will receive more than $181 million in grants to help implement the new health care law by helping] states establish Affordable Insurance Exchanges. Starting in 2014, [the Exchanges will help consumers and small businesses in every state] choose a private health insurance plan. These comprehensive health plans will ensure consumers have the same kinds of insurance choices as members of Congress. [34] states and the District of Columbia have received Establishment grants to fund their progress toward building Exchanges." (Department of Health & Human Services)
[Guidance Overview] FAQs on Summaries of Benefits and Coverage Address Electronic Distribution and Coverage Example Calculator
"Although the latest FAQs do not delay the fast-approaching compliance date for providing [Summaries of Benefits and Coverage, or "SBCs"], plans, plan sponsors and insurers may nonetheless welcome the first-year policies provided in the new guidance. In particular, the rule permitting partial SBCs for plans with multiple insurers may be helpful in preparing initial SBCs, though the FAQ also underscores challenges for later years when information from separate insurers must be combined in the same SBC. In addition, plans and insurers may want to document their SBC compliance efforts in case they wish to use the Departments' one-year good faith compliance policy." (Practical Law Company)
[Guidance Overview] DOL, HHS and Treasury Guidance on SBC Requirements Provides Compliance Exceptions During First Year
"[T]he agencies acknowledged the administrative difficulties for issuers and plans in some circumstances to provide such summaries. [For example, in] discussing a question about health plans that use two or more issuers to provide various types of coverage, the departments said issuers have no obligation to provide coverage information for benefits that it does not insure, but that group health plans �are responsible for providing complete SBCs with respect to a plan.�" (Bloomberg BNA)
[Guidance Overview] Recent Case Highlights Split of Authority on Whether Corporate Agreements Can Amend Employee Benefit Plans
"In Sterling Chemicals v. Evans, the U.S. Court of Appeals for the Fifth Circuit found that a paragraph in an asset purchase agreement satisfied the technical requirements for an employee benefit plan amendment, [and even though] it did not state it was intended to amend the plan....[the language] did, in fact, serve to amend the benefit plan.... [T]he First and Sixth Circuits have held that a corporate agreement cannot amend an employee benefit plan without explicitly setting forth the intent to do so. Last month, the Supreme Court of the United States declined to review the Sterling decision, so the question of whether and how a corporate agreement may amend an employee benefit plan will continue to be an issue that employers must consider when drafting and reviewing corporate agreements." (McDermott Will & Emery)
[Guidance Overview] IRS Notice 2012-31 Addresses 'Minimum Value' Determination for Employer-Sponsored Health Plans (PDF)
"Basing minimum value on benefits generally offered in the large-employer market, which entails recognizing that those plans do not have to offer essential health benefits, is an important distinction that will help large-employer plans meet the minimum value threshold.... The guidance asks for comments on any other benefits (such as wellness benefits) that should be reflected in the calculation of minimum value.... The IRS guidance does not provide any further clarification on how the employer contributions to an HSA or HRA would be adjusted. If the full value is not reflected, a plan could fail to meet the minimum value threshold." (Buck Consultants)
Federal Guidance and Regulation of State Health Benefit Exchanges
"[Information on the Final Rule which i]mplements standards for states related to reinsurance and risk adjustment, and for health insurance issuers related to reinsurance, risk corridors, and risk adjustments consistent with the ACA. These programs will lessen the impact of potential adverse selection and stabilize premiums in the individual and small group markets as insurance reforms exchanges are implemented, starting in 2014. The rule becomes effective May 23, 2012." (National Conference of State Legislatures)
Arizona Now Allowing Some Religious Employers' Health Plans to Opt Out of Contraceptive Drug Coverage Mandate
"[The new law] applies only to 'religiously affiliated' employers, which are defined as non-profit groups that primarily employ and serve individuals of the same religion or religiously motivated organizations with articles of incorporation clearly stating that religious beliefs are central to the organization's operating principles." (The Arizona Republic)
President's Support of Same-Sex Marriage Has No Legal Effect on Employers' Decisions to Offer Benefits to Workers' Domestic Partners
"Last year, a little more than half of employers offered health benefits for domestic partners.... That's up from a little less than one-third in 2010. The biggest factors driving that change are employers' views on whether such benefits help them attract and retain desirable workers." (NPR)
Does Employer-Provided Health Insurance Cause 'Hours Lock'? New Evidence on Women Diagnosed with Breast Cancer
"Employment-contingent health insurance creates incentives for ill workers to remain employed at a sufficient level (usually full-time) to maintain access to health insurance coverage. [The authors'] study employed married women, newly diagnosed with breast cancer, comparing labor supply responses to breast cancer diagnoses between women dependent on their own employment for health insurance and women with access to health insurance through their spouse's employer." (The National Bureau of Economic Research; paid subscription or individual purchase required to retrieve full text)
Many Businesses Offer Health Benefits to Same-Sex Couples Ahead of Laws
"'There's been a steady growth for a long time,' says ... a partner at Mercer. In the early days, some employers worried that adding coverage for domestic partners could make their costs skyrocket by attracting people with higher-than-average health risks, ... but 'that did not happen.' ... In the Mercer survey, coverage of same-sex partners was most common in the West, with 79 percent of large employers offering such benefits. It was least common in the South, at 28 percent. Big differences were also noted within industries. Among manufacturing firms, for example, the coverage rate ranged from a high of 96 percent for pharmaceutical companies to 18 percent for machinery and heavy equipment makers." (Kaiser Health News)
Deloitte Health Care Reform Memo, May 14, 2012
Describes recent developments in various health plan and health insurance matters at the federal and state levels. This issue includes a discussion of the ACA Primary Care Provisions and a chart of the provisions by section number. (Deloitte)
[Guidance Overview] Preauthorization of Surgical Procedure Not Covered by the Plan Was Not a Fiduciary Breach
"This case is another example of how participants may be left without a remedy for harm caused by the actions of a plan fiduciary. The U.S. Supreme Court's decision last year in Cigna v. Amara ... suggested that courts may be more inventive in using equitable principles to fashion remedies for fiduciary breaches. However, this court found no breach of fiduciary duty and therefore did not address the issue of remedies." (Thomson Reuters/EBIA)
[Guidance Overview] Connecticut's Group Health Plan Would Lose Governmental Plan Status by Covering Employees of Non-Profit Contractors
"[T]he DOL concluded that a group health plan sponsored by the State of Connecticut for state employees, retirees, and dependents would lose its ERISA exception as a governmental plan if it extended eligibility to employees of nonprofit entities providing public services through state contracts or funding.... [T]he 175,000 nonprofit employees estimated to become eligible under the new law (compared to 100,000 state employees and retirees currently in the plan) would far exceed the 'de minimis' number of private employees permitted under prior DOL guidance addressing the governmental plan exception." (Thomson Reuters/EBIA)
[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] Affordable Care Act Implementation FAQs -- Set 9 -- The Summary of Benefits and Coverage
"[Question]: A previous FAQ provided a link where written translations for the SBC template and the uniform glossary would be available in the future. Are these translations available? [Answer]: Written translations in Spanish, Chinese, and Tagalog are now available. Navajo translations will be available shortly." (U.S. Centers for Medicare & Medicaid Services, The Center for Consumer Information and Insurance Oversight)
Trend in Massachusetts Experience: Small Employers Moving to Less Generous Health Insurance Plans
"A new analysis ... found that 27 percent of people in Massachusetts who got their insurance through the small group market at the end of 2010 were in a plan with a lower 'actuarial value,' meaning the deductibles and copayments were the highest among plans on the market. That's up from just 2 percent in the first quarter of 2008." (The Boston Globe)
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)
Plan Management Issues for State, Partnership and Federally Facilitated Health Insurance Exchanges (PDF)
"Based on [their findings, the authors] conclude that exchanges' plan management responsibilities represent a considerable expansion of states' oversight of insurers. The law requires oversight that in some cases expands on what states currently do and in other cases represents a wholly new activity. However, to fulfill their responsibilities, state exchanges can leverage the authority and skills of multiple state agencies, including departments of insurance, departments of health, and Medicaid agencies." (National Academy of Social Insurance / The Center on Health Insurance Reforms)
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)
Bill Introduced to Make Health Care a Right in New York State
"More than 70 state lawmakers are co-sponsors.... The proposal would provide comprehensive health coverage for all New Yorkers. Every New York resident would be eligible to enroll, regardless of age, income, wealth, employment, or other status. There would be no premium, deductibles, or co-pays. Coverage would be publicly funded. The benefits will include comprehensive outpatient and inpatient medical care, primary and preventive care, prescription drugs, laboratory tests, rehabilitative, dental, vision, hearing, etc." (Physicians for a National Health Program)
Restricted Health Insurance Enrollment Periods As an Alternative to Individual Mandates
"[Healthcare Town Hall] recently ran a poll on the best course of action to reduce adverse selection if the PPACA individual mandate is struck down by the Supreme Court. The number one answer was 'use limited enrollment windows to reduce the occurrence of people joining a plan only when they become sick.'" (Healthcare Town Hall)
Couples Retiring in 2012 Will Need $240,000 to Pay Medical Expenses Throughout Retirement
"Fidelity has calculated an annual estimate of medical expenses for retirees for more than a decade.... The estimate ... does not include any costs associated with nursing-home care and applies to retirees with traditional Medicare insurance coverage." (MarketWatch)
Employee Benefits Are Good for Employers, Too
"Harvard Business Review Analytic Services surveyed 58 of the 100 companies named to 'The Principal 10 Best' list over the past decade ... Three quarters of those polled reported that benefits contributed to employee retention and 72 percent said they impacted employee loyalty.... When asked to identify the most significant thing they are doing to impact employees' financial security, nine out of 10 respondents mentioned retirement programs and cited generous employer contributions." (MSNBC)
North Carolina Voters Approve Same-sex Marriage Ban
"North Carolina voters on Tuesday approved a state constitutional amendment that bans same-sex marriage and civil unions ... North Carolina law already blocks gay and lesbian couples from marrying, but the state now joins the rest of the Southeast states in adding the prohibition to its constitution." (Yahoo! News)
[Guidance Overview] ML Strategies Health Care Reform Update, May 7, 2012
Weekly update on federal and state health care reform legislation, regulations and initiatives. (Mintz Levin)
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)
[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)
DOL Ruling Puts Kibosh on Connecticut's Idea for Pooling Private and Public Employers' Health Risk
"The U.S. Department of Labor has advised the Malloy administration that opening Connecticut's state employee and retiree health plan to nonprofits and small businesses could jeopardize the legal protections it now enjoys as a government plan." (CT Mirror)
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] Guidance Addresses Minimum Value for Employer Plans, Information Returns, and Exchange Eligibility Determinations
"Most of the minimum value details remain to be worked out (through development of the calculator and checklists), but one interesting point is highlighted with respect to the four categories of benefits.... According to Notice 2012-31, although employer plans are not required to cover all these benefit categories, ... a plan will not satisfy any design-based safe harbor if it fails to do so." (Thomson Reuters/EBIA)
'Accountable Care Organizations' Could Have Medicare Muscle to Transform the Health System
"The drawbacks of fee-for-service reimbursement are hardly secret. In 1909, the playwright George Bernard Shaw wondered why 'any sane nation, having observed that you could provide for the supply of bread by giving bakers a pecuniary interest in baking for you, should go on to give a surgeon a pecuniary interest in cutting off your leg.' A century later, McKinsey Global Institute identified 'payment for more care rather than more value' as one reason U.S. medical spending is more than 25 percent higher per person than even in other industrialized nations." (Kaiser Health News)
AHIP Says Health Insurers Will Continue to Innovate
"'To say that health insurers will go out of business by 2020 is totally inconsistent with what's going on in the real world,' [says Karen Ignagni, President and CEO of the 'America's Health Insurance Plans' trade association]. 'Since the 1990s, health plans have been the engine of change. All around the country, you can see the evidence of how health plans are innovating in any number of areas.'" (Managed Care)
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] HHS Guidance Addresses 'Minimum Value' Calculation by Employer-Sponsored Health Plans and Reporting Requirements
"After considering stakeholder comments, HHS proposes to provide a standardized way for employees and employers to voluntarily collect and communicate employer-sponsored coverage information needed to complete an Exchange application. HHS proposes to allow Exchanges to verify employer-sponsored coverage for the 2014 and 2015 plan years through use of limited pre-enrollment verification based on data sources available to an Exchange and a post-enrollment verification screening process where data sources are not available during the eligibility determination process." (Littler)
[Official Guidance] Text of EBSA Advisory Opinion 2012-01A on Allowing Private Employers Into Connecticut's Group Health Plan
"[The state of Connecticut asked w]hether the status of the Group Health Plan for Employees of the State of Connecticut as a 'governmental plan' within the meaning of section 3(32) of ERISA would be adversely affected if the State permitted participation by certain private nonprofit employers who perform public service functions under contract with the State or receive substantial funding from governmental sources.... [T]he Department would view the participation of private nonprofit employers in the Connecticut State Plan described in your letter as more than de minimis, and, therefore, such participation would adversely affect the status of the State Plan as governmental under ERISA section 3(32)." (Employee Benefits Security Administration)
DOL Updates Interactive Health Plan Compliance Website for Laws Other than Health Care Reform
"While the Advisor provides useful information, employers will need to exercise caution when using it. Because health care reform is not integrated into the information provided in the Advisor or used in its evaluation of whether a plan is in compliance, users should not rely on the results of the interactive tool without first checking to see if health care reform affects the analysis." (Thomson Reuters/EBIA)
[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)
Federal Agencies Investigate Self-Funded Health Plans and Stop-Loss Insurance
"Helping to push this inquiry have been the states, working through the National Association of Insurance Commissioners.... They've been looking for a way to regulate self-insured ERISA plans (which do not have to abide by state insurance laws), in a potential bid to strengthen regulatory power over employer plans, self-funding proponents say." (Thompson Smart HR Manager)
Preparing for the U.S. Supreme Court's Health Care Decision
"By taking a number of interim steps, employer group health plans can position themselves to respond quickly and appropriately -- whether healthcare reform is upheld, partially upheld, or struck down.... These interim steps take into account the full range of possibilities and should position employer group health plans to react to the possible outcomes, respond to inquiries and requests from internal stakeholders, and consider administrative and design issues presented by the eventual Supreme Court decisions." (Morgan Lewis)
[Guidance Overview] Final Regulations on Health Exchanges (PDF)
"The framework proposed in these final rules is complex. The federal government intends to create a streamlined, single-point enrollment stop for Medicaid, CHIP, Exchange coverage, premium assistance and cost-sharing subsidies. This single stop will require tremendous coordination among a number of governmental agencies and insurance carriers. Hopefully, many of the requirements will be successfully automated." (McGraw Wentworth)
Mental Health Spending By Private Insurance: Implications for The Mental Health Parity and Addiction Equity Act
"More than 90% of enrollees used well below the maximum 30 inpatient days or outpatient visits typical of health insurance plans before parity. Simulations indicated that even large increases in utilization would increase total health care expenditures by less than 1%. [The study concludes that the Mental Health Parity and Addiction Equity Act] is unlikely to have a large effect on the growth rate of employers' health care expenditures.' (PsychiatryOnline is charging $35 for a full-text download of the article.) (PsychiatryOnline)
[Guidance Overview] Employer Reporting under Health Reform: How Much Is Too Much, the IRS Wants to Know
"The agency requests comments on questions including: (1) how to determine when an individual's coverage begins and ends; and (2) how to minimize duplication in reporting." (Thompson / Smart HR Manager)
[Official Guidance] Text of Request by IRS, DOL, HHS for Information on Stop Loss Insurance (PDF)
"This document is a request for information regarding the use of stop loss insurance by group health plans and their plan sponsors, with a focus on the prevalence and consequences of stop loss insurance at low attachment points.... Employers and plans that purchase stop loss insurance generally are not subject to State health insurance laws including coverage laws, rating policies, and other State and Federal consumer protections applicable to health insurance, including certain patient protections under the Patient Protection and Affordable Care Act.... It has been suggested that some small employers with healthier employees may self-insure and purchase stop loss insurance policies with relatively low attachment points to avoid being subject to these requirements while exposing themselves to little risk. This practice, if widespread, could worsen the risk pool and increase premiums in the fully insured small group market[.]" (Internal Revenue Service)
What's It Take to Be a 'Bronze' Health Plan Under the Affordable Care Act?
"The study projects what deductibles and coinsurance would meet the requirements of a Bronze plan, presenting two alternatives: One with a deductible per individual of $4,375, with consumers paying 20% of their health care expenses once meeting the deductible. The other with a deductible of $3,475 and patient coinsurance of 40%. Under both plans, total patient out-of-pocket costs would be capped at $6,350, as required by the health reform law. Deductibles for families would be double these amounts." (The Henry J. Kaiser Family Foundation)
Text of EBSA's Annual Report on Self-Insured Group Health Plans, April 2012 Issue (PDF)
"Along with this second annual Report, [DOL] is submitting two detailed appendices produced under contract. Appendix A, Group Health Plans Report: Abstract of 2009 Form 5500 Annual Reports Reflecting Statistical Year Filings, provides detailed statistics describing group health plans that file a Form 5500. Appendix B, Self-Insured Health Benefit Plans 2012, presents a study that explores statistical issues associated with Form 5500 health plan data and analyzes available data on the financial status of employers that sponsor group health plans filing the Form 5500." (Employee Benefits Security Administration)
[Official Guidance] Text of CCIIO Bulletin: Verification of Access to Employer-Sponsored Coverage (PDF)
"Verification of access to employer-sponsored coverage is a necessary part of the process for determining eligibility for advance payments of the premium tax credit available to support the purchase of qualified health plans through Affordable Insurance Exchanges. The purpose of this bulletin is to request comment from the public on a proposed interim strategy and potential regulatory approach for verification of an applicant's access to qualifying coverage in an employer-sponsored plan under section 1411 of the Affordable Care Act. The [HHS] also solicits comments on the development of a long-term verification strategy." (U.S. Centers for Medicare & Medicaid Services, Center for Consumer Information and Insurance Oversight)
DOL Issues Second Annual Health Care Reform Report on Self-Insured Plans
"The [report] contains aggregate information on self-insured employee health plans and financial information on the employers sponsoring the plans.... The report also includes a table comparing aggregate statistics for self-insured and combination self-insured/insured plans for 2008 and 2009 plan years. According to the report, more than 50,000 health plans filed Form 5500s for the 2009 plan year, an increase of almost 7% over the 47,000 filings in the 2008 plan year." (Practical Law Company)
[Official Guidance] Text of IRS Notice 2012-31: Minimum Value of an Employer-Sponsored Health Plan (PDF)
"This notice describes and requests comments on several possible approaches to determining whether health coverage under an eligible employer-sponsored plan ... provides minimum value within the meaning of Section 36B(c)(2)(C)(ii). Beginning in 2014, eligible individuals who purchase coverage under a qualified health plan through an Affordable Insurance Exchange may receive a premium tax credit under Section 36B unless they are eligible for other minimum essential coverage, including coverage under an employer-sponsored plan that is affordable to the employee and provides minimum value. Under Section 36B(c)(2)(C)(ii), a plan fails to provide minimum value if 'the plan's share of the total allowed costs of benefits provided under the plan is less than 60 percent of such costs.' If the coverage offered by the employer fails to provide minimum value, an employee may be eligible to receive a premium tax credit. An applicable large employer (as defined in Section 4980H(c)(2)) may be liable for an assessable payment under Section 4980H if any full-time employee receives a premium tax credit." (Internal Revenue Service)
Obamacare Collapse Would Put Employers Back in Charge of Controlling Health Costs
"First, employers would push harder to control their own costs by shifting more financial responsibility to workers. Data from Mercer's employer survey suggests that a typical large employer can save nearly $1,800 per worker by replacing traditional preferred provider plans with a high-deductible policy combined with a health care account.... It won't stop there. Many employers are convinced they have to go beyond haggling over money, and also pay attention to the health of their workers." (Bloomberg BusinessWeek)
[Guidance Overview] New Michigan Motorcycle Helmet Law Could Impact Self-Funded Group Health Plans
"[T]he Michigan no-fault law, which requires fully-insured employer group health plans to pay primary to no-fault, doesn't apply to ERISA self-funded plans. However, since the no fault law doesn't extend to motorcycles, the typical Michigan employer's self-funded health plan doesn't exclude or pay secondary where a participant is injured in a motorcycle crash." (Miller Johnson)
Employment-Based Health Benefits: Trends in Access and Coverage, 1997-2010 (PDF)
"Both the offer rate (the percentage of workers offered a health benefit) and the coverage rate for employment-based health benefits declined between 1997 and 2010. Between 1997 and 2010, the percentage of workers offered health benefits from their employers decreased from 70.1 percent to 67.5 percent, and the percentage of workers covered by those plans decreased from 60.3 percent to 56.5 percent." (Employee Benefit Research Institute)
Report on State Employee Health Benefits, Updated April 23, 2012
The update provides links to the various states' web sites describing their programs' premiums and benefits for 2012 (in a chart entitled "List of State Employee Health Plan Agencies with Links"). (National Conference of State Legislatures)
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