[Guidance Overview]
Implementing Health Reform: The Small Business Health Insurance Marketplace
"The amendments make changes in the earlier SHOP rules as to two issues: the nature of plan choice that will be permitted in the SHOP exchanges for 2014, and the length of time allowed for employees to enroll in SHOP coverage if they become eligible for special enrollment periods.... HHS also released ... simplified SHOP exchange enrollment forms. The employer form is only three pages long, the employee form only two. The forms, however, are obviously only intended to initiate contact with the employer or employee."
(Timothy Jost in Health Affairs)
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[Guidance Overview]
Final Rule on Wellness Programs Makes Significant Changes
"[T]he final rule [c]reates two new types of subcategories for health-contingent wellness programs: (1) activity-only wellness programs where employees only have to complete an activity related to a health factor to receive a reward; and (2) outcome-based wellness programs where employees must meet some health factor measure or test. Although both subcategories have reasonable alternative standard provisions for obtaining a reward, outcome-based wellness programs have significantly different safeguards for employees[.]"
(HR Policy Association)
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[Guidance Overview]
Trucker Huss Benefits Report, May 2013 (PDF)
Articles include: [1] New October 1, 2013, Employer Disclosure Deadline: DOL Issues PPACA Model Notice of Exchange (and Updated COBRA Model Election Notice); [2] Additional Guidance on 90-day Waiting Period Limitation Issued; [3] IRS Issues Health Insurance Premium Tax Credit Regulations; [4] New FAQs Part XIV Provide Additional SBC Guidance; and [5] IRS Issues HSA Inflation-Adjusted Limits for 2014.
(Trucker Huss)
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Lactation Discrimination Violates Title VII, Fifth Circuit Decides
"The Fifth Circuit's decision held that lactation was a medical condition related to pregnancy and childbirth because it was a physiological state caused by pregnancy and subsequent childbirth.... [T]he court distinguished cases about whether a failure to accommodate an employee who wanted to express milk at work in a particular way violated Title VII."
(Workplace Prof Blog)
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FMLA Leave Cannot be a Reason for Discipline or Dismissal, District Court Rules
"Employers must not impose probation on employees for excessive absences that include leave under the [FMLA]. To do so is akin to using a disciplinary measure to penalize employees for taking qualified FMLA leave. So ruled the U.S. District Court for the District of New Jersey as it permitted the FMLA interference and retaliation claims of a former county board of elections clerk to proceed to jury trial." [Bravo v. Union County, 2013 WL 2285780 (D.N.J. May 23, 2013)]
(Thompson SmartHR Manager)
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New Wellness Rules Are Mixed Bag for Many Employers
"Under the new regulations, this fact intensive analysis is raised to a new level with separate rules for activity-only programs and outcome-based programs. Further, regardless of the type of program (activity or outcome-based), you still must offer participants the ability to revise the alternative standards that are provided, if his/her physician decides the alternative standards are unreasonable."
(Kilpatrick Townsend)
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Many Employers Mulling Use of Private Health Insurance Exchanges (PDF)
"Private health insurance exchanges will rapidly upend insurance purchasing for many of the 170 million people who receive benefits through their employer.... In 2017 approximately 18 percent of the American public will purchase insurance through exchanges, radically transforming the health insurance landscape.... [M]ore than 1 in 4 employers are considering moving to a private exchange in the next three to five years."
(Accenture)
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It's Official: Obamacare's Small-Business Exchange Is Partially Delayed
"The final regulation is essentially the final word; it means that in 2014 many small businesses will need to choose one insurance plan for their employees, rather than leave the decision to workers. The 'many' in that sentence is important: The federal government's rule applies only to the 33 states where HHS has a hand in running the exchanges."
(The Washington Post)
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Disabled Firewalls Lead to $400,000 HIPAA Security Settlement with Operator of Outpatient Health Clinics
"[In] informal comments at a HIPAA security conference shortly after this resolution agreement was announced, an OCR official described this case as almost routine for the agency -- noting that the inadequate risk analyses and assessments continued for an extended period, leading to inadequate policies and procedures and the covered entity's ten-month delay in responding to the problem."
(Thomson Reuters / EBIA)
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Why Do Employers Offer Group Health Insurance?
"For more than 70 percent of small employers, industry insiders estimate that [dropping the group health plan and let employees get their own health insurance] would be a win-win for the employer and employee. If you're an employer evaluating this decision, or an employee potentially receiving the news that you'll be transitioned to a private plan, it's helpful to look at the history of why employers began offering group health insurance."
(The Tennessean)
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The Future of Health Insurance for Uninsured Americans
"64 percent of the uninsured say they haven't decided whether they will buy health insurance by Jan. 1, 2014, as required by the [ACA] ... Only 19 percent said they will get coverage by the deadline, while 10 percent said they plan to stay uninsured and pay the penalty ... 61 percent of uninsured respondents said the main reason they haven't purchased health insurance is because they can't afford it. But many of these consumers aren't clear whether that will change as a result of reform."
(InsuranceQuotes.com)
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Will Consumers Sign On for Health Law's CO-OPs?
"[D]espite the reduced funding and some stumbles ... supporters say they're confident many [CO-OP] plans will succeed. With no shareholders to answer to, they say they enjoy certain advantages over commercial insurers: they are building plans from the ground up and hope to engage members as active partners in their care. They say the nonprofits can be more nimble than large companies, realigning payment incentives for doctors from the get-go, while keeping their operations lean and administrative costs low."
(Kaiser Health News)
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Massachusetts' Individual Health Insurance Mandate to Continue into 2014
"In an effort to bring the state's individual mandate into alignment with ACA, the Board approved [certain] changes to the minimum creditable coverage requirements under the state mandate, effective for plan years beginning on or after January 1, 2014.... In certain situations, individuals will be subject to both the Massachusetts penalty for failure to have MCC and the federal penalty for failure to have minimum essential coverage."
(HighRoads)
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Who Is at Greatest Risk for Receiving Poor-Quality Health Care?
"Overall, participants received 54.9 percent of recommended care.... Women had higher overall scores than men (56.6 percent vs. 52.3 percent), and participants below the age of 31 years had higher scores than those over the age of 64 years (57.5 percent vs. 52.1 percent). Blacks (57.6 percent) and Hispanics (57.5 percent) had slightly higher scores than whites (54.1 percent). Those with annual household incomes over $50,000 had higher scores than those with incomes of less than $15,000 (56.6 percent vs. 53.1 percent)."
(New England Journal of Medicine)
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Social Security Disability Insurance: Action Needed to Address Finances for 8.8 Million Disabled Workers and Those to Come (PDF)
"Currently, 8.8 million disabled workers ... receive Social Security Disability Insurance (DI) benefits.... A temporary reallocation of part of Social Security's 6.2% tax rate from the Old-Age and Survivors Insurance trust fund to the DI trust fund would ensure that both funds can pay full benefits until 2033, after which scheduled taxes would cover about 75% of scheduled benefits.... Alternatively, a 0.2% increase in the tax rate for DI would make DI solvent for the next 75 years."
(National Academy of Social Insurance)
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Medicare Finances: Findings of the 2013 Trustees Report (PDF)
"In 2012, the HI Trust Fund received income of $243.0 billion and paid out $266.8 billion in benefits and administrative expenses, leaving a deficit of $23.8 billion for the year.... The 2013 report finds that the HI Trust Fund will be solvent through 2026. If no changes are made by that year, the HI Trust Fund will still be able to cover 87 percent of payments to hospitals and other providers from current payroll contributions and other revenue."
(National Academy of Social Insurance)
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Consumers May Have a Variety of Health Plans to Choose From This Fall, But at What Price?
"California's surprise announcement last week that the individual premiums in its exchange will be significantly lower than forecast is due in part to the state being only one of six 'active purchaser' states in the nation that have the power to turn away health insurers that don't offer low rates. This result is unlikely to be replicated in the other 44 states."
(HR Policy Association)
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Federally-Run State Exchanges Attract Total of 120 Insurers
"About 25 percent of insurers applying for the online marketplace will be competing for the first time in a state's individual insurance market. And in 75 percent of the 33 states using the federal exchange, at least one new insurance company will be entering the individual market. Insurers likely will offer about 15 health plans in each state, leading White House officials to claim that competition should increase through the exchanges."
(FierceHealthPayer)
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The Brave New World of Employer-Sponsored Health Care (PDF)
"With health care costs continuing to increase at two to three times the rate of inflation, offering traditional health insurance benefits is no longer an option for most companies.... Only 26 percent [of company executives] report that they are very confident that health insurance as an employee benefit will be offered in 10 years.... Key strategies employers can take today to help employees own their health care ... 1. Provide More Information to Employees ... 2. Provide Cost Transparency ... 3. Create a Financial Wellness Action Plan for Long-Term Savings[.]"
(Bank of America Merrill Lynch)
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Mercer Marsh Benefits' Healthcare Survey (Europe, Middle East and Africa)
"The cost of providing health-related benefits for companies in EMEA (Europe, Middle East and Africa) rose by an average of 3.6% in 2012 ... Survey respondents reported that cost rose at a similar rate -- 3.4% -- in 2011. The biggest drivers of cost in 2012 were the increasing utilization of health services, the growing complexity and expense of medical procedures and the impact of large claims, such as those for cancer treatment."
(Mercer)
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[Opinion]
HSAs: Rx for Health Care Reform
"The evolution in health care coverage looks a lot like the migration from traditional pensions to employee-financed 401(k) plans that occurred over the past three decades. But the health care evolution -- one might call it a revolution-- is occurring at a much faster pace.... It sounds like an enormous opportunity for financial advisers."
(Investment News; free registration required)
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[Opinion]
What Paul Krugman Doesn't Know About Health Reform
"As it turns out, the health insurance to be sold in the California exchange excludes some of the best hospitals and the best doctors. Also, the fees paid to providers will not be the same as commercial insurance are paying. They will be somewhere between the commercial rates and Medicare rates. This means that people with exchange-acquired insurance will be less desirable to providers from a financial point of view than people in orthodox plans."
(John Goodman's Health Policy Blog)
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[Opinion]
The Shocking Truth About Obamacare's Rate Shock
"Some people will find the new rules make insurance more expensive. That's in part because their health insurance was made cheap by turning away sick people. The new rules also won't allow for as much discrimination based on age or gender. The flip side of that, of course, is that many will suddenly find their health insurance is much cheaper, or they will find that, for the first time, they're not turned away when they try to buy health insurance."
(Ezra Klein in The Washington Post)
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[Opinion]
Statement on the 2013 Medicare Trustees' Report
"Health reform has significantly improved Medicare's financial outlook, boosting revenues and making the program more efficient by cutting unnecessary costs. The HI trust fund is now projected to remain solvent nine years longer than before the [ACA] was enacted. Under the trustees' main projection, the HI program's 75-year shortfall is 1.11 percent of taxable payroll -- down from last year's estimate of 1.35 percent of payroll and much less than the 3.88 percent of payroll that the trustees estimated before health reform."
(Paul Van de Water, Senior Fellow, Center on Budget and Policy Priorities)
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Benefits in General; Executive Compensation
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Fox Rothschild Newsletter, May 2013
Articles include: [1] New Guidance Issued on the [ACA]'s Implementation; [2] Opportunity for In-Plan Roth Conversion Expanded; [3] Contributing Employers Beware: Has the Tipping Point for Multiemployer Plans Arrived? and [4] The New EPCRS -- Much Like the Old EPCRS.
(Fox Rothschild LLP)
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Press Releases
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