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Health plans - design


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Workers Willing to Compromise on Salary for the Right Benefits, Culture, and Growth Opportunities
"Benefits are almost as important as culture when considering a job offer, with a signing bonus and financial support for training topping the 'most wanted' list. Employers who offer health and dental, 401k contributions, and paid vacation time are probably not standing out from the crowd. Three-quarters of employers offer health and dental and two-thirds offer 401k and 3+ weeks of paid vacation." (HR Daily Advisor)
[Guidance Overview] On the Rollercoaster: How Plan Sponsors Could Be Affected by Recent ACA Developments
"As the price of individual policies available on the marketplace increases, individuals are more likely to look for coverage from their employer's plans which may not look as expensive when the subsidies that helped to reduce the individual policy costs are gone.... The ACA coverage and benefit mandates are still the law for employer sponsored group health plans, as are the reporting mandates and the employer shared responsibility tax for employers with 50 or more full-time employees ... [E]mployers subject to such tax should move forward on preparing the new 2017 Forms 1095-C." (Winstead PC)
[Opinion] Growth of Underinsurance Now Rampant in Employer-Sponsored Plans
"[P]rotection provided by employer-sponsored plans is rapidly deteriorating, including in the highly touted large group plans. A relatively high percentage of individuals with these plans are finding that they are underinsured. They are experiencing financial barriers to health care and are suffering financial hardship when they must access that care." (Physicians for a National Health Program [PNHP])
ACA Round-Up: Oregon 1332 Waiver Approved, Silent Returns Rejected, and More
"Oregon is financing part of its program through a 0.3 percent tax on major medical premiums but projects that the program will reduce premiums by 7.5 percent in 2018, 7 percent in 2019, and 6.4 percent in 2027 compared to what premiums would have been without the waiver. The waiver approval does not state how much federal money will be passed through to Oregon from reduced federal payments for premium tax credits and cost-sharing reductions to assist in paying for the program." (Timothy Jost, in Health Affairs)
[Opinion] Options to Expand Health Insurance Enrollment in the Individual Market
"Options to enhance, increase, or extend tax credits could increase total enrollment in the individual market by 1.0 million to 3.4 million and the insured population by 800,000 to 2.6 million. Adding reinsurance could increase enrollment by 1.2 million to 5.4 million and total coverage by 900,000 to 3.4 million. Costs for these options range from $2.5 billion to $18.8 billion, with those policies producing the biggest coverage gains generally requiring the biggest public investments." (The Commonwealth Fund)
Employee Benefits Cases in the Supreme Court Since ERISA's Enactment
32 pages. "[In] the Court's last 42 terms [since ERISA's 1975 effective date] ... the Court has issued merits opinions in 125 argued cases and one unargued case directly involving employee benefit arrangements including IRAs, and two additional argued cases substantially implicating these arrangements ... for an astonishing total of 128 decisions.... [T]he Court has been concerned with who can bring claims involving employee benefits, what kind of claims can they bring, what kind of remedies can they seek ... and whether State laws implicating employee benefits will be enforced, as frequently as it has considered substantive issues affecting employee benefits." (Eversheds Sutherland)
Tying Health Plan Premiums to Salary Can Aid Lower-Paid Earners
"As the cost of health insurance continues to increase ... more employers are considering plan premium tiers that base employees' contributions for health coverage on their pay level. Higher-paid employees are then, in effect, subsidizing coverage for their lower-paid co-workers.... [Aon Hewitt's] health benefits data covering 1,600 employers found that 21 percent set health insurance premium amounts based on employee pay levels." (Society for Human Resource Management [SHRM])
[Opinion] NASE Applauds Senate Introduction of 'Copper Plan' Health Insurance Legislation
"We applaud this bipartisan group of Senators who understand that greater flexibility in the health insurance marketplace creates access to more affordable care and greater participation. As many small business owners and entrepreneurs continue to face costly health care premiums impeding their ability to secure affordable coverage, the Copper-level plan would help bring relief and guarantee hundreds of thousands more Americans have access to care[.]" (National Association for the Self-Employed [NASE])
[Official Guidance] Text of IRS Rev. Proc. 2017-58: 2018 Cost-of-Living Adjustments for Inflation for Certain Items (PDF)
"For taxable years beginning in 2018, [T]he dollar amount in effect under Section 45R(d)(3)(B) is $26,700. This amount is used under Section 45R(c) for limiting the small employer health insurance credit and under Section 45R(d)(1)(B) for determining who is an eligible small employer for purposes of the credit.... [T]he dollar limitation under Section 125(i) on voluntary employee salary reductions for contributions to health flexible spending arrangements is $2,650.... [T]he monthly limitation under Section 132(f)(2)(A) regarding the aggregate fringe benefit exclusion amount for transportation in a commuter highway vehicle and any transit pass is $260. The monthly limitation under Section 132(f)(2)(B) regarding the fringe benefit exclusion amount for qualified parking is $260.... [T]he term 'high deductible health plan' as defined in Section 220(c)(2)(A) means, for self-only coverage, a health plan that has an annual deductible that is not less than $2,300 and not more than $3,450, and under which the annual out-of-pocket expenses required to be paid (other than for premiums) for covered benefits do not exceed $4,600 ... [T]he applicable dollar amount used to determine the penalty under Section 5000A(c) for failure to maintain minimum essential coverage is $695." (Internal Revenue Service [IRS])
Bipartisan Health Proposal Is Too Late for 2018, But a Salve for 2019
"The new bipartisan health proposal ... would send health insurers a message they have sought all year: that it's safe to stay in the marketplaces.... Though the proposal would guarantee payments to health insurers that President Trump canceled last week, and restore funding for Obamacare advertising that [HHS] slashed, those changes would probably come too late to lower insurance prices or increase sign-ups significantly." (The New York Times; subscription may be required)
Back in the Spotlight: The ACA Again Takes Center Stage
"Besides appropriating funds for the CSR program for a two-year period, the new bill would: [1] create a new 'copper' level plan for the Marketplace Exchange, essentially extending the availability of less expensive catastrophic coverage -- which is now available only to adults under age 30 -- to all adults; [2] provide states with greater flexibility to innovate, both in the design of their Medicaid plans and in the ACA health insurance coverage requirements for insurers within a state, streamlining the waiver approval process; and [3] implement rules for states to enter into interstate health insurance compacts for the sale of insurance across state lines." (Ballard Spahr LLP)
Impact on Employers of ACA Executive Orders
"The first order will allow employers and employees to benefit from alternatives to traditional employer sponsored group health plans, and may even make it easier for healthy employees to find alternative coverage, causing premiums to rise for those who remain on employer plans. The second order seems to be aimed directly at dismantling the ACA by collapsing the insurance exchanges, with the ultimate goal of pushing Congress to act quickly on an ACA replacement or revision." (Frost Brown Todd LLC)
The HSA Opportunity, Explained
"[HSAs] never expire and may be invested. The accounts have a triple tax advantage: tax deductible, tax-free withdrawals, and tax-free earnings on investment returns. Many people do not fully understand the implications of these features.... [J]ust over a third of employees who are covered by a HSA-qualified plan actually contribute. Even more dramatic, less than 3% of HSA account holders currently invest." (BNY Mellon)
Health Reimbursement Accounts in Limbo After Subsidies Cut
"Critics of Trump's move to stop giving subsidies to certain populations say the move will tank the individual market. That means employers that might want to give their workers tax-free money in an HRA to purchase their own coverage might not feel as comfortable sending employees to an unstable market." (Bloomberg BNA)
[Guidance Overview] Is the New Moral Exemption from ACA Contraceptive Coverage a Game Changer?
"By removing the religious element, the agencies have broadened the potential pool of employers that could be exempt from the ACA's rules. The new regulations do not describe any process that a privately held company would have to go through to qualify for the exemption or give any examples of the type of moral convictions that the regulations are designed to accommodate.... The American Civil Liberties Union, the California Attorney General, and the Center for Reproductive Rights have all filed legal challenges." (Ogletree Deakins)
The Alexander-Murray Market Stabilization Package: What's In It, and Where Is It Going?
"The key component to the deal is stable funding for the cost-sharing reduction (CSR) subsidies ... [Also included] is a loosening of criteria for the section 1332 waiver process under the ACA ... [It] changes the requirement that state proposals be 'as affordable as' ACA coverage would be; it requires only that they have 'comparable affordability.'.... The pending agreement also [1] includes up to $106 million to restore consumer outreach efforts that the Trump Administration had rescinded.... [2] would allow anyone to buy a Copper plan, regardless of age or income level.... [3] authorizes funding for state reinsurance programs ... [4] would compel CMS to generate regulations implementing the section 1333 interstate compact component of the ACA, which so far have not been issued." (Health Affairs)
Health Insurer Anthem Brings Pharmacy Business In-House, Taps CVS to Help
"Health insurer Anthem Inc will start managing its billions of dollars of patient prescriptions itself in 2020 ... ending a deal with Express Scripts Holding that had deteriorated into lawsuits over terms. Anthem, which sued the pharmacy benefit manager last year over claims of being overcharged by $3 billion annually, said it would use drug retailer CVS Health Corp to handle prescription fulfillment and claims processing for five years for the new company, called IngenioRX." (Reuters)
Underinsured Rate Increased Sharply in 2016
"Twenty-eight percent of working-age adults in the United States who had health insurance all year were underinsured in 2016, up from 23 percent in 2014 ... More than half of the underinsured (52%) had medical bill problems and 45 percent went without needed health care because of cost.... More than half (56%) of the estimated 41 million adults who are underinsured get their coverage through an employer." (The Commonwealth Fund)
Experiences of the Non-Group Marketplace Enrollees
"This report examines people's experiences with the current health insurance market, with a particular focus on individuals who currently have health insurance they purchased themselves.... 10.3 million people have health insurance that they purchased through the ACA exchanges or marketplaces. For comparison, the report also examines individuals ages 18-64 without health insurance as well as those who get their insurance through their employer." (Henry J. Kaiser Family Foundation)
Is Your HDHP Ruining Your Disease Management and Wellness Program Outcomes?
"[A recent study] suggests that HDHPs resulted in participants accessing preventive healthcare less, even when the preventive visit was completely covered with no cost sharing. Office visits to medical providers were noted to decrease, with subsequent reductions in imaging and lab studies. These reductions appear to be related to both inappropriate and appropriate care. Furthermore, a reduction in medication adherence was noticed -- that is, participants were less likely to fill and use medications they were prescribed." (Hill, Chesson & Woody)
High-Cost Claims Are Raising Employer Risk
"Two factors have combined over the past few years to heighten employer risk for high-cost claims: [1] the rise of costly new medical technology and treatments -- including specialty drugs -- and [2] the ACA requirement to remove limits on annual and lifetime benefits payable. As a result, the market for employer stop loss insurance has become increasingly complicated and costly." (Mercer)
Trump's ACA Moves Put Focus on Courts
"The administration announced last week that it would immediately stop making monthly cost-sharing reduction (CSR) payments to reimburse insurers for subsidies to low-income individuals who buy ACA exchange coverage.... A number of states quickly responded to the announcement with a lawsuit seeking an injunction to ensure that the payments continue ... The decision also puts new pressure on Congress to appropriate funding for the subsidies." (Mercer)
[Guidance Overview] The Individual Mandate for Health Insurance Coverage: In Brief (PDF)
"This report provides an overview of the individual mandate, its associated penalty, and the exemptions from the mandate. It discusses the ACA reporting requirements designed, in part, to assist individuals in providing evidence of having met the mandate. The report includes some national -- and state -- level data on the application of the mandate's penalty in tax year (TY) 2014 and TY2015." [Report R44438, Oct. 11, 2017] (Congressional Research Service [CRS])
The Effects of Iowa's Proposed Stopgap Measure on Health Insurance Costs and Coverage
"The Iowa Stopgap Measure is likely to lower premiums, decrease the number of uninsured, and decrease average health care spending for most groups on the [ACA-compliant] health insurance market. The Iowa Stopgap Measure is also likely to increase the federal deficit, but the federal cost per enrollee on the ACA-compliant individual market would be lower than under current law.... [E]nrollees with incomes over 200 percent of the federal poverty level on the ACA-compliant market could be at risk of foregoing necessary care, as they lose access to the higher actuarial value gold and platinum plans." (RAND Corporation)
[Guidance Overview] State Innovation Waivers: Frequently Asked Questions (PDF)
12 pages. "Under a state innovation waiver, a state can apply to waive ACA requirements related to qualified health plans, health insurance exchanges, premium tax credits, cost-sharing subsidies, the individual mandate, and the employer mandate. The state can apply to waive any or all of these requirements, in part or in their entirety." [Report R44760, Oct. 10, 2017] (Congressional Research Service [CRS])
A New Plan to Rescue the ACA: Medicare-at-55
"Under this proposal, Medicare-at-55 would be universal for people in the 55-64 age group and they would leave their current private insurance. It would require an increase in the Medicare payroll tax contribution ... Medicare-at-55 is quite different from proposals suggested by Democrats in 2009 and 2017, which allowed people aged 55-64 to voluntarily buy into Medicare as an alternative to private insurance.... While the 55-64 age group has higher health care costs than younger people, they have lower costs than current Medicare beneficiaries[.]" (Health Affairs)
[Guidance Overview] Expanded Religious and Moral Exemption from Contraceptive Mandate Released
"These objecting organizations are no longer required to sign an accommodation making their employees eligible for contraceptives through their carrier or [TPA]. The organization may still request that accommodation, but it is optional. Specific steps are required for a plan sponsor previously offering an accommodation that now wishes to revoke that approach.... [P]lan sponsors can simply exclude the items to which they object from their relevant plan materials (plan documents, summary plan descriptions, summaries of benefits and coverage, etc.). No filing with the government or anyone else is required." (HUB International)
[Guidance Overview] White House Takes Steps to Modify Healthcare Rules and Stop CSR Funding (PDF)
"While the Executive Order hints at the possible paths the DOL might utilize to expand access to [association health plans (AHPs)], there is a host of unanswered questions ... [including] [1] will the AHP be treated as a 'multiple employer welfare arrangement' (MEWA) ... [2] will sole proprietors be allowed to participate in the AHP ... [3] could individual non-employees be permitted to participate in AHPs; and [4] will DOL utilize its existing authority ... to except certain self-funded plans from state regulation if the AHP is determined to constitute a MEWA.... The Executive Order appears likely to result in the Departments pulling back on their existing guidance related to the use of non-integrated HRAs. Depending on how the HRA is treated under any new guidance, the Departments will need to address a series of related questions[.]" (Groom Law Group)
[Guidance Overview] President Orders Agencies to Consider Rulemaking Targeted at Changed Health Care Landscape
"[A]lthough questions have been raised as to whether a plan sponsored by a group or association acting on behalf of its employer-members constitutes a single employer for purposes of the MEWA definition, the DOL has historically concluded that such plans are not sponsored by a single employer unless part of a control group. The Secretary of Labor is now being asked to revisit that guidance, particularly with a focus on geography and industry." (Michael Best)
[Opinion] Sorry Everybody, But Trump Hasn't Instigated the Obamacare Apocalypse
"The Trump executive order claims to legalize association health plans, but in reality is much more limited. The order allows small businesses -- but not voluntary associations -- to pool together to buy insurance in bulk.... [T]he likely policy impact of this part of the executive order is minimal to zero.... Short-term, limited duration health insurance plans, or STLDIs, used to be an afterthought in the health insurance market.... Trump's executive order simply reverts back to the pre-2016 rules." (Avik Roy, in Forbes)
How Might Trump Health-Care Order Affect Group Plans?
"An obvious step that would help accomplish the president's goals with respect to HRAs would be allowing employers to fund the accounts for the purpose of providing workers with tax-free cash to buy their own health insurance policies. But would employers welcome that change?" (CFO)
A Fateful Thursday for the ACA: Likely Effects and Legal Reactions
"[A]bout ten states instructed their insurers to assume that the CSRs would be paid in setting their 2018 rates.... [In] five states, insurers are loading the cost of the CSR repeal onto all metal levels.... [A]bout half the states have instructed their insurers to load all the increased cost onto the premiums of silver plans.... [A] few states, apparently including the states where CMS directly enforced the ACA, have given no instructions to insurers, allowing each to pursue its own strategy.... Insurers will not be able to simply stop reducing cost sharing. The cost-sharing reductions are clearly required by federal law.... [T]he attorneys general of 18 states and the District of Columbia ... filed on October 13 a separate action in the Northern District of California ... asking the court to enjoin and declare illegal the CSR funding cutoff." (Timothy Jost, in Health Affairs)
[Opinion] Halting ACA Subsidies Hurts Employer Plans, Too
"Employers rely on a healthy and viable individual health insurance marketplace, since an unstable market could result in further cost-shifting from health care providers to large employer plans. Additionally, erosion of the ACA exchanges would make individual market coverage a less viable option for part time workers, early retirees, and those who would otherwise elect to secure coverage through the individual market rather than sign up for, or remain on, COBRA." (American Benefits Council)
[Opinion] Texas Medical Board Moves Forward with Implementing Telemedicine
"ERIC suggested the Board amend the rules to: [1] Retain portions of the rule that provide requirements for written protocols that address the prevention of fraud and abuse. [2] Keep provisions related to patient notice requirements, including the need to inform patients about the limitations of telemedicine, especially what steps to take if they need in-person follow up care. [3] Clarify that an initial in-person visit is not required to establish the patient-provider relationship under any circumstance. [4] Maintain provisions for the evaluation and treatment of the patient via telemedicine, as well as discussion of in-person follow up care, should the need arise." (The ERISA Industry Committee [ERIC])
[Opinion] Premiums in Obamacare Exchanges Now Up 10% to 20% More After Administration Ends Unlawful Insurance Bailouts/subsidies
"In California, for example, Exchange plans were to increase by 12.5% in 2018, without these additional payments to reduce the cost of Silver plans (the most common Exchange plan, where about 60% of enrollees end up) will go up 25% instead." (Benefit Revolution)
[Guidance Overview] Exemption to ACA Contraceptive Mandate Extended to Objecting For-Profit Entities and Individuals
"For employers, the temporary and proposed regulations issued by the administration extend use of the religious exemption to for-profit, non-governmental plan sponsors of group health plans, including closely-held and publicly held for-profit entities, non-religious non-profit organizations, and institutions of higher education in their arrangements of student health insurance coverage." (Jackson Lewis P.C.)
Administration's Ending of Cost-Sharing Reduction Payments Likely to Roil Individual Markets
"The effect of terminating the payments has been well analyzed, including a report from the Congressional Budget Office. It will drive up premiums as insurers attempt to cover the cost of the reductions. As premiums go up, so will premium tax credits. Indeed, the government will probably pay more in premium tax credits than it saves in cost-sharing reduction payments. Individuals who earn too much to receive tax credits will be particularly hard hit by the premium increases. Some of these could decide to pursue new forms of coverage that might be made available under the measures announced in President Trump's October 12 executive order." (Timothy Jost, in Health Affairs)
Health Care Order May Open Options for Employers
"President Donald Trump's new executive order on health care could create new options for employers, including allowing more of them to fund accounts that workers can use to buy insurance. But companies are unlikely to have any new rules to act on this year -- and when they do, it is unclear whether many will offer these tax-favored accounts, known as Health Reimbursement Arrangements, or HRAs. Instead, companies will be in a holding pattern until the Trump administration draws up final rules for HRAs in the coming months." (The Wall Street Journal; subscription may be required)
[Opinion] Short-Term Health Plans: Still Bad for Consumers and the Individual Market
"Cost-sharing designs in short-term coverage leave members facing major, unpredictable financial risk.... When considering the deductible, the best-selling plans have out-of-pocket maximums ranging from $7,000 to $20,000 for just three months of coverage. In comparison, the ACA limits out-of-pocket maximums to $7,150 for the entire year." (The Commonwealth Fund)
[Guidance Overview] Trump Executive Order Expands Opportunities for Healthier People to Exit ACA
"The fact sheet accompanying the order acknowledges that regulations will proceed through notice and comment rulemaking. This will likely take months. Indeed, rulemaking will likely be proceeded by studies by the affected departments, and any proposed and final rules will likely have to be reviewed by the Office of Management and Budget. Therefore, changes are unlikely to affect plans beginning on January 1 of 2018, although some changes may take effect mid-year." (Timothy Jost, in Health Affairs)
What If Employees Could Buy Coverage with Tax-Free HRA Contributions?
"Only about a third of employers -- of any size -- said they would not consider this option.... Would they be allowed to contribute enough so that employees could obtain coverage of comparable value? And would the individual market offer coverage that employees would want at prices they could afford? The majority of respondents to the survey said they would need to know the answers to these question before they could consider using an HRA for this purpose." (Mercer)
[Guidance Overview] HHS Issues Updates to Mandated Preventive Health Care Services for 2018
"[1] Coverage is required for a daily supplement containing 0.4 to 0.8 mg of folic acid for all women planning to becoming pregnant, or who are capable of pregnancy. [2] Screening for hearing loss in newborn infants is no longer required. [3] Screening for obesity in children and adolescents, six years of age and older, is mandated ... [4] Screening for preeclampsia in pregnant women with blood pressure measurements throughout pregnancy is mandated. [5] A revised immunization schedule for children and adolescents, age 18 or younger ... [is included, along with a] major overhaul of mandated preventive service requirements[.]" (Ogletree Deakins)
[Official Guidance] Text of Executive Order: 'Promoting Healthcare Choice and Competition Across the United States'
"Within 60 days of the date of this order, the Secretary of Labor shall consider proposing regulations or revising guidance, consistent with law, to expand access to health coverage by allowing more employers to form [association health plans (AHPs)]. [T]he Secretary should consider expanding the conditions that satisfy the commonality-of-interest requirements under current [DOL] advisory opinions interpreting the definition of an 'employer' under section 3(5) of [ERISA] ... The Secretary of Labor should also consider ways to promote AHP formation on the basis of common geography or industry....

"Within 60 days of the date of this order, the Secretaries of the Treasury, Labor, and [HHS] shall consider proposing regulations or revising guidance, consistent with law, to expand the availability of [short-term, limited duration insurance (STLDI)]....

"Within 120 days of the date of this order, the Secretaries of the Treasury, Labor, and [HHS] shall consider proposing regulations or revising guidance, to the extent permitted by law and supported by sound policy, to increase the usability of HRAs, to expand employers' ability to offer HRAs to their employees, and to allow HRAs to be used in conjunction with nongroup coverage....

"The Secretaries shall consider and evaluate public comments on any regulations proposed under ... this order." (The White House)

[Official Guidance] President Takes Action to Improve Access, Increase Choices, and Lower Costs for Healthcare
"The order directs the Secretary of Labor to consider expanding access to Association Health Plans (AHPs), which could potentially allow American employers to form groups across State lines.... The order directs the Departments of the Treasury, Labor, and [HHS] to consider expanding coverage through low cost short-term limited duration insurance (STLDI).... The order directs the Departments of the Treasury, Labor, and [HHS] to consider changes to Health Reimbursement Arrangements (HRAs) so employers can make better use of them for their employees." (The White House)
President Trump's Executive Order Advances GOP Go-To Ideas to Broaden Insurance Choices, Curb Costs
"The Trump administration Thursday advanced a wide-ranging executive order aimed at expanding lower-cost insurance options, allowing employers to give workers money to buy their own coverage and slowing consolidation in the insurance and hospital industries.... President Donald Trump's action, which will not take effect in time to affect the upcoming open enrollment for coverage in 2018, signals a shift in the administration's strategy, which relied on Congress to repeal the [ACA]. Trump is now using the force of his executive rule-making authority to implement long-favored GOP policy alternatives." (Kaiser Health News)
[Guidance Overview] Administration Narrows ACA Contraceptive Mandate
"Objecting employers do not need to take any action to utilize the exemption. Objecting employers may use an optional 'accommodation' process to cede the administration of contraceptive coverage to a third party." (Husch Blackwell)
Can Employees Pay for Cord Blood Storage with an HRA, FSA or HSA?
"[If] the storage is merely precautionary, then the storage wouldn't be a qualified medical expense. If there's a current need (for example, the baby or a sibling or parent is actually sick and could benefit from the cord blood in the short term) then there's an argument to count the cord blood storage as a qualified medical expense and allow reimbursement of the costs through an HRA, FSA or HSA." (Mintz Levin)
Association Health Plans: Can the Administration Expand Access Without Congress?
"While the Secretary of Labor's powers are not without limit, [ERISA section 514(b)(6)(B)] does appear to be sufficiently robust to enable a class of self-funded association health plans that would be generally immune from state law. Applying current law rules to determine whether a MEWA is ERISA-covered would constrain membership in the class based on the bona fide association and control requirements ... These requirements are also the product of [DOL] guidance, so the [DOL] presumably could enlarge the class of self-funded MEWAs by adopting a more liberal reading of these requirements. This would, however, require the Department to upend decades of guidance[.]" (Mintz Levin)
21st Century Analytics Improve Costs and the Employee Benefit Experience
"Through the advancement of true cross-vendor analytics, prescription, engagement and measurement (all of which are brought on by the democratization of big data) will allow employers, brokers and consultants to improve the performance of their benefits plans. Delivering on the dual objectives of providing great benefits while controlling compensation costs will require no less than the application of these latest advancements in technology and process. But first, let's understand why this revolution hasn't happened yet." (WorldatWork)
As Benefits Homogenize, Will Tailored Voluntary Packages Help Companies Stand Out?
"The value proposition for employers that offer voluntary benefits alongside core benefits like health and disability insurance, is widely acknowledged. But what's increasingly coming into focus is the need for made-to-order benefits packages that address the unique needs of a specific workforce." (HR Dive)
[Guidance Overview] Retiree HRAs Receiving More Attention from California Public Employers
"Retiree-only HRAs [RHRAs] can provide significant tax-free health benefits and, if structured properly, can help [California] public employers address budgetary and compliance problems ... An RHRA can be used to automatically and, on a mandatory basis, convert some or all of the accumulated PTO into nontaxable retiree health benefits. [California agencies] that wish to eliminate or cut back their FLSA/overtime exposure can offer RHRA contributions in place of current cash-in-lieu benefits." (Best Best & Krieger LLP)
[Opinion] Can Association Health Plans Accomplish the ACA Repeal Congressional Efforts Could Not?
"[If] the federal government reverses its longstanding approach to AHPs and finds that insurance sold through an association of small employers or individuals is, in effect, a large-group health plan, the AHP would have to comply with far fewer standards.... While each small business and individual would purchase a separate insurance policy, the association sponsoring the health plan would be regulated under the same standards as a large employer." (The Commonwealth Fund)
Employers Want Small Fixes to ACA
"The survey of 300 health benefit professionals found that just 35 percent say they favor repeal and replace ... 95 percent would favor simplified ACA employer shared responsibility reporting rules.... 92 percent favor permitting higher contributions to [HSAs], and nearly as many (87 percent) would like to allow contributions up to the level of the out-of-pocket maximum." (Wolters Kluwer Law & Business)
The Potential Impact of Association Medical Insurance Plans
"If the ERISA regulations are relaxed, more association insurance plans may be implemented -- especially targeting those industries or associations employing a younger and healthier population. The healthier demographics will lead to lower association medical insurance premiums and may provide a significant benefit for those participants." (Hill, Chesson & Woody)
Long-Term Disability Insurance Gets Little Attention But Can Pay Off Big Time
"[As] employers continue to shift benefit costs onto employee shoulders, long-term disability is no exception. Increasingly, they're offering the coverage as a 'voluntary' benefit, meaning employees pay the entire premium. The upside is that if employees pay for the coverage themselves with after-tax dollars and they ever become disabled and need to use the coverage, the benefits will be tax-free.... Although voluntary coverage has a tax advantage, ... leaving it up to employees, especially if they're choosing among several other voluntary coverage options like cancer insurance, critical illness coverage and yes, pet insurance, increases the odds they'll skip buying long-term disability coverage." (Kaiser Health News)
[Guidance Overview] 2018 Health FSA Limit Projection, New SF HCSO Amounts, and Revised Contraception Rules
"ABD is projecting that for plan years beginning on or after January 1, 2018, the health FSA salary reduction contribution limit will increase to $2,650 (up from $2,600 currently).... The increase will not be official until the IRS releases its annual inflation-adjusted limits [typically in late October].... The San Francisco Office of Labor Standards Enforcement (OLSE) also recently released the updated 2018 HCSO required health expenditure rates." (ABD Insurance & Financial Services)
EEOC Wellness Program Rules Are Still in Effect, But Changes Are Expected
"While the court still needs to issue a final order deciding whether the current rules will remain in place, it is likely that existing rules will be kept in place through at least next year. Although the exact timeline is still unknown, the EEOC recently notified the court that the agency will need until August 2018 to revise their rules and until January 2019 to implement rules changes." (The Alliance)
The Softening and Widening Stop Loss Market
"The good news ... is the market has never been so soft. That has obvious implications [for] pricing, [as well as] contract provisions such as advance funding, no lasers upon renewal, early lock-in and retiree/international protection. Historically, it was difficult getting many of these embedded in policies whereas today they are standard offerings. The bad news is that it becomes harder to track nuanced differences between many of the carriers." (Frenkel Benefits)
Proposals for Medicare Advantage Plans and VA Providers Could Signal a Rise in Telehealth Uptake
"The Chronic Care Act ... would give [Medicare Advantage] patients the option to receive telehealth services for chronic disease treatment without any necessity for a face-to-face appointment.... The Department of Veterans Affairs' proposed rule ... would clarify for VA healthcare providers that they are able to provide telehealth services to their patients regardless of their location[.]" (Digital Health Legal)
[Guidance Overview] Administration Rolls Back ACA Contraceptive Mandate
"Unlike prior guidance, the new rules cover all nongovernmental nonprofit and for-profit employers, including publicly traded companies. Exemptions based on moral objections to contraception will only be available to nonprofit employers and for-profit employers with no publicly traded ownership interest." (Mercer)

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