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News Items, by Subject

Health plans - design

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Health Savings Account Participants Are Healthcare's Savviest Consumers
"HSA participants are: ... [1] 38 percent more confident they understand their health insurance coverage and 54 percent more confident in forecasting out-of-pocket healthcare costs.... [2] 23 percent more likely to make cost/value-based decisions than the general population....[3] 46 percent more likely to research and compare costs and 37 percent more likely to seek out alternatives.... [4] 68 percent more likely to have a savings goal and 80 percent more likely to be saving aggressively for future healthcare savings." (Alegeus Technologies)
Tracking Section 1332 State Innovation Waivers
"The current statutory language requires that state waiver applications must demonstrate that the innovation plan will provide coverage that is at least as comprehensive in covered benefits; at least as affordable (taking into account premiums and excessive cost sharing); cover at least a comparable number of state residents; and not increase the federal deficit.... Additional details on [specific] state waivers are provided [in this article]." (Henry J. Kaiser Family Foundation)
IRS Doubles Down on Employer Mandate Enforcement (PDF)
"In addition to assessment notices in connection with an employer's failure to offer minimum essential coverage to at least 70% of its full-time employees and their dependents, the IRS is now sending assessments for 2015 coverage that was 'unaffordable' or failed to provide minimum value. If timing is like last year, IRS will start releasing assessment notices for the 2016 calendar year later this year." (Conduent)
Health Plan Trends (PDF)
11 pages. "[E]mployers are increasingly focused on cost control options that don't involve automatically shifting costs to employees. These options include encouraging cost-effective treatment venues, narrow networks, reference-based pricing and centers of excellence.... [This article reviews] ... [1] Issues affecting medical care and costs; [2] Strategies employers use to control health plan costs." (Marsh & McLennan Agency LLC)
Employers, Health Plans Should Prepare to Respond to Last-Minute Health Plan Legislation This Fall
"The legislation passed by the Ways & Means Committee ... includes bills that would: [1] Provide relief for employers relief from the Obamacare's employer mandate and delay for an additional year the effective date of the widely disliked 'Cadillac Tax;' [2] Overrule the 'Use it Or Lose It' requirement ... for healthcare flexible spending arrangement plans (HFSAs) ... [3] Expand expand the availability and usability of HSAs in a multitude of ways.... [A] review of the Committee's schedule makes clear that it isn't finished with health care reform." (Solutions Law Press)
No Funding for DOL Association Health Plan Rule in Budget Bills
"The House and Senate appropriations bills didn't address a request from the White House in its February budget proposal to increase funding for [EBSA] 'to develop policy and enforcement capacity to expand access to AHPs.' Both bills would cut funding to the Labor Department overall." (Bloomberg BNA)
The High Cost of Healthcare: Patients See Greater Cost-Shifting and Reduced Coverage in Exchange Markets 2014-2018 (PDF)
28 pages. "[1] Health plan networks have grown increasingly narrow ... [2] Non-subsidized exchange marketplace premiums have increased faster relative to other markets, such as employer-sponsored insurance and Medicare Advantage, since 2014; [3] Deductibles and maximum out-of-pocket limits (MOOPs) have grown across all payers ... [4] [C]ost-sharing for services after the deductible has remained relatively constant ... [5] Federal and state rules around network adequacy have not kept pace with the growing patient burden." (Avalere, for Physicians for Fair Coverage [PFC])
Insurers Offer Tools to Dig Into Health Costs
"Three of Michigan's largest health insurers developed various software and support tools that provide employers with detailed reports on how their workforces spend health care dollars and where they access care.... 97 percent of human resource practitioners believe they need better tools to evaluate health care cost and use data to make better decisions on benefit plans." (Crain's Detroit Business)
Ways and Means Reports Out Eleven Health Care Bills After a Two-Day Markup
"The bills reported out of the Ways and Means Committee ... deal with the following topics. [1] Delay of the implementation of the Cadillac Tax.... [2] Broadening of Qualified Medical Expense definition.... [3] Increase HSA contribution limits.... [4] Expand eligibility for HSAs ... [5] HSA 'housekeeping' issues.... [6] Modification of the ACA premium tax credit." (Employers Council on Flexible Compensation [ECFC])
[Opinion] Telemedicine: Does It Measure Up to the Hype?
"Along comes the idea of a face-to-face online appointment with a real doctor who can diagnose and prescribe medications or refer to an appropriate care level.... [At] around $49 per visit I thought uptake would be rapid. I was wrong again as I look at 1-5% employee utilization rates. So what happened?" (Frenkel Benefits)
[Guidance Overview] Recent New Jersey Legislation Affects Out-of-Network Health Services
"If a [self-insured plan subject to ERISA] opts in, its members would not be balance billed for out-of-network charges for emergency care in excess of the deductible, copayment, or coinsurance amount applicable to in-network services, and the plan can take advantage of the act's binding arbitration provisions. The opt-in plan must provide each primary insured with a health insurance identification card indicating that the plan has elected to be subject to the act." (Morgan Lewis)
Ninth Circuit: Health Plan Must Cover Room and Board During Residential Treatment for Mental Illness
"The court ruled that if a plan provides benefits for MH/SUD but excludes some types of coverage that it provides for medical and surgical benefits, the exclusion is an impermissible treatment limitation under the MHPAEA." [Danny P. v. Catholic Health Initiatives, No. 16-35609 (9th Cir. June 6, 2018)] (The Wagner Law Group)
Taking the Pulse of Employee Wellness Programs
"Why are employers investing in employee well-being? ... [S]tock values for a portfolio of companies that received high scores in a corporate health and wellness self-assessment appreciated by 235% compared with the S&P 500 Index appreciation of 159% over a 6-year simulation period.... [And one survey] found significantly lower turnover rates among companies doing the most to help employees thrive compared to those doing less." (Mercer)
[Opinion] The Health Care Choices Proposal: Charting a New Path to a Down Payment on Patient-Centered, Consumer-Driven Health Care Reform
"The proposal ... would repeal the Obamacare federal spending scheme and replace it with a more fiscally responsible block grant to the states. The proposal ... [restore] state authority over some critical health insurance regulation. Thus, states would have the ability to adjust insurance rules to their own insurance market conditions, which differ sharply from state to state.... [It] recommends changes to health savings accounts (HSAs), enabling consumers to use them with greater flexibility in meeting their health care wants and needs." (The Heritage Foundation)
A New Twist in the Ongoing Out-of-Network Provider Lawsuit Saga
"Perhaps the most interesting part of this case relates to the claim that the plan used an improper reference pricing model ... The Hospital cited the FAQs under ACA which provide that reference pricing cannot be used as a subterfuge for otherwise prohibited limitations ... Specifically, a 2016 FAQ provides that a plan using a reference price without ensuring adequate access at that price will not be considered to have established a network for purposes of Section 2707(b) of the Public Health Service Act which relates to cost-sharing requirements and permissible MOOPs. The court found this argument somewhat convincing and declined to dismiss this claim." [Salinas Valley Memorial Healthcare Sys. v. Monterey Peninsula Horticulture, Inc., No. 17-7076 (N.D. Cal. May 31, 2018)] (Kilpatrick Townsend)
[Opinion] Ways and Means Bills Would Expand HSA Tax Breaks, Weaken Insurance Marketplaces
"The House Ways and Means Committee is marking up several bills this week that would raise contribution limits for [HSAs] and expand the allowable uses of these accounts, at a cost of $41 billion over ten years ... The bills also include other problematic provisions providing premium tax credits to people who buy plans offered outside the [ACA] marketplaces and delaying the ACA's excise tax on high-cost plans ... In all, the bills would cost $92 billion over the next decade[.]" (Center on Budget and Policy Priorities)
DOL Issues Final Association Health Plan Regs
"The rules would permit more employers to form AHPs, which would be regulated as large health plans. The final regulations do not change existing ERISA preemption rules that authorize broad state insurance regulation of AHPs. The attorneys general of New York and Massachusetts say they plan to sue the Trump administration over the final regulations." (Willis Towers Watson)
[Official Guidance] Text of OPM Final Regs: Federal Employees Health Benefits Program and Federal Employees Dental and Vision Insurance Program: Expiration of Coverage of Children of Same-Sex Domestic Partners
"Understanding that we have provided agencies with additional time for compliance given that overseas federal employees may not have been able to marry immediately following the Supreme Court decision, OPM is issuing a final rule removing references to domestic partners and domestic partnerships from the regulations. Based on the Supreme Court decision and the two additional year's lead time for domestic partners overseas to marry, the current language in the CFR is not needed and may be somewhat confusing. There is no change in coverage for children whose same-sex partners are married." (U.S. Office of Personnel Management [OPM])
Dealing with Reluctance: How to Boost Wellness Program Participation Rates
"Invite employees to help plan a wellness program or come up with new challenges.... [A] mix of group and solo activities will greatly appeal to those who prefer to manage their own health.... [Be] crystal-clear about what data is collected, whether their names are attached to it, and how the data is used.... [M]ake healthy snacks prominently available, offer on-site lunch-and-learns, or provide an app so it's easier to track progress on wellness challenges." (WellRight)
[Guidance Overview] Association Health Plans: The Final Rule Is Issued
"[V]irtually any type of existing trade association should be able to meet the necessary associational and control requirements.... [H]ospitals and hospital based systems should be able to create an AHP to offer health benefits to their aligned medical staffs.... [A] franchisor should be able to offer an AHP to its franchisees to enable those franchisees to offer health benefits to their employees.... [T]he role of the States remains pivotal." (Foley & Lardner LLP)
Specialty Drug Coverage Varies Across Commercial Health Plans
"Across 3,417 decisions, 16 percent of the 302 drug-indication pairs were covered the same way by all of the health plans, and 48 percent were covered the same way by 75 percent of the plans.... Health plans restricted coverage of drugs indicated for cancer less often than they did coverage of drugs indicated for other diseases.... Variations in coverage have implications for patients' access to treatment and health system costs." (Health Affairs)
[Guidance Overview] Association Health Plans: Federal Rule Broadens Opportunities But Some States Clamp Down
"The final rule recognizes that the DOL and many States regulate MEWAs ... The final rule, however, cautions that exceptions to ERISA's preemption provisions, at ERISA Section 514(b)(6), provide a potential future mechanism for preempting State insurance laws that the DOL deems go too far in regulating self-funded AHPs in ways that interfere with the goals of the final rule." (Epstein Becker Green)
Three Things About the ACA Employers Need to Focus on Now
"[1] The IRS is currently assessing employer penalties using '226-J' Letters ... [2] ACA reporting requirements still apply ... [3] The 'Cadillac Tax' is still looming." (Hanson Bridgett LLP)
[Guidance Overview] Association Health Plans: A Detailed Look at the Final Rule
"[E]xpect ongoing activity at the state and federal levels to regulate and monitor new AHPs.... Also expect many states to enact new coverage mandates on AHPs, similar to EHBs.... [T]he overall effect on premiums in the marketplace will depend heavily on state regulation and the design of AHPs." (Greensfelder)
Health Insurance Marketplace: Carriers' Participation in States and Counties in 2019
"A year ago, rate filings caused widespread anxiety, as multiple carriers announced withdrawals from the ACA market, and state officials struggled to fill bare counties. Many of those remaining filed enormous rate increases. In 2018, marketplace enrollment was stable, while unsubsidized enrollment continued its multi-year decline. So far, this year's rate filing season has been sprinkled with news of entry and expansion, and proposed rate hikes that are generally more moderate. With no announced market exits thus far, it seems likely that in 2019 there will be net entry into the ACA marketplace." (Robert Wood Johnson Foundation)
Want to Fix Health Care? Start with Employers
"Focusing on improving outcomes and lowering costs for employer-insured workers will be a quicker path than trying to reform the pharmaceutical or health insurance industries ... because employers are increasingly desperate to stem their rising costs, so have a vested interest in making care more efficient and less wasteful." (CNBC)
[Guidance Overview] DOL Finalizes Expansive Association Health Plan Rule
"ERISA compliance structures would need to be established to ensure that plan documents, summary plan descriptions, and other mandatory notices are timely provided, and that the annual Form 5500 reporting and other mandated reporting can be timely completed. COBRA, HIPAA, and the ACA will also apply to the plan, as will ERISA's fiduciary requirements. As a MEWA, the federal Form M-1 filing may be required, and compliance with state laws regulating MEWAs is also necessary. In most cases, the plan will need to be funded through a trust that meets state law requirements." (Ogletree Deakins)
Court Allows Provider to Proceed With Claim That Plan Violated Cost-Sharing Limit
"The hospital asserted that the plan essentially established a reference price when it reimbursed all of the hospital's services at 140% of Medicare's allowed charge. Because the plan's network did not include any hospitals or otherwise ensure access to hospitals that would accept the reference price, the hospital contended that the plan was required to count out-of-pocket expenses for charges over the reference price toward the maximum annual cost-sharing limit[.]" [Salinas Valley Memorial Healthcare Sys. v. Monterey Peninsula Horticulture, Inc., No. 17-7076 (N.D. Cal. May 31, 2018)] (Thomson Reuters / EBIA)
[Guidance Overview] New Association Health Plans: Coverage of Individual Working Owners
"The 'working owner' must work at least 20 hours per week (80 hours per month) in the business, or earn enough to pay for coverage of the owner and any covered beneficiaries.... The final rule dropped a proposed requirement that the individual have no other subsidized group coverage available, including through a spouse.... The AHP must have procedures to verify that the working owner meets these criteria at the time first covered, and to periodically monitor compliance." (Davis Wright Tremaine LLP)
CMS Marketplace Reports Show Increases In Subsidy-Eligible Enrollees, Effectuated Enrollment Rate
"10.6 million individuals effectuated their coverage for February 2018 ... a higher proportion of marketplace enrollees received premium subsidies relative to 2017; and those who selected a plan during the 2018 open enrollment period were more likely to effectuate their coverage compared to 2017. Premium affordability, however, remains a concern, and CMS devotes an entire report to documenting a decline in individual market enrollment among consumers who are not eligible for advance premium tax credit (APTC)." (Health Affairs)
Healthy Food, Transportation to the Doctor are New Frontiers for Health Insurance Providers
"[WellCare Health Plans has worked] over the last seven years to connect members in need with access to social services including food, medication assistance, and transportation.... [P]roviding this service has led to a 26 percent decrease in emergency spending.... People who live in underserved communities get caught in a cycle where lack of access -- to food, transportation or providers -- leads to poor outcomes.... Closing the transportation gap can reduce the number of missed appointments and help make sure that patients are able to take their medication as directed." (America's Health Insurance Plans [AHIP])
[Guidance Overview] Association Health Plans: A New Frontier?
"Pros: [1] Exemption from various [ACA] requirements ... [2] Reduced reporting and disclosure requirements ... [3] Economies of scale ... Cons: [1] AHPs are MEWAs ... [2] AHPS are subject to ERISA and other laws that apply to group health plans ... [3] Small employers may become subject to Mental Health Parity, COBRA, and other requirements that apply to large employers ... [4] Taxation of health coverage and benefits ... [5] Liability concerns ... [6] Legal uncertainty." (Snell & Wilmer L.L.P.)
The Exchanges Trends Report 2018 (PDF)
12 pages. "Data from the call center shows that the consumer satisfaction rate remained at an all-time high -- averaging 90 percent -- throughout the entire Open Enrollment period. This is up from 85 percent last year. 63 percent of uninsured consumers who have visited Federal platform Exchanges in the past year indicate they didn't purchase a health plan through the Federal platform because the health insurance premium was too expensive, which is up from 52 percent from the end of last year's Open Enrollment Period." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
Early 2018 Effectuated Enrollment Snapshot (PDF)
12 pages. "As of March 15, 2018, 10.6 million individuals had effectuated coverage through the Federal and State-Based Exchanges for February 2018, meaning that they selected a plan, paid their first month's premium, if applicable, and had coverage in February 2018. The total number of members with February 2018 coverage is about 9 percent lower than the number of individuals (11.8 million) who made plan selections during the 2018 Open Enrollment period." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
Trends in Subsidized and Unsubsidized Individual Health Insurance Market Enrollment (PDF)
"Average monthly enrollment in individual market plans decreased by 10 percent between 2016 and 2017 at the same time premiums increased by 21 percent. Most of the decrease in enrollment between 2016 and 2017 occurred among people who did not receive APTC subsidies.... 10 states experienced declining individual market enrollment between 2015 and 2016.... The decline in the non-APTC portion of state markets grew larger and more widespread between 2016 and 2017." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
It's (Summer) Time for Wellness Plan Re-Design
"[A chart] illustrates the wellness rule landscape effective January 1, 2019 for employers that are subject to the ADA. Wellness regulations under HIPAA and the ACA will continue to apply, but they do not impose any limit on incentives (or penalties) for biometric testing or HRAs that are 'participation only' i.e., that do not require physical activity, or specific health outcomes." (E is for ERISA)
IRS Publication 5172: Facts About Health Coverage Exemptions (PDF)
Rev. May 2018. "You obtain exemptions from either the Marketplace or IRS depending on the type. All exemptions are reported on the tax return. If you don't have to file a return, because your income is below your filing threshold, you are automatically exempt. Here are the types of exemptions available along with information about how to obtain them[.]" (Internal Revenue Service [IRS])
[Guidance Overview] DOL Final Rule Expands Availability of Association Health Plans (PDF)
"[T]he AHP Final Rule creates 'two tracks' for AHPs, by allowing both new and existing associations to sponsor AHPs under either the current set of DOL sub-regulatory guidance, or the new AHP Final Rule. The most important consequence for federal law purposes is that AHPs that qualify under existing DOL guidance (limited to the same industry and no 'working owners,' i.e., no self=employed persons) may be able to continue to set premium rates employer-by-employer based on the claims experience of each employer." (Groom Law Group)
[Guidance Overview] DOL Issues Final Regs on Association Health Plans
"The DOL and the states have dual jurisdiction because of the MEWA rules and the exception to ERISA with regards to state insurance law ... There is tension between the Administration's desire to make access to AHPs as broad as possible and certain states' concerns that this access would lead to abuse." (The Wagner Law Group)
Is Arbitration the Future for ERISA Claims?
"Absent further legislation by Congress amending the Federal Arbitration Act or state legislation permitting private attorney general actions such as California's Private Attorneys General Act, the enforceability of mandatory arbitration programs with class waivers can be assured. Employers and plan sponsors who do not have such arbitration programs need to be aware of this significant development and at least consider whether an arbitration program with a class waiver is appropriate for them" (Seyfarth Shaw, via Lexology)
Key Themes on Benefit Administration
"Today's workforce now spans five generations ... Employers, especially those facing a shortage of skilled labor, must prepare for an influx of all-new values, characteristics and behaviors.... To win the battle for employees' attention, to connect with them and guide them to smart benefit decisions, employers need to take a fresh approach to communication. One approach that makes a lot of sense is treating benefits like any other consumer good that employees 'buy,' and using marketing strategy and tactics to 'sell' them to employees." (Benefitfocus)
Individuality in Healthcare: The Massive Influence of Employers
"[Know] your employee community well enough to understand the factors that have the biggest influence on the health of the diverse employee populations you serve.... [Have] strategies in place to get to know employees as individuals and to pair that individuality with inclusion to achieve better outcomes." (Forbes)
Moda Decision Affecting Risk Corridor, CSR Litigation; Sen. Alexander Pushes for Sec. 1332 Waiver Flexibility
"As expected given the stakes, Moda Health Plan has indicated that it will appeal the Federal Circuit's decision. In the meantime, other litigation over risk corridor payments -- which had been stayed pending the Federal Circuit's decision -- can proceed. There are currently two additional cases on risk corridor payments before the same panel of judges on the Federal Circuit." (Katie Keith, in Health Affairs)
[Guidance Overview] MEWAs and AHPs: What You Need to Know About the Association Health Plan Final Rule
"This Legal Alert provides brief background on the Final Rule's single-employer AHP criteria, and includes a chart that outlines some of the key differences between the requirements for MEWAs, single-employer AHPs established pursuant to existing guidance, and single-employer AHPs according to the alternative criteria established under the Final Rule." (Eversheds Sutherland)
New Association Health Plans: Effect on the Washington State Group Health Market
"AHPs [in Washington State] have been allowed to experience-rate between employers and charge different premiums based on their claims history or other underwriting factors. The new regulation makes clear that AHPs formed under prior guidance do not have to comply with the same rules as AHPs formed under the new regulations -- in particular the nondiscrimination rule. In Washington, it will be business as usual for AHPs formed under prior DOL guidance[.]" (Davis Wright Tremaine LLP)
The Individual Mandate is Gone. So Who's Dropping Coverage?
"When [a recent] survey asked adults whether they would drop coverage when the individual mandate tax penalty is repealed, 5% of those with employer insurance said they would.... It's perhaps more concerning that 9% of those getting their insurance through the individual market said they intended to drop coverage[.]" (Mercer)
[Guidance Overview] Final Association Health Plan Regs Provide Opportunity for Small Employers ... Maybe
"[We] now know that the DOL does not intend to alter existing ERISA preemption rules, which authorize State insurance regulation of AHPs ... We now also know that existing AHPs that meet current sub-regulatory guidelines to be considered an AHP do not need to satisfy these new rules to maintain that AHP status. The nondiscrimination provisions in the new rule also limit the opportunity for new AHPs to engage in risk selection by effectively eliminating the ability to medically underwrite individual employer members." (Porter Wright Morris & Arthur LLP)
[Guidance Overview] Association Health Plan Final Rule Brings New Coverage Options for Small Businesses and Self-Employed
"The final rule will be applicable in three phases starting on September 1, 2018. This alert provides an overview of key aspects of the rule, with an emphasis on its nondiscrimination requirements, and highlights several clarifications or modifications to the proposed rule that the DOL made in the final rule." (Faegre Baker Daniels)
[Guidance Overview] DOL Finalizes Rule for Association Health Plans
"[H]ealth insurance issuers may not constitute or control a bona fide group or association in their capacity as health insurance issuers. However, health insurance issuers may act as employers in sponsoring an AHP for the benefit of their employees and may also provide administrative services to an AHP.... Sole proprietors and self-employed individuals will be eligible to participate in AHPs without the need to employ at least one other person." (McDermott Will & Emery)
Telemedicine: What's the Benefit?
" 'Store and forward' telemedicine refers to the acquisition and storing of clinical information that is sent to another site for evaluation. This type of telemedicine is useful in the areas of radiology, dermatology and retinal imaging.... 'Remote monitoring' allows doctors and other medical professionals to monitor a patient remotely using technology.... 'Real-time medicine' is useful for those looking for an alternative to visiting the doctor's office." (WithumSmith+Brown, PC)
What is QSEHRA? A Practical Guide for Small Employers
"To use a QSEHRA, a small business or non-profit must meet two primary requirements: [1] Be 'small' ... [2] Not have a group health plan ... To receive tax-free reimbursements from a QSEHRA, an employee must: [1] Be covered by an insurance plan ... [2] Submit a claim for reimbursement." (Take Command Health)
Some Big Employers Moving Away from High Deductible Health Plans
"Today, 39 percent of large employers offer only high-deductible plans, up from 7 percent in 2009 ... Half of all workers now have health insurance with a deductible of at least $1,000 for an individual, up from 22 percent in 2009 ... About 41 percent say they can't pay a $400 emergency expense without borrowing or selling something[.]" (Insurance Journal)
Is a Benefits Captive Right for Your Company?
"A benefits captive pools self-funded employers together to save on stop-loss insurance ... which could cut claim minimums by half -- from $50,000, which would be out of reach for many employers, to a much more manageable $25,000, for example. Individual employers take on risk below the minimum, and then transfer risk to the captive above that amount. Sharing risk is attractive to employers; however, this only makes sense if each member of the benefits captive is working equally hard to mitigate risk and keep claims low. There are a few ways to do this." (Corporate Synergies)
Thinking About an Association Health Plan? Read the Fine Print
"What are association health plans and what did the administration change? ... When will the plans be available? ... The ACA added some popular protections, including requiring plans to cover preventive care without charging consumers anything out-of-pocket and allowing people to keep their kids on their plan until they reach age 26. How will these provisions be handled under association health plans? ... How are preexisting medical conditions handled in the new rule? ... Will the plans cover a broad range of benefits? ... How could premiums be affected? ... Who's likely to benefit under the rule? ... What if an employer offers a really skimpy plan? Are workers stuck with it?" (Kaiser Health News)
[Guidance Overview] DOL Finalizes Rule to Expand Associated Health Plans
"AHPs will be open to the self-employed (working owners) if they meet certain hours worked requirements or have a level of income from self-employment that supports the cost of the individual's coverage. The proposed rule would have allowed an AHP to simply accept the certification of the working owner that he/she met those qualifications. The final rule ... offers flexibility while at the same time making it clear that AHP fiduciaries have a duty to reasonably determine and monitor that working owners meet the final rule's conditions for coverage." (Benefit Revolution)
Talking Wellness with Your CFO (Minus the ROI Goggles)
"Build and present a well-rounded case that goes beyond healthcare claims and includes things like the value of employee feedback, the benefits of engagement, the savings that comes from retaining an employee, and the importance of leading your industry in attracting talent. If the CFO's still skeptical you could propose doing a pilot program before jumping into a more comprehensive wellness strategy." (Frenkel Benefits)
When Retail Giants Like Walmart and Amazon Invade Healthcare
"Walmart and Amazon have each revolutionized other industries: What's to keep either or both of them from turning healthcare on its head, dethroning the sector's traditional powerbrokers in the process? ... Walmart's accessibility and its rapport with a wide range of consumers, especially among aging populations, could make it a logical partner for some providers. It could even be helpful in developing chronic care models[.]" (HealthLeaders Media)
[Guidance Overview] Green Light for AHPs
"The final rule [requires] that a group or association of employers have at least one substantial purpose other than the provision of health benefits to its members. This is defined quite broadly, and could include simply offering conferences, classes or educational material on business issues to members or conducting public relations activities such as advertising and education on business issues. The primary purpose of the group can be the provision of health insurance." (Kilpatrick Townsend)
[Guidance Overview] DOL Expands Access to Association Health Plans
"Opposition to the expansion of AHPs has primarily focused on: [1] The potential for fraudulent and thinly capitalized AHPs that fail to pay participants' medical claims; [2] The reduced consumer protections applicable to AHPs, because large AHPs would be able to obtain health coverage on the large group market; and [3] The potential that the expansion of AHPs could make the small group and individual health insurance markets less stable by diverting healthy individuals to AHPs. The Attorney Generals for New York and Massachusetts intend to file a lawsuit challenging the legality of the new regulations." (Mazursky Constantine LLC)
[Opinion] American Benefits Council Comments to EBSA on Proposed FAQs About MH/SUD Parity Implementation and the 21st Century Cures Act
"The Departments should clarify that a plan only violates MHPAEA where it cannot demonstrate that the processes, strategies, evidentiary standards, or other factors considered by the plan in implementing the NQTL are comparable to and applied no more stringently to MH/SUD benefits as compared to M/S benefits." (American Benefits Council)
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