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News Items, by Subject

Health plans - info for employees

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Using Your Health Savings Account
"You are not required to take funds out of your HSA at the time that a qualified expense occurs. You can leave that money in your HSA and, as long as you keep your receipts showing that you paid for those qualified expenses, you can wait to reimburse yourself for that expense at any time in the future, even if you are no longer covered by an HDHP when you decide to reimburse yourself." (United Benefit Advisors)
How to Hack Your Employer's Health Plan
"Take full advantage of your employee health benefits, including claiming money from your flexible spending account before you contribute to it.... Drain your FSA early ... Let your HSA grow, but keep your receipts ... Use COBRA to retire (a little) early." (U.S. News & World Report)
Hoping to See Your Doctor Via Telemedicine? Here's a Quick Guide
"Q: Are e-visits available from most hospitals and doctors? A. Not yet. But access is increasing. Ask your doctor, clinic or hospital.... Q: What restrictions do health plans, Medicare and Medicaid put on e-visits? A. Health plan coverage varies, but most private insurers cover e-visits, and 34 states and the District of Columbia require that they do.... Q: Do I need special computer equipment? A. No.... Q: What services can I get through telemedicine? A. Most e-visits are for primary care or follow-up services, such as assessing symptoms or checking on people who have had a medical procedure.... Q. Will I save money if I do an e-visit instead of going into the doctor's office? A. E-visits are generally less expensive than a trip to the doctor, but you may not see the difference if your insurance covers both with only a small copay or no copay." (Kaiser Health News)
[Official Guidance] Text of IRS Publication 969: Health Savings Accounts and Other Tax-Favored Health Plans, for Use in Preparing 2017 Returns (PDF)
22 pages. "This publication explains the following programs. [1] Health Savings Accounts (HSAs). [2] Medical Savings Accounts (Archer MSAs and Medicare Advantage MSAs). [3] Health Flexible Spending Arrangements (FSAs). [4] Health Reimbursement Arrangements (HRAs)." (Internal Revenue Service [IRS])
Make Better Health and Wealth Decisions During Open Enrollment
"[1] Build your health care budget, starting with last year's out-of-pocket costs. [2] Find creative ways to save and look for new locations for you to receive health services. [3] Compare different plans and know the differences in insurance premiums and deductible levels. [4] Consider adding new benefits at various stages of your life. [5] Make your health and financial decisions before the enrollment deadline." (Fidelity)
Guide to Investing Your HSA Account for Growth
"HSAs offer a triple tax advantage ... Withdrawals for qualified medical expenses are always tax-free, regardless of your age ... After age 65 you can use withdrawals for any expense, although they will be taxed at your normal rate.... With maximum annual contributions and minimal medical expense withdrawals, you can build a hefty nest egg to complement your regular retirement plan." (DataPath)
Open Enrollment for Employees: How to Get the Most Out of Your Benefits in 2018
"[S]ome employers don't include retirement benefits on the menu of available health and welfare benefit options during open enrollment season ... [Y]ou might have to take matters into your own hands when it comes to your employer-sponsored retirement plan during open enrollment season.... [E]mployees who are saving for retirement, with access to a HDHP, should consider participating in their employer's HDHP, so that they can take advantage of the HSA offered with it.... [C]onsider critical illness coverage, if offered by your employer ... [M]any employers offer incentives around open enrollment for participation in health screenings, health risk assessments, and wellness activities -- this can essentially put more money back into the employee's pocket, with the added benefit of helping the employee to better understand and manage health risks." (Fidelity)
HRA Plan Primer: Facts About Qualified Expenses, Taxes and More
"If your employer offers an HRA plan, here are some important things to know about the accounts: HRA plan specifics can vary widely.... HRAs are not portable.... HRA plans may restrict which expenses are covered.... Most HRAs cannot reimburse for insurance premiums.... Once reimbursed by an HRA, expenses are no longer tax-deductible.... HRA reimbursements are not taxable under most plan designs." (DataPath)
Employees Still Can't Find Out How Much Health Providers Charge
"More Americans are enrolling in high-deductible health plans, which means they'll pay more out of pocket for 'commodity' health services -- whether lab tests or common surgeries such as hip and knee replacements. They can shop around for high-quality providers that charge less, but they are finding it difficult to do so." (Society for Human Resource Management [SHRM])
Quiz: Do You Get the Most Out of Your Benefits?
"If you scored a 9 or higher, congratulations! Chances are that you see your employee benefits as an integral part of your overall compensation. If you scored an 8 or lower, you may be leaving money on the table by not taking full advantage of everything your employer offers. If you have access to financial coaching via your workplace financial wellness program, consider setting up a time to talk to a planner about how you can fully maximize the value of your employee benefits." (Financial Finesse)
Health Savings Accounts and Filing Your Taxes
"As you prepare and compile tax documents, it's important to know what forms you may need to file if you have a Health Savings Account (HSA). In addition to Form 1040, there are two other very important documents -- Form 1099-SA and Form 8889." (DataPath)
[Guidance Overview] IRS Health Care Tax Tip 2017-01: 'If-X-Then-Y' Chart Explains How the ACA Affects Individual Taxpayers
"As you prepare to file your 2016 tax return, review this chart to see how the health care law affects you." (Internal Revenue Service [IRS])
How to Calculate the Value of Your Benefits
"It's 'open enrollment' season ... [and] a good time ... to estimate how much the benefits you choose are worth to you: Health Insurance (typically $5,000 -- $30,000) ... Retirement Plan (typically 3-6 percent of your salary in matching contributions) ... Stock Purchase Plan (typically 10 to 15 percent of market value per share purchased) ... Disability Insurance ($2,000 to $5,000 per year) ... Life Insurance ($250 to $500 per year) ... Employer Contribution to FICA (7.65 percent of salary) ... Unemployment Insurance (0.3-1.5 percent of salary) ... Your company may offer other benefits such as tuition reimbursement, pre-paid legal assistance, commuter benefits, health and wellness programs, access to group long term care insurance[.]" (Financial Finesse)
Five Medicare Tips for New Retirees
"Moving to Medicare from employer health insurance can be a difficult transition.... [1] There is no family plan in Medicare.... [2] A cap on out-of-pocket costs isn't automatic.... [3] Be strategic in scheduling some procedures.... [4] Wellness features may be different.... [5] A little research may help limit your drug costs under Medicare." (TIME)
How an HSA Can Help You Save for Retirement
"HSAs are portable and can be transferred to the custodian of your choice. While many retirement accounts are subject to required minimum distributions once you reach age 70-1/2, HSAs do not have this requirement. There is also no level of income that excludes you from participating in HSAs as long as you have a qualifying high deductible health plan. You can also accumulate a balance in the account that can be used tax-free for future medical expenses." (U.S. News & World Report)
[Official Guidance] Text of Final Regs: Definition of Terms Relating to Marital Status
"This document contains final regulations that reflect the holdings of Obergefell v. Hodges ..., Windsor v. United States, ..., and Revenue Ruling 2013-17 ... and that define terms in the Internal Revenue Code describing the marital status of taxpayers for federal tax purposes.... While [the regulations] will continue to provide that registered domestic partnerships, civil unions, and other similar relationships not denominated as marriage under state law are not recognized as married for federal tax purposes, [they are clarified to] ensure that there is a point of reference for which state law is applicable when determining whether the alternative legal relationship is recognized as marriage under state law. Accordingly, ... the terms 'spouse,' 'husband,' and 'wife' and 'husband and wife' do not include individuals who have entered into a registered domestic partnership, civil union, or other similar relationship not denominated as a marriage under the law of the state, possession, or territory of the United States where such relationship was entered into, regardless of domicile." (Internal Revenue Service [IRS])
Health Savings Accounts: How and When a Participant Should Make a Contribution
"Learn before the beginning of the plan year the amount and timing of your employer contribution so that you can plan your personal contributions accordingly. Plan to make pre-tax payroll contributions if your employer offers a Cafeteria Plan. You should begin the discipline of regular HSA deposits. Check to see whether your employer has set up a negative election, Most do not, but some do. Review your contributions before the end of the calendar year to make sure that you have not made an excess contribution (and correct the excess contribution if you have made one)." (Xerox HR Insights)
Do You Know How Good Your Surgeon Is?
Infographic. "[W]hen healthcare consumers who need surgery start their research of potential hospitals or surgeons, they are bombarded with confusing amounts of ratings, 'best of' lists, and hoards of big data. When it comes to patient reviews, can you trust an anonymous Yelper to guide you to a quality surgeon? And when you come across websites with a ton of data like complication rates, volumes, mortality, or readmissions, how do you make appropriate conclusions about the risks you potentially face when you choose your healthcare provider?" (mpirica)
[Official Guidance] Text of 2015 Instructions for IRS Form 8965: Health Coverage Exemptions and Shared Responsibility Payment Calculation (PDF)
19 pages. "What's New: ... Several changes have been made to the types of coverage exemptions available for 2015. Some coverage exemptions have been added, clarified, or are no longer available.... A flowchart has been added to help you figure your shared responsibility payment." (Internal Revenue Service [IRS])
[Official Guidance] Text of CMS Final Bulletin on Out-of-Pocket Cost Comparison Tool for the Federally-Facilitated Marketplaces (PDF)
"The purpose of this bulletin is to provide information on the OOP Cost Comparison Tool, how the tool computes OOP Cost, and how it is incorporated into the FFMs' web sites. This comparison tool will be available to consumers ... for the 2016 annual open enrollment period beginning November 1, 2015." [Unnumbered document, Oct. 29, 2015] (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
Understanding How to Enroll in Health Insurance through Health Insurance Marketplaces
"Use this series of fact sheets to find out how to sign up for marketplace health insurance and how to get financial assistance to help pay for the cost of coverage. These fact sheets also answer key questions about how to find a plan that is affordable and meets your health care needs." (Families USA)
Tips for Maximizing Your Health Benefits During Annual Enrollment
"Participate in the enrollment process.... Determine the best source of coverage for your dependents.... Reassess your and your dependents' health care needs.... Don't buy on price alone.... Explore other health plan choices offered by your employer.... Evaluate your plan's provider network ... Take advantage of opportunities to improve your health and lower your health costs.... Take an additional step if you are enrolled in COBRA.... Take a 'health and wealth' view to spend your dollars wisely." (Aon Hewitt)
Ninth Circuit: SPD Discretionary Grants Are Ineffective to Invoke Firestone Defense
"The Prichard decision serves as a reminder to plan sponsors that all important plan provisions must not only be described in the SPD, but included in the plan document itself. Plan sponsors may address this issue in a number of ways, including: (i) having a combined plan document/SPD, when appropriate; (ii) incorporating the SPD into the plan document; or (iii) including parallel language in the plan document and the SPD." [Prichard v. Metropolitan Life Ins. Co., No. 12-17355 (9th Cir. Apr. 21, 2015)] (Paul Hastings LLP)
[Opinion] Administration Should Tell Obamacare Applicants About Risk of Losing Subsidies
"A privately owned corporation is obliged to disclose the risks of pending litigation to interested parties. Apparently, this constraint does not apply to the federal government. Indeed, Team Obama is cheering the fact that millions of people are bailing into Obamacare exchanges, putting their health coverage at risk, and pretending that everything is going swimmingly." (National Center for Policy Analysis Health Policy Blog)
Dilemma Over Deductibles: Costs Crippling Middle Class
"[Employer-provided coverage,] long considered the gold standard of health insurance, now often requires workers to pay so much out-of-pocket that many feel they must skip doctor visits, put off medical procedures, avoid filling prescriptions and ration pills -- much as the uninsured have done.... [The] size of the average deductible more than doubled in eight years, from $584 to $1,217 for individual coverage. Add to this co-pays, co-insurance and the price of drugs or procedures not covered by plans -- and it's all too much for many Americans." (Shreveport Times)
2013 Retirement Survey Key Findings and Issues: Experiencing Change in Retirement (PDF)
"This report presents findings from the 2013 Risks and Process of Retirement Survey, specifically those relating to the phases of retirement. 'Phases of retirement' refers to changes that take place during retirement. The report uses quotations from the series of focus groups to illustrate the findings and addresses factors relating to how people decide to retire and to changes in lifestyle and needs over the course of retirement, including paid employment and housing." (Society of Actuaries)
[Official Guidance] Text of IRS Notice 2015-9: Penalty Relief Related to Advance Payments of the Premium Tax Credit for 2014
"This Notice provides limited relief for taxpayers who have a balance due on their 2014 income tax return as a result of reconciling advance payments of the premium tax credit against the premium tax credit allowed on the tax return. Specifically, this Notice provides relief from the penalty under Section 6651(a)(2) of the Internal Revenue Code for late payment of a balance due and the penalty under Section 6654(a) for underpayment of estimated tax. To qualify for the relief, taxpayers must meet certain requirements... This relief applies only for the 2014 taxable year." (Internal Revenue Service [IRS])
Beyond Retirement: Navigating Your Total Employee Benefits Package
"Even if you have been with the same company for years, it's important to reevaluate your needs and make sure you're getting the most out of your benefits. Here are some basic guidelines to help you understand what you need to consider: Retirement Plan ... Health Insurance ... Sick and Vacation Time ... Stock Options or Profit Sharing ... other perks." (AFS 401k Retirement Services)
Insights for Improvement: Data and Analysis from the 2014 Inside Benefits Communication Survey (PDF)
19 pages. "Professionals spent the most time during the last year working to improve employees' understanding and perceived value of benefits (56%). Time dedicated to lowering overall health plan costs was second (47%), followed by maintaining overall compliance (47%).... [K]eeping employees and families engaged in their benefits year-round is their largest communications challenge (75%). That percentage is essentially unchanged since ... 2012. However, the lack of engagement could be linked to a lack of frequency, since the majority (64%) also say they only communicate with employees once a year at annual enrollment." [Infographic also available.] (Benz Communications and National Business Coalition on Health)
ACA Considerations for Severance Agreements
"It is not uncommon for employers to offer to pay for continuing COBRA coverage for a former employee as part of a severance agreement.... Let's say that an employee loses his job, and his or her employer agrees to pay for COBRA for three months. If the end date of this employer contribution does not fall during Covered California's open enrollment period, the employee will be forced to maintain COBRA coverage until the next open enrollment period in order to avoid any gaps in coverage." (Liebert Cassidy Whitmore)
Amount of Savings Needed for Health Expenses for People Eligible for Medicare: Good News Not So Rare Anymore (PDF)
"In 2014, a man would need $64,000 in savings and a woman would need $83,000 if each had a goal of having a 50 percent chance of having enough money saved to cover health care expenses in retirement. If either instead wanted a 90 percent chance of having enough savings, $116,000 would be needed for a man and $131,000 would be needed for a woman.... Savings targets declined between 2 percent and 10 percent between 2013-2014. For a married couple both with drug expenses at the 90th percentile throughout retirement who wanted a 90 percent chance of having enough money saved for health care expenses in retirement by age 65, targeted savings fell from $360,000 in 2013 to $326,000 in 2014." (Employee Benefit Research Institute [EBRI])
Planning for Health Care Costs in Retirement: A 2014 Survey of Age 50+ Workers
"Almost four in ten 50+ workers (38%) are not saving for health care costs, and many (44%) do not have any plans to do so in the future.... While a majority of 50+ workers (62%) say they are saving for health care costs, more than half (55%) are worried they may not be able to afford health care costs.... A majority of 50+ workers (57%) plan to work past the age of 65, including roughly two in ten (18%) who say they will never retire." (AARP)
Choosing a Health Plan Is Hard, Even for a Health Economist
"Already, the lack of price transparency is enough to make a health economist despair. But it gets worse. Some aspects of plan quality are available to most consumers, like consumers' ratings of customer service and how well doctors in each plan communicate with their patients. But a crucial feature of health plans is not as easily or widely accessible: the extent to which each covers services provided by one's favorite doctors and hospitals." (The New York Times; subscription may be required)
How to Pick the Right Health Plan for 2015
"The vast majority [of employees] end up 'auto-enrolling' -- that is, staying in the same plan year after year ... That might not be the best strategy this time around ... [M]any employees will receive enrollment materials for the first time, due to an ACA provision requiring large companies to offer health coverage to a wider pool of workers." (The Wall Street Journal; subscription may be required)
What Every Family Should Know About High Deductible Health Insurance
"The average deductible for single coverage under employer plans this year is $1,217. That's almost double what it was in 2006. The trend is not going to abate. Next year 4 in 5 large employers will offer a high deductible plan and 1 in 3 will offer only a high deductible plan. Moreover, the deductibles in the plans offered on the (Obamacare) health insurance exchanges are more than twice as high as the average employer plan. High deductibles are not necessarily a bad thing. They may be a good thing. Here are ten things you should know in planning for your own health insurance needs." (John Goodman, in Forbes)
41 Percent of Employees Spend Less Than 15 Minutes on Benefits Selection
"Most workers (73 percent) only sometimes, rarely, or never understand everything that is covered by their policy. More than 6 out of 10 workers (64 percent) sometimes, rarely, or never understand changes in their coverage. Sixty-four percent disagree or only somewhat agree that they are more prepared for open enrollment this year compared to last year." (Wolters Kluwer Law & Business)
Tips to Help Employees Prepare for the Upcoming Open Enrollment Season
"Take an active role ... Assess your and your dependents' health care needs ... Evaluate your plan's provider network ... Evaluate whether a CDHP is right for you ... Determine the best source of coverage for your dependents ... Take advantage of health and wellness programs ... Understand how your employer coverage works in comparison to ACA Marketplaces ... Take a holistic view of health and financial wellness." (Aon Hewitt)
HSA Contributions May Produce Large Lifetime Accumulations and Tax Savings (PDF)
"HSAs provide account owners a triple tax advantage. Contributions to an HSA reduce taxable income. Earnings on the assets in the HSA build up tax free. And distributions from the HSA for qualified expenses are not subject to taxation.... This paper examines the amount of money an individual could accumulate in an HSA over his or her lifetime. It also examines lifetime tax savings from HSA contributions. Limitations of an HSA are also discussed." (Employee Benefit Research Institute [EBRI])
Top 10 Employee ACA Questions
"Respondents say the most common questions from employees are related to the health insurance exchanges (e.g., How do the exchanges work? Am I eligible? Are they free? Could I qualify for a subsidy? How does exchange coverage compare with my current coverage?) Below are the ten most common questions employees are asking about ACA along with some answers to help guide employer responses." (International Foundation of Employee Benefit Plans [IFEBP])
Most Employees Fear Shift to Exchange Coverage
"A Morning Consult survey found 63 percent of 1,250 likely voters said they're either somewhat or very concerned that their employers will transfer their coverage to the exchanges. It also found 51 percent of respondents think such a shift would have a negative impact on the quality of their health coverage. Meanwhile, only 16 percent of consumers said buying an exchange plan would have a positive impact, and 34 percent said it would have no effect." (FierceHealthPayer)
Helping Employees Be Better Consumers for Their Health Care Benefits
"Create a consistent message about your organization's healthcare offerings and then disseminate information the same way you would a marketing campaign.... Encourage employees to meet with you face-to-face if they have questions.... Be a translator.... Make sure employees know where to go to find information[.]" (Employee Benefit News)
Successful Consumer-Directed Health Plan and Wellness Programs Require Employee Education
"[It's] critical employees understand the ins-and-outs of the health plan as well as the accompanying savings/spending account and wellness initiatives.... Some best practices: [1] Include details about how to meet high deductibles and when the health plan starts paying covered benefits; [2] Specify how and when the savings/spending account gets funded and how employees can manage their funds; [3] Demonstrate the programs in action with clear instructions and examples; [4]Communicate the requirements for earning wellness program incentives[.]" (Healthcare Trends Institute)
[Guidance Overview] Text of IRS Fact Sheet for Individuals: The ACA's Individual Shared Responsibility Requirement
"The individual shared responsibility provision requires you and each member of your family to either: Have minimum essential coverage, or Have an exemption from the responsibility to have minimum essential coverage, or Make a shared responsibility payment when you file your 2014 federal income tax return in 2015. You will report minimum essential coverage, report exemptions, or make any individual shared responsibility payment when you file your 2014 federal income tax return in 2015." (Internal Revenue Service [IRS])
How to Create a Benefits Plan That Appeals to the Young and Cool
"Millennials care about their benefits.... Millennials want to choose what type of coverage they get.... Millennials have competing benefit offers; they need to be courted.... Millennials want real-time, instant information ... But they also crave face-to-face mentorship.... Insurance Cards will no longer do the trick." (Forbes)
Obama to Allow Two-Year Renewal of Old Health Insurance Policies
"Americans who kept their health plans that didn't comply with Obamacare requirements will be able to renew those policies for two more years, according to a person familiar with the matter. The Obama administration, which has been deliberating the issue since November, is expected to announce today the extension of the health plans, said the person, who asked not to be identified because the decision wasn't yet public." (Crain's Chicago Business)
[Guidance Overview] IRS Offers Health Care Tax Tips to Help Individuals Understand Tax Provisions in the ACA
"The IRS has designed the Health Care Tax Tips to help people understand what they need to know for the federal individual income tax returns they are filing this year, as well as for future tax returns. This includes information on the Premium Tax Credit and making health care coverage choices. Although many of the tax provisions included in the law went into effect on Jan. 1, 2014, most do not affect the 2013 tax returns." (Internal Revenue Service [IRS])
Financial Planning Considerations for Same-Sex Couples After Windsor (PDF)
"As a result of the new ruling, employee benefits and financial planning strategies once available only to opposite-sex married couples may now be available to same-sex married couples. This paper highlights several of the changes that have taken place, and details how same-sex couples may wish to incorporate them into their financial planning." [Includes a checklist.] (Prudential Retirement)
Text of District Court Opinion Finding that SPD Description of Conversion Rights Not Mandated by ERISA (PDF)
"Plaintiff argues that plan participants would not ... understand that 'conversion' referred to the ability to change a group policy into an individual life insurance policy. Unfortunately for Plaintiff, the provisions in the SPD about the conversion privilege are indisputably written in a user-friendly manner with clear language. Even if this were not true, Plaintiff cannot establish that Defendants committed any violation of their ERISA duties with respect to the SPD. The statute simply does not require that the SPD even include notification to participants and beneficiaries of any conversion rights." [Prouty v. The Hartford Life and Accident Insurance Co. and C&S Wholesale Grocers, No. 12-cv-12097-MAP (D. Mass. Feb. 12, 2014)] (U.S. District Court for the District of Massachusetts)
District Court Rules That SPD Can Be a Plan Document
"In a recent federal district court decision, the court concluded an SPD constitutes the plan document if there is no other plan document. The SPD precluded double dipping; the administrative services contract did not address the issue. The participant claimed that under Cigna v. Amara, the SPD could not be the plan document and that the plan document therefore had to be the administrative services contract. The federal district court disagreed, stating that if there is only an SPD, then the SPD is the plan document and it can be enforced." [L&W Associates Welfare Benefit Plan v. Wines, No. 12-cv-13424 (E.D. Mich. Jan. 13, 2014)] (Stinson Leonard Street)
Summary Plan Descriptions Used as Plan Documents Pose Risk
"Despite the risks associated with noncompliance, 66 percent of respondents said they have a formal compliance strategy and 69 percent said that they have teams devoted to governance, compliance, or to both ... Nearly a third of employers said that they have neither a governance nor a compliance team ... About half of the companies with a combined compliance and governance function or with one function or the other used their summary plan descriptions as plan documents[.]" (Bloomberg BNA)
HSAs Drive Greater Employee Health Engagement
"Employees and members of their families who are enrolled need to understand why it is important for them to take a more active role in managing their health and their health care spending. This usually requires communication focused on their role as a health care consumer. Once they understand their role, they also need access to resources that help them make informed health care decisions." (Idaho Business Review)
Balancing Wellness Programs and Employee Privacy
"From the beginning of any wellness campaign, an employer has to answer three important questions: [1] Why are employees being asked to share private health information? [2] How is the information protected? [3] What, if anything, will the employer do with the information once it is shared? ... [It] is the employers' imperative to clearly communicate how information will be used and for what purposes. If employers are not proactive with this communication, distrust around the program, and ultimately the employer, will develop." (Idaho Business Review)
The Little Sisters Case and EBSA Form 700
"It seems like a bureaucratic thing to do, but gaining an understanding of what it means to sign government form EBSA 700 is the key to a historic religious controversy now before the Supreme Court ... Signing that form, the federal government argues, is a simple way for a religious organization like the Little Sisters to avoid what they regard as a sin: providing contraceptives and other pregnancy-related services to their female employees. But signing, the Little Sisters counter, would be the very act of violating their faith by clearing the way for such services for those employees. In the government's view, that is a legal issue, easily resolved by a court. To the Little Sisters, it is a religious question, and only they can decide what their faith tells them about it. The Supreme Court may have to decide which it is, and soon." (SCOTUSblog)
Can Consumers Make Affordable Care Affordable? The Value of Choice Architecture
"Tens of millions of people are currently choosing health coverage on a state or federal health insurance exchange as part of the [ACA].... [The authors] conducted 6 experiments asking people to choose the most cost-effective policy using websites modeled on current exchanges.... Without interventions, respondents perform at near chance levels and show a significant bias, overweighting out-of-pocket expenses and deductibles. Financial incentives do not improve performance, and decision-makers do not realize that they are performing poorly. However, performance can be improved quite markedly by providing calculation aids, and by choosing a 'smart' default. Implementing these psychologically based principles could save purchasers of policies and taxpayers approximately 10 billion dollars every year." (E. J. Johnson, R. Hassin, T. Baker, A. T. Bajger, and G. Treuer, via PLOS [Public Library of Science])
Text of CMS Advice to Consumers on Using Health Insurance after Enrolling through the Marketplace (PDF)
"[If] you did sign up and your insurance card has not yet arrived your coverage may already be effective. If you need to see a doctor or get a prescription filled before you get your insurance card, call your insurer to confirm that your coverage is in fact effective.... All consumers must pay their premium after enrolling in a plan in the Marketplace. However, each insurance company sets their own payment deadline. Some insurers may accept your first payment after your coverage has become effective and pay for care you receive after January 1, 2014. Contact your insurer to find out when and how you need to make your payment and what flexibility they are able to give you." (Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services)
ACA Can Survive Low Enrollment and Adverse Selection in the First Year (PDF)
"If enrollment grows throughout 2014 as technical problems are overcome and outreach efforts continue ... competitive pressures are likely to dissuade insurers from ratcheting up premiums. In a competitive market, insurers must set premiums for 2015 based on expected enrollment in 2015, not based on any losses that occurred in 2014. Simply put, insurers cannot recoup losses without achieving significant market share, and achieving market share requires that they price their products competitively for expected enrollees in the coming year." (Urban Institute)
HR Spends More Time Educating About Benefits
"Despite competing priorities, one-third of HR professionals in the U.S. (32 percent) have increased the time they spend educating employees about workplace benefits ... Over the past two years, HR practitioners have spent significantly more time on activities related to their health care plans (61 percent of respondents), their company's 401(k) plan (38 percent), recruitment and layoffs (32 percent), and other compensation and employee-benefit-related issues (22 percent). The larger the company, the more likely it was that the HR professional put more time into these areas." (Society for Human Resource Management)
Healthier Wellness Communication
"Employees don't know nearly as much as they should about benefits packages, healthcare reform and wellness programs, according to the results of a [recent survey] ... [T]he most helpful ways to talk to employees about wellness involve more personal interaction with experts. According to the survey, only 13.8 percent of employees prefer a live presentation as a way to get information about their benefits." (Human Resource Executive Online)
[Guidance Overview] Many Annual Notice Requirements Apply to Employer Group Health Plans in 2014
Checklist and discussion of health plan notice requirements, including those under: Women's Health and Cancer Rights Act (WHCRA); Medicare Part D Notice of Creditable or Non-Creditable Coverage; HIPAA Notice of Privacy Practices; Children's Health Insurance Program Reauthorization Act (CHIPRA); Summary of Benefits and Coverage; and Notice Regarding Grandfathered Plan Status. (Miller Johnson)
What Employees Think About Your Benefits Communication (PDF)
"While the largest segment (29%) of employees said they preferred one-on-one interactions with their HR department, their employers most frequently use non-interactive, text-based formats such as email (62.5%), websites (53.5%), and direct mail (52.8%) to communicate benefits information.... [L]ess than one third (29.5%) actually understand that they're only able to change enrollment information during open enrollment or qualifying events.... When asked how important is it to include their spouses and partners when deciding which health plan to get, 71.5% say it's important or very important." (ALEX)
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