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<< Older News  |  December 5, 2020


All News > Health Plan Design

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Access to Employer-Sponsored Health Coverage for Same-Sex Spouses: 2020 Update
Henry J. Kaiser Family Foundation Link to more items from this source
Dec. 4, 2020

"[As] of mid-2020, while employer offer of same-sex spousal coverage has increased over time, it remains less common than opposite sex spousal coverage. These increases follow two other Supreme Court rulings (United States v. Windsor and Obergerfell v. Hodges) which guaranteed the right to marriage nationwide and paved the way for wider access to health insurance through the workplace[.]"

Tags: Domestic Partner or Same-Sex Benefits  •  Health Plan Design

Actors Sue SAG-AFTRA Health Plan; 12,000 to Lose Coverage
National Public Radio [NPR] Link to more items from this source
Dec. 4, 2020

"The plaintiffs say that nearly 12,000 people will lose their health care next month -- about a third of those participating in the union's plan. Moreover, they say, many of those losing coverage are senior citizens who in many cases have paid into the plan for decades. Members will have to prove earnings of at least $25,950 to get health coverage through the union. Under the new rules, however, that income cannot include pensions or residuals[.]"

Tags: Health Plan Costs  •  Health Plan Design

Health and Welfare Benefits: 2020 Year in Review (PDF)
Alston & Bird Link to more items from this source
[Guidance Overview]
Dec. 3, 2020

35 presentation slides. Topics: [1] Legislative Developments; [2] Regulatory Developments -- Non-COVID: Final Health Plan Transparency Rules, ICHRA Final Rule and Follow-up Guidance on Pay-or-Play and Non-Discrimination Requirements, DOL Electronic Disclosure Rule (for qualified plans), New SBC requirement for 2021, 2021 NBPP (includes some important HSA guidance re: coupons), Direct Primary Care, and Grandfather Rule Relief; [3] Misc. Sub-Regulatory Developments: 2021 Cost-of-living Adjustments for Popular Benefits; [4] Health Plan Litigation Developments; [5] Recap of Coronavirus Impact on Employer H&W Benefits; [6] State Law Potpourri; [7] Cafeteria Plan, Grace Period, and Carry-Over Relief; and [8] COBRA, Claims and Appeals, and Special Enrollment Extensions.

Tags: COBRA  •  Coronavirus (COVID-19)  •  Health Plan Administration  •  Health Plan Design

Text of CMS Draft 2022 Actuarial Value Calculator Methodology (PDF)
Center for Consumer Information & Insurance Oversight [CCIIO], Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS] Link to more items from this source
[Official Guidance]
Dec. 3, 2020

24 pages. "The AV Calculator represents an empirical estimate of the AV calculated in a manner that provides a close approximation to the actual average spending by a wide range of consumers in a standard population. This document is meant to detail the specific methodologies used in the AV calculation.... The draft 2022 AV Calculator is available [online].... [T]he 2022 AV Calculator does not affect any 2021 plans, and will only be applicable for 2022 plans.... [CMS] will accept comments on the draft 2022 AV Calculator, as well as the draft 2022 AV Calculator User Guide and the draft 2022 AV Calculator Methodology until ... December 24, 2020."

Tags: Health Plan Costs  •  Health Plan Design

CMS Looks to Permanently Expand Telehealth Services
FierceHealthcare Link to more items from this source
Dec. 3, 2020

"The Trump administration added more than 60 telehealth services that will be reimbursable during the public health emergency caused by the COVID-19 pandemic. Those changes to telehealth coverage will also be allowed permanently in rural areas."

Tags: Health Plan Design  •  Medicare  •  Teleheath

Ninth Circuit Rejects Dialysis Provider's Challenge to Plan's Reimbursement Provisions Under Medicare Secondary Payer Rules and ERISA
Thomson Reuters Practical Law Link to more items from this source
Dec. 2, 2020

"The Ninth Circuit dismissed the provider's claims, concluding that: [1] The provider's claim for benefits, which it brought as the beneficiary's assignee, was based on the alleged MSP violation. [2] The provider could not bring a claim for equitable relief under ERISA because the assignment form did not include an assignment of equitable claims." [DaVita Inc. v. Amy's Kitchen, Inc., No. 19-15963 (9th Cir. Nov. 24, 2020)]

Tags: Health Plan Design

To Reform Health Insurance, Let Employees Be in Charge
The Federalist Link to more items from this source
Dec. 2, 2020

"A recent survey ... found that about one in six (15 percent) employers are planning to offer or considering the HRA option, with larger employers expressing an even stronger interest. It makes every sense that they should do so, given the widespread benefits: employers gain predictability in health-care costs, while workers gain a bigger choice of plans and coverage they can take with them from job to job.... The HRA regime seems far preferable to the well-intentioned, albeit bureaucratic and clunky, regime outlined in the AEI paper."

Tags: Health Plan Design  •  Health Plan Policy

Restore Preventive Health Care During COVID-19
Moss Adams LLP Link to more items from this source
Dec. 1, 2020

"This disruptive period provides a rare opportunity for health plans and providers to partner in targeted areas of benefit to members, patients, and communities. In particular, working together to strengthen patients' sense of value and trust in preventive and chronic care while maintaining COVID-19 safety precautions will be critical to reducing preventable morbidity and mortalities, as well as unnecessary costs."

Tags: Coronavirus (COVID-19)  •  Health Plan Design

Prepare for the Big Reset in Benefits
HUB International Link to more items from this source
Dec. 1, 2020

"2021 is destined to be the Year of the Big Reset as employers and employees adjust to what the coronavirus has brought about in terms of needs and expectations.... [1] The reset on health plans -- and benefit programs ... [2] The growing need for mental health and financial wellness support ... [3] Focus sharpens on COVID vaccines and specialty drug cost pressure continues."

Tags: Coronavirus (COVID-19)  •  Health Plan Design

Supreme Court Hears Oral Arguments on Latest ACA Case
Frost Brown Todd LLC Link to more items from this source
Dec. 1, 2020

"The Supreme Court decided to take the latest constitutional challenge to address four legal questions: [1] Whether Texas and the individual plaintiffs have standing to bring the lawsuit to challenge the individual mandate. [2] If the plaintiffs have standing, whether the TCJA rendered the individual mandate unconstitutional. [3] If unconstitutional, whether the remaining portions of the ACA can survive. [4] If the entire ACA is found to be unconstitutional, whether the entire law should be unenforceable nationwide or whether it should be unenforceable only to the extent that provisions injure the individual plaintiffs." [California v. Texas, No. 19-840; Texas v. California, No. 19-1019 (cert. pet. granted Mar. 2, 2020; oral arg. Nov. 10, 2020)]

Tags: Health Plan Design  •  Health Plan Policy

The Best Employee Perks That Actually Help Retention
Nerd's Eye View Link to more items from this source
Nov. 30, 2020

"[K]eeping employees happy is a function of not only having meaningful work to do, but also compensating them appropriately for that work. In recent years, this has led to an ever-growing number of 'perks' that firms offer employees to keep them happy, from retirement benefits to health insurance, to education reimbursement to student loan support, and gym memberships, and employer-provided meals. But in the end, employers can't just pile on a never-ending stream of employee benefits and perks in the hopes that it will help employees to retain; at some point, the question becomes: what are the best 'perks' and employee benefits that really, actually help to retain employees?"

Tags: Health Plan Design  •  Misc. Benefits  •  Retirement Plan Design

Text of HHS Proposed Notice of Benefit and Payment Parameters for 2022 and Pharmacy Benefit Manager Standards; Updates to State Innovation Waiver (Section 1332 Waiver) Implementing Regs
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS] Link to more items from this source
[Official Guidance]
Nov. 30, 2020

395 pages. "This proposed rule sets forth payment parameters and provisions related to the risk adjustment program; cost-sharing parameters and cost-sharing reductions; and user fees for Federally-facilitated Exchanges and State-based Exchanges on the Federal platform. It includes proposed changes related to special enrollment periods; Navigator program standards; direct enrollment entities; the administrative appeals processes with respect to health insurance issuers and non-federal governmental group health plans; the medical loss ratio program; acceptance of payments by issuers of individual market Qualified Health Plans; and other related topics. It proposes clarifications to the regulation imposing network adequacy standards with regard to Qualified Health Plans that do not use provider networks. It proposes changes to the regulation requiring the reporting of certain prescription drug information by qualified health plans or their pharmacy benefit managers. It also proposes a new direct enrollment option for Federally-facilitated Exchanges and State Exchanges. This proposed rule also proposes changes related to section 1332 State Innovation Waivers." [Also see: Fact Sheet and Press Release]

Tags: Health Plan Administration  •  Health Plan Design  •  Health Plan Policy

The 2022 Proposed Payment Notice: Exchange Provisions
Katie Keith, via Health Affairs Blog Link to more items from this source
[Guidance Overview]
Nov. 30, 2020

"In the proposed rule's most dramatic change, CMS would allow states to opt into an Exchange Direct Enrollment (Exchange DE) option where states could transition away from a single, centralized exchange ( to enrollment via private sector entities (insurers, web-brokers, and agents and brokers)."

Tags: Health Plan Administration  •  Health Plan Design

The 2022 Proposed Payment Notice: Medical Loss Ratios, Special Enrollment Periods, and More
Katie Keith, via Health Affairs Blog Link to more items from this source
[Guidance Overview]
Nov. 30, 2020

"CMS proposes to amend the definition of prescription drug rebates and other price concessions in its MLR formula.... The 2022 proposed payment notice includes no changes regarding the coverage of essential health benefits (EHB) and instead merely lays out timelines for state reporting.... CMS proposes a series of changes to special enrollment periods (SEPs) for exchange enrollees who become newly eligible for APTC and for those who are eligible for a SEP but did not receive timely notice of the triggering event. CMS also addresses the cessation of employer contributions to COBRA."

Tags: COBRA  •  Health Plan Administration  •  Health Plan Design  •  Prescription Drug Costs

Group Health Plan Sponsors and the COVID-19 Vaccine
Segal Link to more items from this source
Nov. 24, 2020

"There will be a phased-in distribution process initially targeting health care providers and vulnerable groups. Once a vaccine is approved, most group health plans will have to cover it (and related administration costs) within 15 days, at no cost. There are significant legal issues involved in addressing whether employers can mandate that employees receive vaccinations, and there is no guidance at this time on the COVID-19 vaccine."

Tags: Coronavirus (COVID-19)  •  Health Plan Design

What Are We Trying to Prevent Anyway? The Evolution of Preventive Services
Milliman Link to more items from this source
Nov. 20, 2020

"Preventive services are a key component of many health insurance plans. The introduction of the [ACA] brought about many legislative changes intended to improve the health of people in the United States. One such change was the introduction of mandatory coverage with no cost sharing for services determined to be preventive. Historically, preventive service status has been determined based on clinical evidence. This paper examines the evolution and future of preventive services."

Tags: Health Plan Design  •  Health Plan Policy

Managing Use of Health Care Services After People Satisfy Their Deductible: What Do Copayments and Coinsurance Do?
Employee Benefit Research Institute [EBRI] Link to more items from this source
Nov. 20, 2020

"Coinsurance reduces use of inpatient care and specialist physician office visits more than copayments do. However, while most employers already use coinsurance for inpatient care, only 44 percent use coinsurance for office visits.... [E]mployers seeking to manage use of health care services and spending -- especially among high users of health care services -- may look to moving from copayments to coinsurance for office visits as a way to do so."

Tags: Health Plan Costs  •  Health Plan Design

Better Prediction of Rising Health Spending to Improve Cost Containment
National Institute for Health Care Management [NIHCM] Link to more items from this source
Nov. 20, 2020

"Spending patterns over two years were best described by classifying patients into five groups: minimal users comprised 11 percent of the population; low-, moderate- and high-cost patients accounted for 15, 25, and 41 percent, respectively; and patients with rising costs were 8 percent of the population.... Across patients with similar baseline spending, the odds of subsequently incurring rising spending were higher for patients using fewer medications, having fewer office visits, seeing a larger number of different physicians and using tobacco. These factors suggest patients to target for intervention."

Tags: Health Plan Administration  •  Health Plan Costs  •  Health Plan Design

Loss of Jobs with Health Coverage During the Pandemic Reveals Significant Industry Differences (PDF)
Employee Benefit Research Institute [EBRI] Link to more items from this source
Nov. 20, 2020

"Manufacturing workers were most affected by loss of jobs with employer health insurance because manufacturing has one of the highest rates of ESI coverage (66 percent). ... [B]ecause only 40 percent of workers in retail had ESI prepandemic, these workers accounted for 12 percent of lost jobs with ESI."

Tags: Coronavirus (COVID-19)  •  Health Plan Design

Mental Health and Substance Use State Fact Sheets
Henry J. Kaiser Family Foundation Link to more items from this source
Nov. 20, 2020

"The state-level facts sheets explore the prevalence of mental illness and substance use and related deaths, and access, affordability, and costs of care. Key findings include: ... [1] Average biweekly data for October 2020 found that 37.7% of adults in the U.S. reported symptoms of anxiety and/or depressive disorder, up from 11.0% in 2019. [2] The states with the highest percentage of adults reporting symptoms of anxiety and/or depressive disorder in October 2020 were New Mexico (43.7%), Nevada (42.6%), Kentucky (42.4%), Louisiana (41.4%), and California (41.2%)."

Tags: Health Plan Design

AMA Prescribes Actions to Ease Negative Effects of High-Deductible Health Plans
American Medical Association [AMA] Link to more items from this source
Nov. 19, 2020

"The new AMA policy encourages employers to: [1] Provide robust education to help patients make good use of their benefits to obtain the care they need. [2] Take steps to collaborate with their employees to understand employees' health insurance preferences and needs. [3] Tailor their benefit designs to the health insurance preferences and needs of their employees and their dependents. [4] Pursue strategies to help enrollees spread the costs associated with high out-of-pocket costs across the plan year."

Tags: Health Plan Costs  •  Health Plan Design

Persuasive Perks: A Simple Chart to Help Your Business Prioritize Employee Benefits
Principal Financial Group Link to more items from this source
Nov. 19, 2020

"The winning combination is probably a mix of established ideas (such as the bedrock of company health insurance) and new ones shaped by the pandemic (more flexible schedules). This simple chart organizes benefits into a hierarchy according to cost to the employer -- as well as tiers within each price level to show which benefits tend to be more foundational. This may help you set or adjust your priorities for 2021."

Tags: Health Plan Design  •  Misc. Benefits  •  Retirement Plan Design

Text of District Court Opinion Overturning DOL Advisory Opinion on Health Benefit Program Offered by Limited Partnership to Its Limited Partners (PDF)
U.S. District Court for the Northern District of Texas Link to more items from this source
Nov. 18, 2020

30 pages. "Because the Limited Partners are working owners and bona-fide partners, they may participate in the single employer welfare benefit plan set up by DMP, so long as DMP employs at least one common-law employee. Accordingly, [DOL Advisory Opinion 2020-01A] is set aside as arbitrary and capricious under the APA and contrary to law under ERISA and Defendants are ENJOINED from refusing to acknowledge the ERISA-status of the Plan or refusing to recognize the Limited Partners as working owners of DMP." [Data Marketing Partnership, LP v. DOL, No. 19-800 (N.D. Tex. Sep. 28, 2020)]

Tags: Health Plan Design

77% of Americans Unfamiliar with Proposals to Lower Medicare Age Link to more items from this source
Nov. 17, 2020

"For those ... ages 55 to 64, most are worried about their ability to afford health insurance before reaching the current Medicare eligibility age of 65. Fifty-seven percent of the employed group is worried ... Thirty-three percent of those employed and unemployed and under 65 are planning to reduce preventive care appointments and/or everyday household purchases like groceries to afford health insurance before they reach 65.... Thirty-eight percent of the non-working group gets health insurance through either a former employer or a partner's employer[.]"

Tags: Health Plan Design  •  Medicare

The Implications of Eliminating Essential Health Benefits
Urban Institute Link to more items from this source
Nov. 17, 2020

"In this analysis, [the authors] ... estimate the shares of a typical nongroup insurance premium attributable to an array of different benefits. [They] also estimate the financial implications for people using those benefits should they be eliminated from the nongroup insurance benefit package."

Tags: Health Plan Design  •  Health Plan Policy

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