This webcast will examine the just-released grandfathered health plan regulations that determine whether health plans have to comply with the full scope of PPACA, or whether certain important provisions can be avoided. You'll learn the 12 main ways grandfathered status can be lost, special rules for collectively bargained plans and whether the law applies to retiree-only plans, dental, vision and more.
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[Official Guidance]
Fact Sheet: The Affordable Care Act's New Patient's Bill of Rights
Excerpt: "The new regulations will prohibit insurance plans from denying coverage to children based on a pre-existing conditions. This ban includes both benefit limitations (e.g., an insurer or employer health plan refusing to pay for chemotherapy for a child with cancer because the child had the cancer before getting insurance) and outright coverage denials . . . ."
(U.S. Department of Health & Human Services)
[Official Guidance]
Text of DOL Wage and Hour Division Administrator's Interpretation No. 2010-3: FMLA Definition of 'Son and Daughter'
3 pages. Excerpt: "It is the Administrator's interpretation that the regulations do not require an employee who intends to assume the responsibilities of a parent to establish that he or she provides both day-to-day care and financial support in order to be found to stand in loco parentis to a child. For example, where an employee provides day-to-day care for his or her unmarried partner’s child (with whom there is no legal or biological relationship) but does not financially support the child, the employee could be considered to stand in loco parentis to the child and therefore be entitled to FMLA leave to care for the child if the child had a serious health condition."
(Wage and Hour Division, U.S. Department of Labor)
[Official Guidance (DOL News Release)]
U.S. Department of Labor Clarifies FMLA Definition of 'Son and Daughter'
Excerpt: "The U.S. Department of Labor [on June 22] clarified the definition of 'son and daughter' under the Family and Medical Leave Act to ensure that an employee who assumes the role of caring for a child receives parental rights to family leave regardless of the legal or biological relationship."
U.S. Department of Labor
[Guidance Overview]
The Definition of 'Grandfathered Status' Under the New Health Care Reform
Excerpt: "A 'grandfathered plan' is a group health plan was in existence on the date of enactment of Health Care Reform, March 23, 2010. Regulations published June 14, 2010 provide guidance on what will cause an existing group health plan to lose grandfathered status."
(Troutman Sanders LLP)
Obama Warns Health Insurers Against Using Reform to Boost Premium Rates
Excerpt: "''Insurance companies ... shouldn't see it as an opportunity to enact unjustifiable rate increases,' Obama said ... ' He also 'said companies must publicly justify any rate increases on both the federal health Web site and their own sites, adding that there are 'genuine cost drivers that are not caused by insurance companies'' . . . ."
(Henry J. Kaiser Family Foundation)
Gains from Choice in Health Insurance
Excerpt: "The value of choice is explored in a recent study [titled: Let Them Have Choice: Gains from Shifting Away from Employer-Sponsored Health Insurance.]"
(National Bureau of Economic Research; paid subscription or individual purchase required to retrieve fulltext)
Tax Breaks for Employer-Sponsored Health Insurance
Excerpt: "This tax exclusion is extremely costly -- it reduces federal and state tax revenues by $260 Billion per year and is the government's third largest expenditure on health care, after Medicare ($400 Billion) and Medicaid ($300 Billion)."
(National Bureau of Economic Research; paid subscription or individual purchase required to retrieve fulltext)
Bariatric Surgery: The Benefits and Risks for Plan Sponsors (PDF)
Excerpt: "Recent studies demonstrate that bariatric surgery offers health benefits to many morbidly obese individuals, forcing increasing numbers of plan sponsors to consider covering it as part of the group medical plan. However, plan sponsors covering bariatric surgery should consider limiting their coverage to include only proven centers of excellence, as explained in this article."
(WorldatWork via Aon Consulting)
Senator Scales Back Proposed COBRA Subsidy Extension Plan
Excerpt: "Under the amendment that Sen. Casey proposed last week to tax extension legislation, employees laid off from June 1 through Nov. 30, would be eligible for the 65% federal premium subsidy for six months."
(Business Insurance)
Most Americans Say Paid Sick Days a Basic Worker's Right
Excerpt: "Researchers at the National Opinion Research Center at the University of Chicago found 75% of survey respondents consider paid sick days a basic worker's right, and 75% believe that employers should be required by law to provide paid sick days to workers."
(PLANSPONSOR.com)
High-Deductible Health-Insurance Plans Grow More Attractive to Employers
Excerpt: "High-deductible health plans and the health savings accounts (HSAs) that link to them are becoming a familiar fixture on the insurance landscape, even though they get mixed reviews from many consumers and health-policy experts."
(The Washington Post; free registration required)
Facing New Pressure, Health Plans Beef Up Customer Service
Excerpt: "Cutting inscrutable health-insurance jargon out of their communications. Opening retail stores to answer people's questions and offer wellness classes. Measuring customer-service efforts to give callers a better experience."
(MarketWatch, Inc.)
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Executive Compensation; Benefits in General
ERISA Plans' Ultimate -- and Criminal -- 'Prohibited Transaction' Rule
Excerpt: "We all have a general knowledge that kickbacks and racketeering schemes of any sort are illegal. But many do not realize that there is a specific 'anti-kickback' rule applying to ERISA plans that is NOT found in ERISA, but instead under criminal law."
(Business of Benefits)
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