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Interim Final Regulations Could Mean Trouble for Grandfathered Health Plans
Excerpt: "Employers with grandfathered plans must analyze whether the benefit of being grandfathered is justified by the cost and administrative burden of maintaining grandfathered status. To do this, an employer must know which provisions of PPACA do and do not apply to grandfathered plans and which of those provisions are relevant to its own plan."
(Perkins Coie LLP)
Interim Final Rule on Appeal Process Changes from Health Care Reform (PDF)
6 pages. Excerpt: "The Rule also provides that where a plan or issuer does not 'strictly adhere' to these requirements, the claimant will be deemed to have exhausted the internal claims and appeals process and may immediately initiate an external review or pursue any available remedies, such as judicial review."
(Groom Law Group)
New Rules Cover Claim Appeals, External Reviews for Nongrandfathered Health Plans
The target page provides links to the 'Full Alert' on the new rules; Full text of PPACA rules on claims, appeals and external review; Full text of proposed excise tax rules from the IRS; Full text of news release on new rules from HHS; Full text of fact sheet on new rules posted on Healthcare.gov; and, Full text of NAIC model external review standards.
New Mental Health 'Safe Harbor' Gives Health Plans Some Breathing Room
Excerpt: "Until final rules are issued, the enforcement safe harbor will allow health plans to split their outpatient classifications (in-network and out-of-network) into two subclassifications: office visits and all other outpatient items and services."
More Employers Peg Workers' Insurance Premiums to Health Status
Excerpt: "As companies put the final touches on their health care plans for 2011, more of them say they are planning to penalize workers who decline to participate in disease management or lifestyle behavior programs, who smoke, or who do not take part in voluntary health screenings offered by an employer."
Americans Cut Back on Visits to Doctor
Excerpt: "The drop in usage is showing up as health-care companies report financial results. Insurers, lab-testing companies, hospitals and doctor-billing concerns say that patient visits, drug prescriptions and procedures were down in the second quarter from year-ago levels."
(The Wall Street Journal)
Health Research Group Promotes Employer Self Insurance
Excerpt: "Employers should consider taking advantage of the additional claims data available and potential for additional employee wellness programs and self-insure their health care plans, a research group says."
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Benefits in General; Executive Compensation
Feds Could Lose Talent Without Same-S.ex Leave, Benefits, Report Says
Excerpt: "Almost two-thirds of Fortune 1000 companies and 83 percent of Fortune 100 companies offer leave and other benefits to such employees, while the federal government is hamstrung by the Defense of Marriage Act, prohibiting recognition of same-s.ex marriage and proscribing benefits to such couples, according to CRS."
(Thompson Publishing Group Inc.)
Webcasts and Conferences
Employers Forum Workshop
in New York on September 7, 2010
presented by U.S. Department of Labor, Employee Benefits Security Administration (EBSA)
Newly Posted Employee Benefits Jobs
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