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BenefitsLink Health & Welfare Plans Newsletter
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[Official Guidance]
Text of HHS/DOL/IRS Proposed Regs on Required Summary of Benefits and Coverage (PDF)
34 pages, as published in today's Federal Register. "These regulations generally propose standards for group health plans (and their plan administrators), and health insurance issuers offering group or individual health insurance coverage, that will govern who provides [a summary of benefits and coverage, or 'SBC'], who receives an SBC, when the SBC will be provided, and how it will be provided. The Departments invite comment . . . ."
(U.S. Internal Revenue Service / Employee Benefits Security Administration / Centers for Medicare & Medicaid Services)
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6th Annual Obesity and Wellness Congress [Advert.]
Convening providers, payers, employers and public purchasers, the 6th Annual Obesity and Wellness Congress will discuss preventative and collaborative solutions to reverse the nationwide epidemic of obesity.
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[Official Guidance]
Proposed Template for the Summary of Benefits and Coverage (PDF)
57 pages, as published in today's Federal Register. "The proposed summary form and glossary were developed through a public process led by the National Association of Insurance Commissioners (NAIC) and a working group composed of stakeholders."
(U.S. Employee Benefits Security Administration)
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[Guidance Overview]
Guidance on Purchasing Health Coverage in an Insurance Exchange (PDF)
"Though neither set of rules has a direct impact on large employers, the rules have some implications for large employers under the so-called 'employer shared responsibility' requirements. In addition, the preamble to the proposed Treasury regulations includes several statements regarding rules that are expected to be included in forthcoming guidance on the employer shared responsibility and other related rules."
(Sutherland Asbill & Brennan LLP)
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[Guidance Overview]
California Supreme Court Limits Plaintiff's Recoverable Economic Damages for Medical Expenses
"The California Supreme Court reversed the Court of Appeal and concluded that 'an injured plaintiff whose medical expenses are paid through private insurance may recover as economic damages no more than the amounts paid by the plaintiff or his or her insurer for the medical services received or still owing at the time of trial.'"
(Snell & Wilmer L.L.P,)
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[Guidance Overview]
Proposed Rule Implements the Affordable Care Act's State Exchanges
"Although the primary audiences for this proposed rule are the states that intend to establish Exchanges and the health insurance issuers that are likely to sell coverage through the Exchanges, the proposed rule asks for comments on many aspects of how employers would interact with the Exchanges."
(The Segal Group, Inc.)
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Register for our Exclusive Webcast [Advert.]
Michele Levine, Director of Global Benefits, Avon Products, will provide information about how Avon leveraged the Extend Health Medicare exchange to deliver health care insurance choice, savings and satisfaction to its Medicare-eligible retirees. Register now.
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[Guidance Overview]
New Summary of Benefits and Coverage Rules: Five Months Late
"[F]or a calendar year plan, [as a practical matter] an employer will need to make all plan design decisions, including plan and contribution changes, by early to mid-October in order to communicate with employees by no later than November 1st."
(Gary Kushner's Benefits Blog)
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[Guidance Overview]
Guidance Provided on Summary of Health Benefits and Coverage
"Plan sponsors should begin to consider the process by which they will prepare and communicate SBCs by the March 23, 2012, deadline and pay close attention to any changes in the final guidance, which will be issued in the next several months."
(Ballard Spahr LLP)
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More Detail Needed on New Health Care Benefit Summaries
"For instance, the examples make no distinction between costs employees would pay depending on whether the service was delivered in or out of network . . . . In addition, requiring employers to use government-set figures, which presumably would be national averages, could end up confusing employees if a particular employer's costs are different, which is likely since costs vary greatly across the country."
(Business Insurance)
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Lawsuit Highlights Trend of States Forcing Employers to Disclose Confidential Employee Medical Data
"The Liberty Mutual Insurance Company recently filed suit under [ERISA] seeking an injunction against the State of Vermont's subpoena requesting that the company turn over confidential and sensitive information on individual participants enrolled in the company's health plan. As part of the state's effort to create a 'unified health care database,' Vermont wants the participants' 'name, gender, date of birth, city zip code, social security number, as well as the following information . . . ."
(HR Policy Association)
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Lower Utilization Ups Health Insurers' Earnings
"Revenues for the top seven U.S. managed care firms increased an average of 5.1% vs. the first half of last year. Six posted higher net income during the first half, while five increased their enrollment, according to company documents . . . ."
(Business Insurance)
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FSA Advocates Push to End Cap on Contributions
"Under the provision in the Patient Protection and Affordable Care Act, contributions employees can make to their FSAs will be limited to $2,500 starting in 2013. In succeeding years, the annual limit will rise in tandem with increases in the Consumer Price Index."
(Business Insurance)
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Press Releases
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Jeanette Hull, News Editor
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Holly Horton, Business Manager
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