[Guidance Overview]
Third Circuit Limits Relief Available to ERISA Welfare Plans Seeking Reimbursement of Medical Expenses
"The Third Circuit's ruling appears to depart from existing case law in two significant respects. First, the Court applied equitable considerations in circumstances where the plan provisions specifically addressed the reimbursement issue and were not found to be ambiguous. Second, using its equitable authority, the Court reformed the plan without finding that the conditions for reformation identified in Amara had been satisfied."
(Proskauer Rose LLP)
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American Health Care Congress and Exhibition [Advert.]
Bringing together the health care community to discuss strategies aimed at more efficient and effective operation of our health system post-reform. December 5-6, 2011, Anaheim, CA.
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[Guidance Overview]
DOL FAQs on Health Care Reform and the Mental Health Parity Requirements
"[R]egarding the FAQs addressing the MHPAEA, it should be noted that an exception to the nonquantitative treatment limits might permit some differences in practices, including preauthorization standards, based on recognized clinically appropriate standards of care."
(Practical Law Company)
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The Potential of Value-Based Insurance Design
"It seems that even . . . relatively slight improvements in adherence through the use of VBID resulted in gains in health outcomes. It is well known that adherence to drugs, such as statins, drops off over time in patients with asymptomatic disorders. The outcome of this study suggests that factors other than cost need to be considered for VBID to reach its full potential."
(HCPLive)
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Supreme Court Names Two Lawyers to Argue Points in Health Care Law
"The Supreme Court on Friday made two prominent Washington lawyers very happy and very busy, appointing them to argue on behalf of positions that neither side in the challenges to the 2010 health care law has chosen to embrace."
(The New York Times; free registration required)
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Medical Stop-Loss Insurers Warming Up to Wellness Programs
"Many stop-loss underwriters providing excess coverage will consider effective wellness and disease management programs in calculating premiums for specific stop-loss coverage, which pays claims of an individual plan member that pierce a certain deductible threshold, or aggregate stop-loss coverage, which pays when total actual claims exceed 125% of total expected claims."
(Business Insurance)
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Wellness Awards Shrink Health Care Costs
"In 'Energizing Workplace Wellness Programs: The Role of Incentives, Rewards & Recognition,' the IRF examines whether workplace wellness programs can play a significant role in reducing the largely preventable conditions brought on by the poor health choices that escalate U.S. health care costs, threatening to consume as much as 25 percent of GDP by 2025."
(Incentive Research Foundation)
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Democrats Urge Obama to Protect Contraceptive Coverage in Health Plans
"[A]fter protests by Roman Catholic bishops, charities, schools and universities, the White House is considering a change that would grant a broad exemption to health plans sponsored by employers who object to such coverage for moral and religious reasons."
(The New York Times; free registration required)
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Legal Questions and Answers That Will Decide the Health Law's Fate
"The challenge to the Affordable Care Act that the U.S. Supreme Court will consider this March involves a series of complex and inter-related legal questions. How the court views each one -- including the constitutionality of the law's individual mandate and Medicaid expansion, as well as the application of the Anti-Injunction Act and the question of severability -- will trigger a cascade of related decisions."
(The Henry J. Kaiser Family Foundation)
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Small Businesses Have New Tools in Choosing Health Insurance
"In addition to featuring information about new benefits in the law, HealthCare.gov also has a health insurance finder tool, which displays information about insurance plans with estimated base rates, doctor choices, number of applications that were denied, and other details that allow consumers to compare options. And as of today, this insurance tool includes private coverage options for small businesses: http://finder.healthcare.gov/."
(HealthCare.gov)
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Architect of Obama's Health Care Plan Fears a 'Political' Decision by the Supreme Court
"Jonathan Gruber, an M.I.T. professor and a key intellectual architect of President Obama's overhaul of the American health care system, said, 'You know, I think basically, what they've constructed, the Affordable Health Act, is the best possible private-sector solution to our problem of the uninsured that we have available, you know, short of single-payer.'"
(Capital New York Media Group, Inc. via Physicians for a National Health Program)
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Fifth Consecutive Month of Health Cost Increases in September
"Data released [November 17, 2011] by S&P Indices for the S&P Healthcare Economic Composite Index indicate that the average per capita cost of healthcare services covered by commercial insurance and Medicare programs increased by 5.75% over the 12-months ending September 2011."
(Healthcare Town Hall)
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[Opinion]
The 2012 Presidential Candidates and the U.S. Health Care System: A 'Plank' Summary
"[This] summary provides a current snapshot of the candidates and their various blueprints for reform. Our intent is to be thorough and accurate in compiling what they have said or indicated they will do. As plans take shape, CAHI will explain what the proposals really mean for our health care system and, most importantly, for Americans' access to affordable health insurance coverage. And we'll eliminate the 'spin' so you don't have to."
(Council for Affordable Health Insurance)
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[Opinion]
Leveraging Health Care Exchanges
"Unless the U.S. Supreme Court rejects the entirety of the healthcare-reform law, healthcare exchanges will become effective in 2014. And while some are fearful of the change, the shift could be a very good thing for employers and employees alike."
(Human Resource Executive Online)
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[Opinion]
The Conservative Case for Health Care Reform's Individual Mandate
"In fact, the only individuals who may actually be forced to do something they would not do voluntarily are those who can afford insurance but choose not to buy it. It is these individuals and families whose supposed rights to not have insurance are being defended by critics of the new law."
(Los Angeles Times)
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[Opinion]
Making Sense of Multiple Health Delivery System Reform Efforts
"The list of delivery system reform efforts that are currently being designed, planned, and implemented, in both public and private sectors, is impressive. We have patient-centered medical homes, health homes, accountable care organizations, initiatives to reduce avoidable rehospitalizations, programs to improve transitions to and from nursing homes, and health information exchanges, to name just a few."
(The Commonwealth Fund)
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[Opinion]
Health Care Costs and Unhealthy Politics
"The whole debt problem is growing medical costs. Yes, pretty much the WHOLE problem. The cost of health care is going up faster than inflation."
(The Washington Post; free registration required)
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Benefits in General; Executive Compensation
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[Guidance Overview]
ISS 2012 Policy Updates (PDF)
"On November 17, ISS issued updates to its U.S., Canadian, European and other international voting policies for the 2012 proxy season that will apply to all publicly traded companies with shareholder meetings on or after February 1, 2012."
(Frederic W. Cook & Co., Inc.)
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[Guidance Overview]
Upcoming Benefit Deadlines
Listed are deadlines from December 1, 2011, to January 31, 2012.
(The Law Firm of Baker & Daniels LLP)
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Press Releases
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