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BenefitsLink Health & Welfare Plans Newsletter
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[Guidance Overview]
Common Questions About HSA Contributions
"[An] employee's yearly contribution limit is prorated based on the period the employee is actually HSA-eligible. That is the general rule, often called the 'general monthly contribution rule.' By contrast, under the 'full-contribution rule' described [later in this article] an individual may be treated as HSA-eligible for the entire year and entitled to make contributions up to the annual maximum HSA contribution limit if the employee becomes covered by an HDHP in a month other than January and is HSA-eligible on December 1 of that year."
(Verrill Dana, LLP)
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[Guidance Overview]
Final IRS Regulations Clarify Premium Tax Credit Rules
"The regulations include clarifications to proposed guidance, including rules on whether coverage is affordable and the impact of automatic enrollment.... The final regulations address commenters' concerns that an individual could be automatically enrolled for minimum essential coverage under an employer-sponsored plan that is unaffordable or does not provide minimum value, and become ineligible for the premium tax credit."
(Practical Law Company)
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Twelve Health Reform 'Consumer Oriented and Operated Plans' Approved for 2014
"To date, a total of 12 Consumer Oriented and Operated Plans (CO-OPs) have been approved to receive repayable loans to help them establish private nonprofit, consumer-governed health insur.ance companies, the Centers for Medicare and Medicaid Services (CMS) has announced. The CO-OP plans were created by the Patient Protection and Affordable Care Act (ACA) to give consumers and small businesses more health insur.ance choices. Starting Jan. 1, 2014, CO-OPs will be able to offer health plans through Affordable Insur.ance Exchanges in each state, as well as outside of an Exchange."
(Wolters Kluwer Law & Business / Health Reform Talk Blog)
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Voluntary Reporting By Employers Appears Critical to Exchanges
"The ability of the new health insur.ance Exchanges to make efficient and accurate determinations regarding an individual's eligibility for advance payment of premium tax credits appears dependent on the voluntary disclosure of real-time information by employers. The Department of Health and Human Services is asking for comments from the public on how best to establish a voluntary reporting system—and whether alternative data sources exist—to verify whether an individual has access to employer-sponsored coverage. For 2014 and 2015, a limited verification process is being proposed."
(Deloitte)
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Should The States Set Up ObamaCare Exchanges?
"Under the Patient Protection and Affordable Care Act (PPACA), state governments are expected to set up health insur.ance exchanges through which individuals will buy their own health insur.ance, in many cases with substantial subsidies. Should the states comply? ... More than half the states have already decided not to operate the new federally funded risk pools—which make health insur.ance available to people who have been denied coverage for a pre-existing condition—for the same premium healthy people would pay."
(John Goodman's Health Policy Blog)
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Value-Based Insur.ance Design Resulted in More Patients Following Doctors' Orders
"Objectives: To determine whether participation in a value-based insur.ance design (VBID) program was associated with improved medication adherence ... Results: VBID was associated with improved medication adherence ranging from 1.4% to 3.2% at 1 year, which increased to 2.1% to 5.2% 2 years following VBID adoption.... Following principles of VBID, ... copayments [are set to be] lower for medications that are more effective or more cost-effective than other medications in the same drug class. An alternative VBID approach [reduces] cost sharing for certain populations of patients or subgroups who are most likely to benefit from improved access to treatment."
(American Journal of Managed Care)
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Some Large Employers Look to Direct Contracting With Doctors
"Though there is no official count of the number of employers engaged in direct contracting, people in the industry say interest is growing. Employers' direct contracts vary in scale. For some large employers, such as Lowe's, the home improvement chain, direct contracting has created a niche side benefit for employees. Lowe's reached a deal that allows employees and their dependents to be transported to Cleveland Clinic for heart surgery at no out-of-pocket cost."
(American Medical Association)
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Poll: What It's Like to Be Sick in America
"3 of 4 people who were sick said cost is a very serious problem, and half said quality is a very serious problem. Nearly half of those with recent serious illness say they felt burdened by what they had to pay out of their own pocket for care."
(National Public Radio)
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How Mobile Devices Are Transforming Health Care (PDF)
"[Mobile] technology is poised to alter how health care is delivered, the quality of the patient experience, and the cost of health care. Mobile technology is helping with chronic disease management, empowering the elderly and expectant mothers, reminding people to take medication at the proper time, extending service to underserved areas, and improving health outcomes and medical system efficiency. In this report, ... [Darrell M. West of the Brookings Institution] review adoption of innovative examples of m-health, its impact on service delivery and medical treatment, and how mobile devices are saving money in the health care system."
(Brookings Institution)
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Joint Study by Consumer Groups and Unum Shows Importance of Disability Insur.ance
"A new study conducted by the Consumer Federation of America, a nonprofit coalition of consumer groups that supports expansion of employer-provided disability insur.ance, and Unum, a disability insur.ance provider, revealed that two-thirds of Americans who work in the private sector lack disability insur.ance. This fact is startling considering that most respondents said missing work for three months or more due to sickness or injury would cause them financial hardship,"
(Insur.ance News)
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Health Care Costs Are Top Concern During 'Small Business Week'
"In highlighting the high cost of coverage for small businesses, the [National Federation of Independent Business (NFIB)] offered these solutions for lowering the cost health insur.ance: Defined contribution plans, Equal tax treatment in the individual market, Insur.ance portability, Interstate markets for health insur.ance, Malpractice reform."
(Fox Business)
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L.B.J.'s Goal Not Yet Attained: Medicare Not Preventing Financial Burden of Geriatric Health Care
"When President Lyndon B. Johnson signed Medicare into law in 1965, he noted that its benefits to older Americans were not only medical, but financial: 'No longer will illness crush and destroy the savings that they have so carefully put away over a lifetime.' Fifty years later, Dr. Amy Kelley, a geriatrician at Mount Sinai School of Medicine in New York, has amassed disheartening evidence that L.B.J. was wrong.... During their final five years, 18 percent of [the elderly people studied] ran up out-of-pocket expenses greater than their total assets. If you exclude their houses (the kind of asset you can't easily use to pay for drugs or doctors), a full 33 percent owed more in medical expenses than they had in assets."
(The New York Times; free registration required)
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Tracking Implementation of the Affordable Care Act by the States
"[A] comprehensive monitoring and tracking project to examine the implementation and effects of the ACA in ten states. Derived from site visits and extensive interviews with state officials and health care stakeholders, this series of reports documents each state's progress in establishing an exchange, implementing insur.ance reforms, and preparing for an expansion of Medicaid."
(Urban Institute)
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Federal Health Care Reform's Mandates Didn't Work Well at State Level
"A new study ... examines the experience of eight states ... that adopted the two basic pillars of the Obama plan in the 1990s. Those two measures are Guaran.teed Issue, and Community Rating.... All eight states encountered similar problems. People who'd been previously uninsured bought coverage as soon as they suffered a heart attack or contracted diabetes. Pregnant women entered the plans, then dropped out after giving birth. Premiums for young, healthy people soared. Typically, a 60-year old's medical care runs about six times that of someone in their twenties. But in New York, insurers must charge exactly the same premiums for both. For many years, Maine limited the difference to just 20%. So the young Americans needed to make the plans work mostly dropped out. Instead of shrinking the ranks of the uninsured -- the goal touted by the states -- their numbers often increased."
(Fortune Magazine)
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Unintended Consequences of Enacting Insur.ance Market Reforms Without an Individual Mandate
"The Health Care Reform Act Kentucky passed in 1994 guaran.teed access to coverage for all consumers without regard to pre-existing medical conditions and premiums could not be varied based on a person's health status. The law did not require all individuals to purchase health care coverage, providing a powerful incentive for people to wait to purchase coverage until after they need medical care. As a result of these reforms, individuals' insur.ance premiums skyrocketed, in some cases over 100 percent, and the number of uninsured Kentuckians did not meaningfully decrease."
(AHIP Coverage)
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Health Plan's Network Policy Was Clear Enough to Ward Off ERISA Claims
"Rejecting a plan participant's claims that plan documents should specifically list in-network providers, the 7th U.S. Circuit Court of Appeals held that a plan clearly providing information on how to check for provider status was sufficient to escape benefits-denial and fiduciary-breach claims.... [T]he court also rejected an argument that call center representatives did not confirm provider status, finding that such poor communication does not per se create a fiduciary violation. [But] the appeals court raised the possibility of higher statutory penalties arising from the plan's violation of ERISA disclosure requirements." [Killian v. Concert Health Plan (7th Cir., April 19, 2012).]
(Thompson SmartHR Manager)
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Eighth Circuit Disability Case Addresses Meaning of 'Regular Occupation' and Language Needed to Confer Discretion
"In determining the claimant's 'regular occupation' or 'own occupation,' does the [disability] Plan have to rely on 'actual job duties,' or may it rely on the Department of Labor's generic definitions contained in the Dictionary of Occupational Titles [DOT]? In the absence of a more precise definition, [the 8th Circuit said] 'Regular Occupation' could be interpreted as referring to duties that are commonly performed by those who hold the same occupation as defined by the DOT, or the duties the specific claimant actually performed[.]'" [Hankins v. Standard Insur.ance Company (8th Cir. May 14, 2012).]
(Lane Powell)
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Fee Disclosure FAQs Ease Some SBC Rules (PDF)
"[The electronic distribution] safe harbor does not appear to be a temporary transition approach and should be available in future years. However, because this safe harbor is only available 'in connection with online enrollment,' apparently it cannot be used by plan sponsors that provide an option for paper or telephone enrollment in addition to online enrollment. In other words, in those situations, paper delivery appears to be required."
(Buck Consultants)
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Guide to HHS Surveys and Data Resources
The Guide to HHS Surveys and Data Resources is a compilation of information about all major data collection systems sponsored by the U.S. Department of Health and Human Services, including health status and behaviors; health care access; resources, utilization and expenditures; insur.ance coverage and financing; and social determinants of health and quality of care.
(Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services)
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American Academy of Actuaries Affirms Concerns Set Forth by Actuaries in Official Report of Medicare's Financial Condition (PDF)
"Because Medicare plays a critically important role in ensuring that older and certain disabled Americans have access to health care, the American Academy of Actuaries' Medicare Steering Committee urges action to restore the long-term solvency and financial sustainability of the program. The sooner such corrective measures are enacted, the more flexible the approach and the more gradual the implementation can be. Failure to act now will necessitate far more drastic actions later."
(American Academy of Actuaries)
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Two Medical Conditions Can Equal One FMLA Serious Health Condition
"[W]hen reviewing an employee's medical condition within the context of FMLA, the employer's focus should be on the cumulative, adverse effects of the related medical conditions afflicting the employee at the time she seeks leave from work. In a nutshell, two can equal one."
(FMLA Insights)
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[Opinion]
3 Reasons Why Card-Carrying Capitalists Should Support Paid Family Leave
"[Every] card-carrying capitalist should support paid family leave public policy because: [1] Paid family leave acknowledges and addresses a reality that directly impacts every business and, therefore, should be planned for strategically, uniformly and deliberately; [2] Paid family leave is NOT a tax, but income replacement insur.ance program funded by employees at minimal cost and [3] We are paying for a cost for caregiving already, albeit indirectly and inefficiently."
(Forbes)
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[Opinion]
Skipping Prostate Test Can Kill
"[A]ren't patients better advised to get the facts first and then the counseling if needed, rather than being discouraged from finding out whether they have cancer in the first place? The task force's approach seems based on the theory that what you don't know can't hurt you. Well, it can."
(USA TODAY)
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[Opinion]
Prostate Cancer Screening's False Promise
"Hospitals, medical practices, fraternities, politicians, radio and TV stations and even an adult diaper manufacturer have sponsored mass screenings. Men who attend them are rarely informed of the risks of screening and are often promised unproven benefits. These two decades of mass screening are estimated to have caused more than 1 mil.lion American men to receive unnecessary treatment causing numerous common side effects[.]"
(CNN)
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Benefits in General; Executive Compensation
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[Guidance Overview]
Loss Causation in ERISA Lawsuits Alleging Breach of Fiduciary Duty (PDF)
"If a hypothetical prudent fiduciary could have made the same decision that the fiduciary actually made, the loss was not caused by the fiduciary's imprudence, and the fiduciary is not liable for the loss. The U.S. courts of appeal are divided on the question of whether the burden of proof regarding loss causation falls on the plaintiff or the defendant.... [Two] federal appellate courts have adopted a common-law rule under which the burden is on the defendant to prove that the loss was not caused by the defendant's breach of fiduciary duty. The application of this common-law rule is unjustified: although the courts are authorized to develop federal common-law rules under ERISA, ERISA does not authorize the courts to adopt common-law rules that conflict with the provisions of the statute."
(John M. Vine, Esq. of Covington & Burling, in BNA Insights)
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[Guidance Overview]
Proposed New York State Regs Could Limit Certain Executive Compensation Arrangements (PDF)
"On May 16, 2012, Governor Andrew Cuomo announced the issuance of proposed regulations by thirteen New York State ... agencies that would impose significant executive compensation and administrative expense spending limits on not-for-profit and for-profit entities (as well as certain individuals) that receive specified levels of State funds or State-authorized payments of funds ... These proposed regulations ... are scheduled to take effect on January 1, 2013 ... [and] would generally restrict covered entities and individuals from directly or indirectly spending more than $199,000 annually in State Funds on the 'executive compensation' of a covered executive [unless certain prescribed conditions are satisfied]."
(Bond Schoeneck & King)
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Press Releases
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