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BenefitsLink Health & Welfare Plans Newsletter
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[Guidance Overview]
HHS Regulations Would Require Benefit Information from Small Group Plans
"The regulations would ... Require the three largest small group insur.ance plans in a given state to report certain benefit and enrollment coverage and enrollment information to HHS, so that plans offered in the state will know how essential health benefits will be evaluated and provided. Propose recognizing two agencies on an interim basis, the National Committee for Quality Assurance (NCQA) and the Utilization Review Accreditation Commission (URAC), as the entities that will accredit qualified health plans."
(Practical Law Company)
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[Guidance Overview]
HHS Issues Proposed Rule on Essential Health Benefits Data Collection Standards
"The new proposed rule 'includes data reporting standards for health plans that represent potential state-specific EHB benchmarks,' i.e., standards that would apply to issuers of the largest three small group market products in each state. The stated purpose of the proposed rule is to 'collect sufficient information on potential benchmark plans' benefits to enable plans seeking to offer coverage in the individual or small group market in 2014 to know what benefits will be included in the EHB benchmark.' Among other information, the proposal would require the relevant insur.ance issuers to provide administrative data necessary to identify their health plans; data and descriptive information on certain health plans; data on any treatment limitations imposed on coverage; data on drug coverage; and plan enrollment data."
(Littler Mendelson LLC)
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[Guidance Overview]
Cafeteria Plan Relief for $2,500 Limit Too Late for Many Plans
"Until [IRS Notice 2012-40], 'taxable year' was not defined. Therefore, the most conservative/cautious approach would be to assume the limit applied to the calendar year (the participants' taxable year) irrespective of a cafeteria's plan year and under normal cafeteria plan rules, plans would need to be amended for the lower limit prior to the beginning of any plan year that begins in 2012 (and ends in 2013).... Unfortunately, there is no relief for plans that have been proactive. If a non-calendar year plan amended to lower its contribution limit to $2,500 early for ease of administration there is no guidance allowing plan participants to change their elections mid-year. It appears these plans must keep the $2,500 limit, as amended."
(Wolters Kluwer Law & Business / ftwilliam.com)
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More Health Plan Participants Checking Out Prices (PDF)
The latest Thomson Reuters-NPR Health Poll found that a 16 percent of Americans indicated they sought pricing information before receiving healthcare services, and of those who did, 49 percent received this information from insur.ance companies. This represents a significant shift from when respondents were asked the same questions in 2010, when only 11 percent said they sought such pricing information.
(Thomson Reuters)
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ML Strategies Health Care Reform Update, June 4, 2012
Weekly update on developments in federal and state health care reform legislation and regulations. Includes summaries of recent regulatory activity by HHS, CCIIO, IRS and CMS.
(Mintz, Levin, Cohn, Ferris, Glovsky and Popeo, P.C.)
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A Medicare Exchange Could Be Your Answer. [Advert.]
With the group model becoming increasingly unsustainable, how do you cut costs and still take care of your retirees? Discover the top 4 reasons organizations are exiting their Group Plan & moving to a Medicare Exchange.
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Health Care Tax Credit Receiving Lackluster Response from California's Small Businesses
"[O]ne of the measures of the [Affordable Care Act] that has already been implemented doesn't seem to be reaching its target audience. The provision is a tax credit aimed at helping small businesses afford pricey health insur.ance. John Arensmeyer, CEO of the Small Business Majority says in fact 57 percent of all small businesses in California do not know about the tax credits."
(Capital Public Radio)
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Segal's 2011 Study of State Employee Health Benefits Points to Need for Evaluating and Changing Plan Design
"Segal suggests ... Adding new case-management services that improve patient-discharge planning to reduce hospital readmission rates; Improving medication-adherence programs that keep employees on the most cost-effective drug therapies to help avoid complications from disease; Conducting dependent eligibility audits and revising enrollment processes to allow only qualified dependents into the plans; Renegotiating and bidding vendor contracts to obtain the most up-to-date market pricing and discounts; Auditing plan administrators for self-insured programs to identify processing and overpayment issues; Reviewing contribution strategies and varying contribution rates based on participation in healthy lifestyle programs (e.g., different rates for smokers and non-smokers), preferred plans or targeted wellness programs; Targeting wellness and disease management programs that are meaningful and highly engaging for employees and that help address the primary cost drivers; and Educating participants about how to make wise and healthy choices."
(The Segal Company)
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Positive Guidance on $2,500 Health FSA Cap Update for 2013 (And Some Maybe Even Better News) (PDF)
"The IRS ... stated in this guidance that it is considering changing the 'use it or lose it' rule to provide relief to employees and to lower or eliminate the risk of loss.... This is potentially the most exciting news to hit the FSA arena in years, but the specific form of the relief could significantly influence the extent to which employers would adopt any modification and employees would understand its value."
(Kushner & Company)
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Deloitte Health Care Reform Memo, June 4, 2012
Describes recent developments in various health plan and health insur.ance matters at the federal and state levels. This issue includes a discussion of the House Ways & Means Committee consideration of changes to flex and health savings accounts; HHS proposed rule on essential health benefits, which requires reporting from three largest plans in each state; and a GOP report that PhRMA support for ACA was based on deal to prevent drug importation.
(Deloitte Center for Health Solutions)
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Design and Implementation Considerations of ACA Risk-Mitigation Programs (PDF)
"Joint Academy/SOA research brief that summarizes the key findings and policy implications of a study, conducted by Milliman and sponsored by the SOA, of the risk mitigation programs under the Affordable Care Act (ACA) -- risk adjustment, reinsurance, and risk corridors"
(American Academy of Actuaries and Society of Actuaries)
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[Opinion]
Recent Post by Health Care Economics Blog Misleads the Supreme Court
"In a post at the Health Affairs blog, Jill Horwitz and Helen Levy propose to teach the Supreme Court justices Economics 101 in the matter of the constitutionality of the Patient Protection and Affordable Care Act ... In particular they are responding to errors in economic reasoning they claim to find in a brief filed by the American Action Forum (AAF), representing the views of dozens of prominent economists. Unfortunately, [rather] than shed light on the economics of health policy, they seriously mislead."
(John Goodman's Health Policy Blog)
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Benefits in General; Executive Compensation
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DOL Seeking Nominations for ERISA Advisory Council
"The terms of five members of the Council expire this year. The groups or fields they represent are as follows: (1) Employee organizations; (2) employers; (3) investment counseling; (4) actuarial counseling; and (5) the general public. The Department of Labor is committed to equal opportunity in the workplace and seeks a broad-based and diverse Council."
(U.S. Department of Labor)
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Press Releases
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