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[Guidance Overview]
Agencies Release Proposed Rules on Wellness Programs, Essential Health Benefits, and Health Insurance Market Reforms
"The proposed rule addresses both 'participatory wellness programs' ... which are generally available to all employees regardless of their health status, as well as 'health-contingent wellness programs,' which provide rewards to employees who meet a specific health-related standard.... [Regarding Essential Health Benefits,] HHS acknowledged that ... a number of potential benchmark plans do not include certain services, such as coverage for pediatric oral and vision services, as they are often covered under stand-alone policies, nor do they ordinarily identify habilitative services as a distinct group of services. To address benefits that might not be covered in a typical plan, the proposed rule establishes special standards and options for states and plans to define and supplement the benchmark plan with these benefits."
(Littler Mendelson LLC)
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[Guidance Overview]
New Regs Address 'Results-Based' Wellness Programs
"The regulations provide substantial new information on how employers and insurers may comply with the requirement of offering a 'reasonable alternative standard' -- or waiver of the otherwise applicable standard -- to employees who cannot attain the results-based goals due to medical reasons.... Limited as they are to results-based programs, the regulations are not of pressing importance to employers and advisors who work with 'participation-only' wellness programs, under which no health-related goal or result must be achieved in order to receive the financial reward."
(E is for ERISA)
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HHS Regs Provide Details on Essential Health Benefits
"Health insurance plans will now have to cover the same number of prescription drugs as the benchmark plan in their states. That basically means there will be a higher number of prescription drugs covered in each class, such as antipsychotics or antidepressants, than had previously been required."
(The New York Times; free registration required)
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Implementing Health Reform: Essential Health Benefits, Actuarial Value and Accreditation
"There are few surprises in this proposed rule for those who have been following guidance issued to date on the issues it addresses.... But it does give insurers additional flexibility on some issues, such as the coverage of habilitative services or setting deductibles for low actuarial value small-group plans. In other areas, the proposed rule gives consumers additional protections, such as access to a wider variety of prescription drugs."
(HealthAffairs Blog)
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U.S. Supreme Court Clears Way for New Challenge to Obamacare
"The Supreme Court on Monday arranged for a Virginia university to go forward with new challenges to two key sections of the new federal health care law -- the individual and employer mandates to have insurance coverage. The Court did so by returning the case of Liberty University v. Geithner ... to the Fourth Circuit Court ... [to hear Liberty's] claims that they violate rights to religious freedom or to legal equality under the Constitution. The Fourth Circuit had not ruled on either of those claims, because it ruled that Liberty was barred by the Federal Anti-Injunction Act from suing to stop those mandates." [Editor's note: The Supreme Court ruled in June that a challenge to the health care law on other constitutional grounds was not barred by the Anti-Injunction Act.]
(SCOTUSblog)
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[Advert.]
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Hobby Lobby Files Appeal in Battle Against Obamacare Contraception Coverage Mandate
"The chain's appeal [filed in the 10th Circuit Court of Appeals] states in part that Chief Executive Officer David Green [and] his family in less than six weeks 'must either violate their faith by covering abortion-causing drugs or be exposed to severe penalties -- including fines of up to $1.3 million per day, annual penalties of about $26 million and exposure to private suits.'"
(Fox News)
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Failure to Provide COBRA Election Notice Results in Fines Against Employer and Award of Attorneys' Fees
"The court found that it could not credibly conclude that the failure to send the COBRA notice was inadvertent due to the contradictions, evasions and disingenuous answers from the employer's employees during trial. Therefore, the court found that the employer intentionally withheld the COBRA notice.... [It] awarded a penalty of $75 a day for the period beginning on the deadline for providing the COBRA election notice and ending at the end of the 18-month COBRA period, for a total of $37,950. Due to the employer's bad faith, size as a large national company, and to deter others from acting in bad faith and with disregard for COBRA's requirements, the court also awarded $42,192.58 in attorneys' fees and $2,910.87 in costs." [Evans v. Books-A-Million, No. CV-07-S-2172-S (N.D. Ala. Oct. 29, 2012)]
(Haynes and Boone, LLP)
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Health Care Reform Challenges for Employers Echo Those of Pension Reform
"[E]mployers now face a defining decision: Offer subsidized healthcare benefits to employees, or pay a penalty for not doing so and leave their employees to find their own way via health-insurance exchanges. This decision is not so different from the one made by employers some 20 years ago with regard to what kind of retirement benefits to provide employees. For many companies, the choices made then are now having unintended -- often adverse -- consequences."
(Human Resource Executive Online)
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Time Off to Go to Las Vegas to Care for Mom Was Legitimate FMLA Leave
"By and large, courts tend to dismiss FMLA lawsuits where the family member for whom the employee is caring is not seeking treatment at the remote destination.... But the court reviewing [this] situation bucked the authority preceding it, finding that it didn't matter where [the employee] was providing the care -- so long as she was providing it." [Ballard v. Chicago Park District, No. 10 C 1740 (N.D. Ill., Sept 29, 2012)]
(FMLA Insights)
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Health Insurance Exchanges Emerge As Red vs. Blue
"The federal government gave states more time to decide if they want to pursue their own health insurance exchanges under the Affordable Care Act, but the leaders of some states said they already knew which way they were heading.... 'With incomplete regulations and unrealistic deadlines, states and the federal government will struggle to have a health insurance exchange ready for open enrollment on Oct. 1, 2013, that is not beset with major complications for the insurance market and the respective residents of the states,' [Bruce Greenstein, secretary of the Louisiana Dept. of Health and Hospitals] wrote to HHS Secretary Kathleen Sebelius."
(American Medical Association)
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Deloitte Health Care Reform Memo, November 26, 2012
"No industry is as pervasive in its impact financially and personally as health care, and none has been as insulated from consumerism as this one. Branding matters in most industries because a trusted brand conveys quality and value to its customers. Branding in health care has not kept pace."
(Deloitte)
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Benefits Fight Brings Lesbian Married Couple to High Court
"Within weeks of her wedding, [Karen Golinski] applied to add her spouse to her employer-sponsored health care plan, a move that would save the couple thousands of dollars a year. Her ordinarily routine request still is being debated more than four years later, and by the likes of former attorneys general, a slew of senators, the Obama administration and possibly this week, the U.S. Supreme Court."
(TIME)
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Self-Funded and Large Employers Also Affected by New Regs on Essential Health Benefits
"New reform standards for health plan value and coverage are important for employers, first because they will determine the kind of insured coverage that small employers buy. But grandfathered and self-funded employer health plans also need to know the rules to avoid penalties under health reform.... The law does not require large or self-funded plans either to cover all 10 EHBs, or adhere to cost-sharing rules when covering EHBs. However, EHBs are important for large, self-funded employers because they bear on other reform mandates, such as lifetime limits. For example, if a self-funded plan does cover any EHBs, it may not impose limits on them."
(Thompson SmartHR Manager)
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[Opinion]
Health Care Reform, Gangnam Style
"[W]e are living in a healthcare world that is rapidly turning into a retail market out of the emerging ashes of what was previously the domain solely of the healthcare wonkery. More than ever it is becoming downright essential for actual humans to understand the 'rap' ... that the healthcare world turns out.... As the healthcare world rapidly transmogrifies from the old-fashioned Marcus Welby version to a world of ACOs, Medical Homes, IDNs, etc. under the PPACA (... a healthcare BINGO!), consumers are going to need not just transparency of costs, but transparency of language."
(The Health Care Blog)
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[Opinion]
Wake Up, CEOs -- You're About to Lose Your Best Employees
"If the health reform actually does result in affordable premiums (and that's still a huge 'if') it's going to be easier for talented people who are tired of shabby treatment by corporate employers to quit and set up shop on their own."
(Forbes)
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[Opinion]
Health Insurance Exchanges May Be Too Small to Succeed
"[N]ot all health care markets are composed of rational, well-informed buyers and sellers engaged in commerce. Some have a limited number of service providers; in others, patients are not well informed about the services they are buying; and in still others, the quality of the service offerings vary from provider to provider. So the question is: What effect does insurer competition have in a marketplace with so many imperfections? ... In imperfect health care markets, competition can be counterproductive. The larger an insurer's share of the market, the more aggressively it can negotiate prices with providers, hospitals and drug manufacturers."
(The New York Times; free registration required)
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Benefits in General; Executive Compensation
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ISS Issues 2013 U.S. Corporate Governance Policy Updates
"Investors continue to rank executive compensation as the top corporate governance topic. The 2013 Updates to the pay-for-performance evaluation undertaken in advance of an advisory 'say-on-pay' vote on executive compensation refine how the subject companies' peer groups are selected, adjusting the criteria in an effort to include within the relevant peer group companies that have more in common with the subject company. The 2013 Updates also add the concept of 'realizable pay' to the qualitative analysis for large cap companies."
(Vorys, Sater, Seymour and Pease LLP)
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Press Releases
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