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[Guidance Overview]
Fees on Self-Insured Health Plans and Health Insurance Policies to Fund the PCORI
"There are situations, however, when the same individual must be taken into account more than once in calculating the fee. When the same individual is covered under a health insurance policy and a self-insured health plan, he or she is taken into account in calculating the amount of the fee payable both by the insurer and by the plan sponsor. For example, an individual is counted twice if he or she is covered by (i) a major medical insurance policy and a self-insured prescription drug program, or (ii) a group health insurance policy and an HRA."
(Sidley Austin LLP)
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[Guidance Overview]
Health Plans Must Pay Reinsurance Fees
"Reinsurance fees will be imposed on both self-insured and insured group health plans in 2014, 2015, and 2016. HHS announced in proposed regulations that the reinsurance fees will be $63 ($5.25 per month) per covered individual in 2014.... The reinsurance fees are separate from and in addition to the Patient Centered Outcomes Research (PCOR) fees.... However, the methods for counting covered individuals (i.e., covered employees, spouses, partners, and children) for the two fees are similar[.]"
(Vorys, Sater, Seymour and Pease LLP)
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Health Insurance in the U.S. -- We Pay More for Less
"Health insurance premiums have shot up more than 60 percent in the last eight years, and if they keep up at this pace the average family of four will be paying $25,000 a year just for health insurance ... At the same time, deductibles are also going up for employer-sponsored plans, so workers are paying more and more for less and less ... Earlier this year the independent Institute of Medicine made a formal pronouncement on what think-tanks and academic institutions had been saying for years. It said the U.S. health care system wasted $750 billion in 2009, about 30 percent of all health spending, on unnecessary services, excessive administrative costs, fraud, and other problems."
(NBCNews.com)
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Trends in Employer-Sponsored Health Insurance Premiums and Employee Contributions in Major Metropolitan Areas, 2003-2011
"Analysis of employer-sponsored health insurance costs in 41 U.S. metropolitan areas shows a 61 percent average increase in premiums for family coverage from 2003 to 2011, and a 21 percent increase over the past three years. Growth in family coverage premiums ranged from 35 percent in Sacramento, Calif., to 87 percent in Columbia, S.C. ... If the average rate of growth seen over the past eight years continues to the year 2020, the cost of family coverage in 18 of these 41 metro areas will exceed $25,000."
(The Commonwealth Fund)
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Nurse Who Suffered Panic Attack and Was Sent Home Can Pursue FMLA Interference Claim
"[The employer] argued that it could not have known of the need for leave because Clinkscale had not previously been diagnosed with an anxiety disorder. The Court found this unsupported by the FMLA, which specifically contemplates circumstances in which the need for qualifying leave arises unexpectedly. To assume an employee's previously clear medical history precluded a subsequent FMLA claim when her need for medical leave arises unexpectedly was 'patently unreasonable,' the Court found." [Clinkscale v. St. Therese of New Hope, No. 12-1223 (8th Cir. Nov. 13, 2012)]
(Jackson Lewis LLP)
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What an Employee Does in Vegas . . . May Qualify As FMLA Leave
"The Ballard case turns previous court rulings pertaining to FMLA claims 'on their collective head' and signals a need for employers and HR to approach FMLA leave requests from a new angle ... Companies and HR professionals would also be wise to obtain adequate medical certification that describes the family member's serious health condition and specifically outlines the 'caring for' functions that the employee must provide the family member[.]" [Ballard v. Chicago Park District, No. 10 C 1740 (N.D. Ill., Sept. 29, 2012)]
(Human Resource Executive Online)
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Study Shows High Economic Impact of Cancer on Employees
"Cancer in U.S. workers leads to productivity losses of more than 33 million disability days per year, amounting to $7.5 billion in lost productivity. Based on the average wages of the workers surveyed, disability costs due to cancer were equal to 20 percent of total healthcare expenditures. Nearly 85 percent of the workers with cancer worked for smaller companies with fewer than 500 employees."
(American Cancer Society, American Heart Association, American Diabetes Association, and Three Other Health Care Organizations)
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[Opinion]
Court Allows New York Archdiocese's HHS Mandate Challenge to Proceed
"For the first time, a federal court has permitted a Health and Human Services (HHS) mandate challenge by a religious nonprofit organization to go forward.... The U.S. District Court for the Eastern District of New York found that the government's temporary enforcement suspension against some religious employers, which the Administration misleadingly labels a 'safe harbor,' was insufficient to protect the archdiocese and two of its affiliated health care nonprofits from the threat of immediate harm."
(The Heritage Foundation)
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[Opinion]
Repairing Obamacare
"ObamaCare is a deeply flawed piece of legislation. Its defects are so huge that Democrats are going to want to perform major surgery on it in the near future, even if the Republicans stand by and twiddle their thumbs. That raises this question: What changes need to be made in the legislation to turn it into a health reform that solves existing problems without creating even more serious new problems?"
(John Goodman's Health Policy Blog)
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[Opinion]
Businesses Face Wrenching Choice About Mandated Health Care Coverage
"Recent news media coverage has highlighted larger businesses reducing employee hours below 30 hours per week in order to avoid the employer-mandate requirements or penalties. Smaller businesses, too, might be forced to reduce employment below the 50 full-time equivalent employee threshold, or resist growing above the threshold, to avoid the mandate. None of these options is productive, and they ultimately harm employees and the economy. Replacing one full-time position with two part-time positions is not job creation."
(USA TODAY)
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[Opinion]
'Employer Mandate' Attacks Leave Sour Taste
"Yes, the employer mandate will add to some companies' costs of doing business, and those costs no doubt will be passed along to customers. Papa John's says the price of a pizza could increase 11 cents to 14 cents per pie. But is that such a terrible price to pay to ensure that some of the nation's hardest working, lowest paid employees will get health coverage they've never had?"
(USA TODAY)
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Benefits in General; Executive Compensation
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Avoiding SEC Comments on Executive Compensation Disclosures
"When drafting the executive compensation proxy disclosure for their 2013 annual meetings, companies should consider the following specific topics on which the SEC staff frequently issues comments: [1] Compensation Discussion & Analysis (CD&A) generally. [2] Disclosure of performance targets. [3] Benchmarking and peer groups. [4] Factors considered when determining compensation. [5] The role of compensation consultants. [6] Using non-GAAP financial measures."
(Practical Law Company)
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U.S. Census Bureau Projections Show a Slower Growing, Older, More Diverse Nation a Half Century from Now
"According to the projections, the population age 65 and older is expected to more than double between 2012 and 2060, from 43.1 million to 92.0 million. The older population would represent just over one in five U.S. residents by the end of the period, up from one in seven today. The increase in the number of the 'oldest old' would be even more dramatic -- those 85 and older are projected to more than triple from 5.9 million to 18.2 million, reaching 4.3 percent of the total population."
(U.S. Census Bureau)
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Press Releases
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David Rhett Baker, J.D., Editor and Publisher
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