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2013 Open Enrollment May Be True Test for Benefits Communications
"Benefits managers are just months away from what may prove the most challenging open needs enrollment season of their careers. For some, a large number of employees who never before qualified for group health insurance now might. For others, a move to a private exchange must be handled with the delicacy of a diamond cutter. For all, proper open enrollment communications strategy and execution will be paramount."
(Employee Benefit News)
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Fewer Blood Pressure Screens May Be More Effective
"[H]aving frequent blood pressure readings often lead to expensive and inconvenient false positives which can result in excessive and potentially harmful treatment.... Your wellness program may be doing harm to your employees by recommending excessive screening. As evidence piles up that you may be giving employees potentially harmful advice, you may be putting your company at risk. If your plan is self-insured, pointing to your wellness vendor may not give you a free pass."
(Cracking Health Costs)
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Employee Health Plan Options Shrinking to One with a High Deductible
"Historically, one of the perks of working at a big company has been generous health benefits with modest out-of-pocket costs. But increasingly, large companies are offering their employees only one option: a plan with a relatively high deductible linked to a savings account for medical expenses."
(The Washington Post)
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Wireless Technology Changing U.S. Healthcare
"[I]t's estimated that if chronic patients agreed to remote monitoring, the savings would amount to more than $21 billion a year. That's just one indicator of the great promise of mobile technology and healthcare."
(The Washington Post)
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It's a Mandate! It's a Tax! How Word Choice Effects Obamacare Compliance
"New research suggests the controversy over the [ACA's individual health insurance] mandate may have been a blow to its credibility -- and Americans' willingness to comply. That's the takeaway from a new paper ... that looks at the difference between describing the health law's penalty for not carrying insurance as a 'mandate' or a 'tax'."
(The Washington Post)
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Health Care Spending in the 50 States and Select Counties (PDF)
"Before moving forward with implementation of the Affordable Care Act, it is important to consider how spending from state to state varies in terms of the health care sector's size relative to the states' economies, and to examine how the sizes of the states' health care sectors have evolved over time. The State of Provider data set from the Centers for Medicare and Medicaid services provides an excellent source for these comparisons and allows for an examination of spending over a thirty-year period."
(National Center for Policy Analysis)
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Individually-Owned Health Insurance Policies Failing to Meet ACA Benefit Standards
"[Of] 11,100 individual plans [in a recent study], less than 2% covered all items required for individual and small group plans under the ACA ... Almost all individual plans studied by HealthPocket had coverage for hospitalization, emergency care and ambulatory services, including visits to a primary care physician or specialist. On average, the plans covered 76% of what will be required under 11 general essential benefits categories."
(American Medical News)
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Temp Agencies See Opportunity In Health Law
"School administrators in Dothan, Ala., aren't sure whether health act rules taking effect next year will require them to offer medical coverage to substitute teachers, who lack it now. But they aren't waiting to find out. The system has decided to hire subs through Kelly Services, a temporary staffing agency, to avoid any health-cost obligations that might come as their direct employer."
(Kaiser Health News)
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Miller Chevalier Focus on Employee Benefits, March 25, 2013
Articles in this issue include: Next Steps for Employers Regarding the FICA Tax Treatment of Severance Pay Following the Sixth Circuit's Affirmance of Quality Stores; HIPAA Omnibus Rule Impacts Group Health Plans; and San Francisco Health Care Security Ordinance Enforcement Initiative.
(Miller & Chevalier Chartered)
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Minnesota Health Insurance Exchange Coming Soon
"Minnesota is one of only 18 states that have reportedly opted to establish and operate their own health insurance exchange beginning in 2014.... The exchange is intended to supplement, not replace, continued operation of a private marketplace for individual and small group health insurance in Minnesota. The board will be responsible for seeking funding for the exchange from a combination of government agencies, philanthropic organizations, and public and private sources, with the restriction that revenue-raising efforts must not advantage any specific health benefit plan, health carrier or insurer producer active in the exchange."
(Faegre Baker Daniels)
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Kentucky Governor Signs Ground-Breaking Pharmacy Transparency Legislation into Law
"Kentucky has become the first state to enact legislation that provides pharmacists with transparency into how health plans determine pharmacy reimbursements for generic drugs, and establishes an appeals process when a dispute arises over those payment levels.... This transparency legislation will simply let pharmacists know how individual health plans will calculate a pharmacy's reimbursement, and require timely updates to those rates to reflect market prices. With that information a small business community pharmacy owner can better evaluate contract proposals and determine whether they make business sense to accept."
(National Community Pharmacists Association)
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Value-Based Insurance Design Yields Near- and Long-Term Improvements in Medication Adherence (PDF)
"Value-based insurance design (VBID) ... aims to align patient cost sharing with the value of a particular clinical service, often by eliminating or reducing copayments for effective treatments.... [A recent study found that, before] implementation of the VIBD program, the groups had similar adherence rates (ranging from 75 to 83 percent adherence depending on drug class). In the adjusted analyses, VBID participants' adherence improved significantly[.]"
(AcademyHealth)
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New Definition of Wellness Needed
"What is desperately needed is a new set of goals for wellness/prevention. In benefit plans today, about 6-8% of members -- the so-called 'outliers' -- are spending 80% of plan dollars. Only a tiny fraction of that spending may be preventable through wellness.... What is absolutely certain is no matter how a company does wellness and prevention, its employees and covered family members are going to have major diseases anyway."
(Cracking Health Costs)
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Why Do Some States Spend More on Health Care?
"One of the interesting features of the [ACA] is that reform basically takes place at the state level. Yet the states are very different. Some spend more than twice as much on health care as others, as a percent of state income.... For example, over a 40-year period: The variation in Medicaid spending across the 50 states, as a percent of state domestic product, was from two to three times greater than the variation in private sector spending. The variation in Medicare spending was from one and a half to two times greater that the variation in private sector spending."
(Timothy Jost in Health Affairs Blog)
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House Subcommittee Chairman Questions Why Obamacare Exchange Application Is Collecting Voter Information
"After completing the online application and learning of their eligibility status for various insurance policies, the applicant is then asked on page 59, 'Would you like to register to vote?' The placement of the question could lead some to think their subsidy eligibility is contingent on voter registration. Additionally, since many of these applications will be administered by 'navigators,' which may include politically active tax-exempt organizations ... it raises questions as to why HHS is gathering voter information, how the agency intends to use such information and how the information could be used by the navigators."
(U.S. House Ways and Means Committee Chairman David Camp)
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Today's High Coinsurance Health Insurance Policies: Poor Protection Against Medical Expenses
"[An analysis of] 9,711 plans ... found that those plans with the highest average coinsurance expense for consumers also averaged the least financial protection against annual out-of-pocket expenses. For example, plans with coinsurance rates up to 10% capped annual out-of-pocket expenses at $4,286 on average with this average rising to $8,825 for plans with coinsurance rates above 40%. While a direct correlation existed between coinsurance rates and out-of-pocket limits that resulted in a shift of healthcare costs to consumers, a similar relationship did not exist when examining coinsurance rates and deductible amounts."
(HealthPocket)
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Federal and State Regulators Drop Antitrust Case Against Blue Cross Blue Shield of Michigan
"The U.S. Department of Justice, State of Michigan and Blue Cross Blue Shield of Michigan today filed a joint motion with the U.S. District Court in Detroit to dismiss an antitrust lawsuit filed against BCBSM over the use of Most Favored Nation clauses in some hospital contracts. The parties have agreed that the injunctive relief sought by the DOJ and State of Michigan is now unnecessary in light of the enactment of state legislation ... which bans the use of Most Favored Nation clauses by the health insurance industry in Michigan as of Jan. 1, 2014, and an order of the Michigan Insurance Commissioner that MFNs in any health insurer's contracts are unenforceable as of February 2013."
(Blue Cross Blue Shield of Michigan)
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[Opinion]
Proof That Obamacare 'Rate Shock' Is An Ugly Insurance Company Deception
"What the insurance industry is not telling you ... is that the overwhelming majority of young people who would be charged a higher premium to make up for the lower premiums to be paid by their elders will either be covered by the premium subsidies ... or eligible for Medicaid ... Therefore ... the lowered premium costs to the oldest participants in an insurance plan 'would have very little impact on out-of-pocket rates paid by the youngest nongroup purchasers'."
(Forbes)
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[Opinion]
Deloitte Health Care Reform Memo, March 25, 2013
"Obamacare shifts money to favor the delivery of outpatient care through hospital owned networks. The irony is that in the name of lowering costs, Obamacare will almost certainly make the practice of medicine more expensive. It turns out that when doctors become salaried hospital employees, their overall productivity falls."
(Deloitte)
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[Opinion]
That's What You Get, When You Kick the Can Down the Road
"Here at the third anniversary of the [ACA], the bulk of the law will not begin to take effect until next year -- and its full process will continue through 2019, all the way to the Presidential election after the next Presidential election. Perhaps then it is small wonder that [a recent poll found] that a solid majority of Americans, fifty-seven percent, have no idea what the impact of the [ACA] will be. Three years after 'health care overhaul' was signed into law we're still Waiting for Godot."
(Physicians for a National Health Program)
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[Opinion]
Cost to Launch the California Health Insurance Exchange Approaches $1 Billion -- Does That Sound Like a Lot to You?
"So far California has received $910 million in federal grants to launch its new health insurance exchange under the [ACA]. The California exchange, 'Covered California,' has so far awarded a $183 million contract to Accenture to build the website, enrollment, and eligibility system and another $174 million to operate the exchange for four years. The state will also spend $250 million on a two-year marketing campaign. By comparison California Senator Barbara Boxer spent $28 million on her 2010 statewide reelection campaign while her challenger spent another $22 million."
(Health Care Policy and Marketplace Review)
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Benefits in General; Executive Compensation
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Discounted Stock Options Hit With Section 409A Surtaxes
"[A recent] ruling upheld the IRS assessment of a 20% surtax plus interest on distributions the plaintiff received under deferred compensation arrangements found to be noncompliant. The amounts in dispute total $3,172,832, plus another $304,456 in interest. While in this challenge to the IRS assessment the court still must decide whether discounted stock options were actually granted, it brushed off all the plaintiff's legal arguments claiming that Section 409A does not apply to discounted options." [Sutardja v. United States, No. 11-724T (Fed. Cl. Feb. 27, 2013)]
(myStockOptions.com)
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In 2012, for Every Person Aged 65 or Older, There Were Four People of Working Age in the EU27
"The old age dependency ratio in the EU27 increased from 21.1% in 1992 to 26.8% to 2012. During this period, the ratio rose in all Member States, except Ireland ... As a result, the total age dependency ratio in the EU27 grew slightly over the last two decades, from 49.5% in 1992 to 50.2% in 2012, meaning there are around two persons of working age for each dependent person. In the Member States, the total age dependency ratio in 2012 ranged from 39% in Slovakia to 56% in France and 55% in Sweden."
(Eurostat via Perspective PensionSurveys)
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Employers Show Increasing Appetite for Technology to Improve Employee Health Engagement (PDF)
"[This study] examined the current use and future potential for three key technologies: gamification, mobile apps and social media.... [G]amification is the most prevalent (62 percent) and ranks highest in employers' perception of effectiveness.... Social networking is used in some fashion by 50 percent of organizations, but ranks highest in concerns over privacy of personal information. Mobile technology is the least implemented (36 percent) but leads the pack as the highest priority for future adoption or expansion (40 percent)."
(Buck Consultants)
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Claims Administrator Not Liable for Statutory Penalties for Failing to Provide Requested Documents
"You know already that a plan administrator can be liable for statutory penalties under ERISA for failing to provide requested plan documents. But what if the claims administrator failed to provide documents Will the claims administrator have to pay statutory penalties? NO. But what if an agent of the plan administrator failed to provide documents? Does the plan administrator have to pay? NO." [Delprado v. Sedgwick Claims Management, United Health Group Inc., et al. (N.D.N.Y. Mar. 20, 2013)]
(Lane Powell PC)
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Press Releases
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David Rhett Baker, J.D., Editor and Publisher
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