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[Guidance Overview]
Required Preventive Services Under the ACA
"With respect to weight-management counseling, plan sponsors may want to develop custom programs with discounted provider network services, clear clinical management rules, and protocols and reporting tools to make sure care is appropriate and help manage costs. In addition to implementing the preventive services benefits operationally, it is important to have documentation of the benefit, both so that plan participants can understand their coverage and that the plan sponsor can demonstrate the benefit if audited by the [DOL] or [CMS]."
(Segal Consulting)
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[Guidance Overview]
Checklist for Group Health Plan Disclosure Requirements
"While health care reform created some of these new requirements, many of them became effective years earlier.... [W]hile some of these additional disclosure requirements can be satisfied by having the right language in the SPD, others require a separate, specifically-worded notice."
(Poyner Spruill LLP)
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[Guidance Overview]
Proposed EEOC Regs Permit Spousal Health Risk Assessment Incentives
"The rules would limit the maximum inducement for an employee's spouse to complete a [health risk assessment (HRA)] as follows: [1] Determine the total annual cost of coverage for the plan and tier in which the employee is enrolled. [2] Take 30% of the Step 1 total cost of coverage. [3] Determine the total annual cost of employee-only coverage for the plan in which the employee is enrolled. [4] Take 30% of the Step 3 employee-only cost of coverage. [5] Subtract the result in Step 4 from the result in Step 2. The result in Step 5 is the cap on the spousal HRA incentive for that employee."
(ABD Insurance & Financial Services)
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[Guidance Overview]
ACA Auto-Enrollment Requirement Repealed
"President Barack Obama signed H.R. 1314, the 'Bipartisan Budget Act of 2015,' which among other things repealed the auto-enrollment requirement from the FLSA.... Note, however, employers may decide to use 'default' or 'negative' elections for enrolling employees into health plan coverage or certain other benefits. Under a default or negative enrollment arrangement, an otherwise eligible employee will be deemed to have elected a certain type and level of coverage, unless the employee timely returns a written waiver of that coverage.... This practice may even be applied to HSA contributions made under a cafeteria plan."
(Jackson Lewis P.C.)
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[Guidance Overview]
D.C. Commuter Benefits Are Almost Here: Employers Must Comply by January 1
"Employers with 20 or more employees working in the District of Columbia have fewer than 90 days left to comply with the new law requiring them to offer commuter benefits to employees by January 1, 2016. All employees, both full-time and part-time, count for purposes of determining whether an employer must comply with the D.C. ordinance. The ordinance covers all employers -- public, private, and nonprofit -- with the minimum number of employees."
(Ogletree Deakins)
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Plan Sponsors Admit They're Unprepared for Post-ACA Reform
"One in three employers expects to outsource more aspects of their benefits program as a direct result of the ACA. Nearly 70% of employers expect greater compliance and administrative burdens. About 20% of employers expect to offer benefits on a private exchange in the next year.... Of those thinking of self-insuring, 58% say the ACA is the main reason."
(PLANSPONSOR)
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Battle Over Cadillac Tax Heats Up
"Longtime opponents of the ObamaCare 'Cadillac tax' met with lawmakers this week with a new message: We're willing to compromise.... Rather than eliminating the tax entirely, they pitched exempting the contributions that are made to employers' health savings accounts, which could otherwise be subject to the 40 percent excise tax."
(The Hill)
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States Take Aim at Health Insurance Providers Fee in New Litigation
"Three states -- Kansas, Louisiana and Texas -- filed a complaint in federal court on October 22, 2015 challenging the constitutionality and legality of the Affordable Care Act's health insurance providers fee.... The plaintiffs contend that the health insurance providers fee is unconstitutional and illegal ... [including] the argument that the fee is an unconstitutionally coercive exercise of Congressional power.... The plaintiffs also argue that the federal government's reliance on actuarial standards published by the American Academy of Actuaries comprises an unconstitutional delegation of rulemaking authority to a private entity."
(Sheppard Mullin)
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Actuarial Value, Benefit Richness, and the Implications for Consumers
"[C]onsumers may not be aware of the differences between Actuarial Values (AVs) from the AVC and benefit richness values used in pricing. If they were known, they could lead consumers to make different benefit plan choices. Furthermore, we explore the extent to which the ACA has introduced discontinuities in what could otherwise be a continuous benefit richness slope. In short, the asymmetrical approach to different models may lead to a narrower range of choices for consumers."
(Milliman)
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[Opinion]
Next Steps for Federal Health Care Policy
"We need to change incentives and foster competitive markets so that people make choices about health care that are more cost-effective: [1] We should not provide public subsidies for health insurance that is unduly expansive. That means keeping the so-called Cadillac tax ... [2] We should increase competitive pressure in Medicare by moving to a system of premium support ... [2] We should restructure payments to Medicare's fee-for-service providers ... [3] We should make the underlying markets for health care and health insurance more competitive by limiting consolidation among providers and insurers[.]"
(The Brookings Institution)
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[Opinion]
Market Disruption Is Coming to the Benefits Business -- It Will Come from the Outside, Not Inside
"[It] is the underlying costs of health care that drive health insurance costs.... You can eliminate the insurance companies but not reduce health care costs to any significant degree.... The true disruptors are going to impact the market in ways many of us may not yet even imagine. But they will come, because there are many people interested in bending the cost curve including the government, employers, employees, and any individual paying an insurance premium."
(Joe Markland)
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[Opinion]
Chamber of Commerce Comment Letter to IRS on Proposed Regs for Minimum Value of Eligible Employer-Sponsored Health Plans (PDF)
"[We] do not believe that the ACA gives the Treasury and the IRS (or any Agency) the authority to mandate that inpatient hospital and physician services must be covered by self-insured plans or those plans offered in the large group market ... In issuing a final rule, we urge the Treasury and IRS to recognize that the ACA bases minimum value on the plan's own payment of the total allowed costs, and that there is no statutory language to support additional benefit mandates. Finally, before a final rule is issued, we urge that the Treasury and IRS provide appropriate economic analysis regarding alternative regulatory approaches and the likely economic impact of the approach they take."
(U.S. Chamber of Commerce)
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[Opinion]
Senators Ask CMS for Information on Failed ACA CO-OPs, Question Accounting Methods
In a letter to CMS, the Senators include the following requests: "[1] Has CMS pursued any remedies for the recovery of funds from terminated CO-OPs? If not, what steps will CMS take to recoup losses from CO-OPs that appear unlikely to repay their loans?.... [2] Please provide all information related to the process by which CMS conducts oversight of the CO-OP program ... [3] Please describe CMS's interaction with state insurance regulators in identifying CO-OPs performance issues ... [4] The Healthcare.gov 'window shopping' site is out of date and shows consumers incorrect information, even listing CO-OPs that are no longer in existence. What CMS official is responsible for updating the site, and why does CMS continue to provide consumers with false information?"
(Committee on Finance, U.S. Senate)
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Benefits in General; Executive Compensation
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Affluent Boomers Consider Long-Term Care Top Risk to Well-Being in Retirement, Yet Only 3 in 10 Have Made Financial Plan to Address Issue
"Only half of all Boomers, and just 44 percent of pre-retiree Boomers, have developed a formal financial or retirement plan. Interestingly, those with advisors are more than twice as likely as those without to have a formal financial or retirement plan (62% vs. 26% respectively).... Boomers have relatively sub-par knowledge about long-term care. When asked 11 quiz questions about the issue, the average respondent answers just 7 of them correctly. They are least familiar with the cost and average length of stay in a nursing home as well as the likelihood of needing long-term care at an early age."
(John Hancock)
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Early Retirement and the ACA (PDF)
12 pages. "While many groups will benefit from the ACA, those who have left or will leave full-time jobs and are under the age of 65 are among those with the most to gain. This paper explains how older Americans not yet eligible for Medicare can take advantage of their new insurance options and enjoy enhanced career flexibility later in life."
(Prudential)
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Press Releases
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David Rhett Baker, J.D., Editor and Publisher
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