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IRS Releases 2016 Versions of HSA Reporting Forms, Discontinues Preprinted Forms
"While there have been no significant changes in the content of these forms, the change in their distribution -- from preprinted forms to online forms -- will require changes to the procedures used by some trustees and custodians. For those unfamiliar with these forms, we note that they provide information needed by account holders, who have reporting obligations of their own."
(Thomson Reuters / EBIA)
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No Surprises in the Final Rules Issued Under ACA
"To maintain grandfather status, the plan must include a statement that it is believed to be a grandfathered plan, and contact information for questions or complaints, in any summary of benefits provided to participants ... Self-funded or other group health plans that are not required to cover essential health benefits (EHB) but which cannot impose annual or lifetime dollar limits on EHBs that are covered can choose between the 51 EHB base-benchmark plans selected by a State or the District of Columbia and the FEHBP base benchmark plan."
(Kilpatrick Townsend)
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Supreme Court Justices to Consider Whether ERISA Preempts State Healthcare Databases
"The Court repeatedly has upheld statutes of general application that have only incidental burdens on ERISA plans.... [Vermont official Alfred Gobeille] argues that the burdens here are trivial -- the claims administrator for respondent Liberty Mutual ... already prepares the data that is required, because it provides that data for its non-ERISA operations in Vermont.... Liberty Mutual emphasizes the possibility of byzantine conflicting disclosure obligations, with each of the fifty states requiring slightly different disclosures.... Unfortunately for Liberty Mutual, though, the case was not presented to the district court as an 'as applied' challenge.... As a result, the record includes no information at all suggesting that the data collection is burdensome and quite a bit suggesting that it is not." [Gobeille v. Liberty Mutual Ins. Co.,(2d Cir. Feb. 4, 2014, cert. pet. granted June 29, 2015)]
(SCOTUSblog)
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Sixth Circuit Allows USERRA Claim for Improper Continuation of Group Health Plan Coverage
"At least one claim in this lawsuit may have been avoided if the employer had clearly communicated its practices and procedures for continuing health coverage during periods of military leave. DOL regulations allow plan administrators to develop reasonable requirements for electing continued health plan coverage under USERRA, consistent with the plan's terms and USERRA's requirements. Developing and consistently following definite procedures and communicating details such as the cost of continued coverage will provide administrative certainty and may help avoid confusion and inconsistencies that can lead to lawsuits." [Eichaker v. Village of Vicksburg, No. 15-1128 (6th Cir. Oct. 5, 2015)]
(Thomson Reuters / EBIA)
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PBM Pricing: Do Diligence! (PDF)
"The standard contract typically allows the PBM discretionary authority to choose and change pricing references, which drugs are on the formulary list and their tier placement, all of which impact your plan's cost. The task is ... to know the cost implications of the contract provisions that favor the PBM.... Plan sponsors should ask if the PBM is using the same [Maximum Allowable Cost (MAC)] list with the plan sponsor as it does with its network of pharmacies, and if the PBM uses the same pricing in retail and mail service. Ask for a copy of the MAC pricing list. Plan sponsors should also insist that the MAC list the PBM provides in the RFP process is the one it actually uses once the contract is signed."
(Chelko Consulting Group)
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AARP, GAO, HHS Examine Increasing Rx Drug Prices
"A report from the AARP found that retail prices for more than one hundred specialty prescription drugs increased by nearly 11 percent in 2013. A separate report from the Government Accountability Office found that expenditures for new drugs in Medicare Part B were concentrated among a few drugs, mostly biologics, and most were costly for beneficiaries. The reports come as the Department of Health and Human Services held a forum Nov. 20 on prescription drug prices."
(Bloomberg BNA)
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Businesses Say Feds Wrong to Assume Wages Will Rise as Benefits Shrink
"Survey findings vary, but it's clear at least a third to half of all employers have health plans that would trigger the tax in the next five years if they didn't shift more of the costs to employees. A huge drop in benefit growth rates in 2011 clearly enabled employers to increase wages at that time ... Wage growth should have picked up as the unemployment rate dropped to 5% since then ... and Bureau of Labor Statistics data show it hasn't."
(USA TODAY)
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Patients Want to Price-Shop for Care, But Online Tools Unreliable
"It's unclear how common these inaccuracies with online estimators are, but the tools are becoming more popular, as patients shoulder a bigger share of the cost of their medical care. Outside companies are developing the online calculators, and most insurers offer them.... Some of the estimators reflect an aggregate range of possible costs; others are based on historic pricing, or claims data from varying sources. Many ... are limited in the type of procedures they include."
(Kaiser Health News)
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Information Frictions and Adverse Selection: Policy Interventions in Health Insurance Markets
"[R]ecent evidence suggests that many consumers have information frictions that lead to suboptimal health plan choices.... In this paper we develop a general framework to study insurance market equilibrium and evaluate policy interventions in the presence of choice frictions.... [The authors] find that friction-reducing policies exacerbate adverse selection, essentially leading to the market fully unraveling, and reduce welfare. Risk-adjustment transfers are complementary, substantially mitigating the negative impact of friction-reducing policies, but having little effect in their absence."
(National Bureau of Economic Research [NBER])
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Americans' View on Government-Run Healthcare Is Changing
"A small majority (51%) of US adults now believe that the federal government has a responsibility to ensure all Americans have health insurance coverage ... This is the first time since 2008 that a majority has said this.... In 2009 ... Americans were evenly split on the matter before shifting to the viewpoint that the government was not responsible for healthcare coverage. However, in the year's leading up to the ACA, there was much stronger support from Americans who believed healthcare coverage was the government's responsibility."
(American Journal of Managed Care)
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2016 Premium Increases in the ACA Marketplaces: Not Nearly as Dramatic as Reported (PDF)
40 pages. "Rate increases in 2016 are generally modest, though higher than in 2015.... [T]he average increase in each insurer's lowest-cost silver plan premium across all 20 states plus the District of Columbia is 5.6 percent. If consumers in each rating region enroll in the plan with the lowest silver premium available to them in 2015, and do the same in 2016, on average they will see their premium increase by 4.3 percent."
(Urban Institute and Robert Wood Johnson Foundation)
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Benefits in General; Executive Compensation
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[Guidance Overview]
The Future of Benefits for Same-Sex Spouses and Partners (PDF)
"Until recently, some employers voluntarily extended benefits to same-sex partners in recognition of the fact that same-sex couples had limited ability to marry. However, now that same-sex marriage is legal in all 50 states and recognized under federal law, employers must extend certain spousal benefits to same-sex spouses and can do so without additional administrative complexity. In addition, some employers are phasing out unmarried partner benefits by requiring partners to marry in order to be eligible for spousal benefit coverage."
(McDermott Will & Emery via Bloomberg BNA Pension & Benefits Daily)
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