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[Guidance Overview]
New ADA and GINA Wellness Regs Complicate Wellness Program Compliance Analysis and Risks
"The new requirements apply regardless of whether the wellness program is part of a health plan or a free standing wellness plan.... For fiscal year plans these limits will apply in the middle of the plan year because the application of the rules to employers is effective on January 1, 2017 and there is no delay to the beginning of a plan year.... [T]he ADA and GINA apply to employers who employ fifteen or more employees for each working day in each of twenty or more calendar weeks in the current or preceding calendar year. Thus, wellness programs for employers with fewer than fifteen employees in the current or preceding calendar year in less than the requisite number of weeks may be able to not be concerned with these rules[.]"
(Winstead PC)
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[Guidance Overview]
EEOC Final Rules on Employer Wellness Programs: What Employers Need to Know
"The EEOC rules provide a roadmap for employers to draft or revise wellness plans that, by the EEOC's standards, comply with the ADA and GINA. Specifically, employers should ensure that the information requested or medical testing involved in their wellness plans does not exceed that permitted by the rules. Additionally, employers should confirm that their wellness plans satisfy the criteria for voluntariness set forth in the final rules."
(Holland & Knight)
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[Guidance Overview]
EEOC Finalizes Wellness Program Regulations
"[T]he ADA and GINA rules establish separate, but identical limits on the incentives that may be offered. An employee could receive incentives to provide information about his or her own medical conditions (under the ADA) and incentives for his or her spouse's participation in a health-risk assessment (under GINA), and each set of incentives would, on its own, need to be less than 30 percent of the total cost of self-funded coverage under the applicable plan."
(Ballard Spahr LLP)
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[Guidance Overview]
Congressional Risk Corridor Payout Limits Spawning Legal Difficulties
"[One] lawsuit alleges that the federal government currently owes [failed Iowa CO-OP] Co-Opportunity over $22 million in reinsurance, risk adjustment, and risk corridor payments, as to which it currently admits liability. Beyond these admitted debts, the federal government owes Co-Opportunity $113.6 million in risk corridor payments which it is unable to pay because they exceed the amount that can be collected from insurers that owed money to the program. If all of these risk corridor funds were available, the complaint alleges, Co-Opportunity could cover the claims of its participants and repay much of the debt it owes the federal government."
(Timothy Jost in Health Affairs)
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Partial Self Funding and Population Health Management: Facts, Concepts, and Strategies
34 presentation slide. Topics include: [1] Opportunity provided by the ACA; How do Fully Insured / Self Funded Plans compare ? ERISA; [2] Financial Breakdown of Self Funded Plans: A Review of Individual Components: What is Stop Loss Insurance? What are my network options ? How do you choose a Third Party Administrator? Underwriting Partially Self Funded Plans; Risk Sharing Strategies. [2] Strategies for Health Improvement and Cost Reduction: Claim Auditing; On Site Clinic; Restricted Networks; Reference Based Pricing; Telemedicine; Medical Tourism; Sample Population Health Management."
(WellNet)
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CMS Releases Medicare Current Beneficiary Survey (MCBS) Public Use File
"Beginning with data collected in the 2013 Medicare Current Beneficiary Survey (MCBS), a public use file (PUF) and accompanying documentation is available free for download ... The MCBS PUF is an easy to use data file with select data items that allow researchers to conduct analysis on health disparities, access to and satisfaction with healthcare, and medical conditions for community dwelling Medicare beneficiaries. The MCBS PUF ... provides a publically available alternative for those researchers interested in the health, health care use, access to and satisfaction with Medicare of beneficiaries, while providing the very highest degree of protection to the Medicare beneficiaries' protected health information meeting all necessary de-identification of the data and mitigating disclosure risk."
(Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
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Employers Look to Private Medicare Exchanges as Alternative to Group Retiree Health Coverage
"According to Kaiser Family Foundation data, just 23 percent of employers with over 200 employees offered retiree health benefits last year. But that statistic doesn't tell the whole story. Rather than exiting retiree benefits, a growing number of employers are looking to other avenues to provide benefits to retirees, including private Medicare exchanges."
(OneExchange from Towers Watson)
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Uninsurance Rates and the Affordable Care Act
"The uninsurance rate for nonelderly adults increased in the decade before the passage of the [ACA], driven by declining rates of employer-based coverage, especially during the recession at the end of the decade. The ACA was intended to decrease the percentage of the population without health insurance and to provide 'quality, affordable health care for all.' The purpose of this brief is to consider how uninsurance rates are changing under the ACA."
(Robert Wood Johnson Foundation)
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Health Insurers Not Responsible for Rising Premiums, Exec Says
"Physicians and hospitals account for 55 percent of health costs, while pharmaceuticals represent 22 percent -- up 6 percent in the last year alone, writes John D. Bennett, M.D., president and CEO of Capital District Physicians' Health Plan. Meanwhile, the percentage going to plan administration has hit a historic low."
(FierceHealthPayer)
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Benefits in General
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[Guidance Overview]
GASB 73/74/75: Timing Considerations for Compliance with New Financial Reporting Rules (PDF)
"There are several important dates to consider when calculating and reporting OPEB liability ... For plan reporting, the actuarial valuation must have been performed as of a date no more than 24 months prior to the plan's FYE. For employer reporting, the actuarial valuation must have been performed as of a date no more than 30 months and one day prior to the employer's FYE.... The measurement date is the date as of which the net OPEB liability is measured ... For purposes of GASB Statement Nos. 73 and 75, the measurement date may be selected from a range starting no earlier than the end of the employer's prior FYE and ending no later than the employer's current fiscal year."
(Milliman)
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New Overtime Rules May Affect Benefits Plans
"The laws surrounding most employee benefits plans allow various classifications to be deemed non-discriminatory as long as all those individuals within the same classification are treated the same. Therefore, some companies today may offer only certain benefits or benefits levels to certain groups of employees.... Many plans include overtime in their plan definition of compensation. The change could also affect plans that exclude overtime pay from the plan's definition of compensation if the new overtime pay causes the definition to become discriminatory in favor of highly compensated employees (HCEs)."
(The Huffington Post)
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Press Releases
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Lois Baker, J.D., President
David Rhett Baker, J.D., Editor and Publisher
Holly Horton, Business Manager
BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2016 BenefitsLink.com, Inc. All materials
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