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[Guidance Overview]
HHS Final Rule Addresses Categorical Exclusions for Health Services Related to Gender Transition
"The Final Rule [states] that all health-related insurance plans or other health-related coverage ... that currently have explicit categorical or automatic exclusions of coverage for all health services or care related to gender dysphoria or associated with a gender transition are unlawful on their face; in sum, by singling out the entire category of gender transition-related services, such an exclusion or limitation systematically denies services and treatments for transgender individuals and is, by definition, prohibited discrimination[.]"
(Littler)
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Text of the 2016 Annual Report of the Board of Trustees of the Medicare Trust Funds (PDF)
267 pages. "Notwithstanding recent favorable developments, current-law projections indicate that Medicare still faces a substantial financial shortfall that will need to be addressed with further legislation. Such legislation should be enacted sooner rather than later to minimize the impact on beneficiaries, providers, and taxpayers.... Medicare's costs under current law rise from their current level of 3.6 percent of GDP to 5.6 percent in 2040 and to 6.0 percent in 20 90. Under the illustrative alternative, in which adherence to the MACRA and ACA cost-reducing measures erodes, projected costs would rise to 6.2 percent of GDP in 2040 and to 9.1 percent in 2090."
(The Boards of Trustees, Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Fund)
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Text of Congressional Republican Proposals for Health Care Reform (PDF)
37 pages. "[This] plan advances a series of proposals that not only protects the health insurance Americans receive through their job, but also moves toward a fairer system that ensures access to coverage for all Americans. It allows for more choices, not top-down mandates, so that Americans can pick the benefits that work best for them. Recommendations: [1] Expanding Consumer-Directed Health Care Options; [2] Expanding Opportunities for Pooling; [3] Making Support for Coverage Portable; [4] Preserving Employee Wellness Programs; [5] Preserving Employer-Sponsored Insurance; [6] Protecting Employers' Flexibility to Self-Insure; [7] Purchasing Across State Lines; [8] Medical Liability Reform."
(U.S. House Republicans)
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House GOP Health Plan, Unsurprisingly, Is Market-Based
"[As] part of a full repeal of the [ACA], the current law's mandates for individuals and insurers would disappear under the GOP plan. It would overhaul Medicare by transitioning to a premium support system under which beneficiaries would receive a set amount to pay for coverage.... People who do not receive health insurance through their employer, Medicare, or Medicaid would receive an advanceable, refundable flat tax credit.... Although the white paper gives no specific value, it says the tax credit 'would be large enough to purchase the typical pre-Obamacare health insurance plan.'"
(Morning Consult)
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Boeing Contracts Directly with California Health System for Employee Benefits
"The move ... marks the expansion of Boeing's direct-contracting approach, which it has already implemented in recent years in Seattle, St. Louis and Charleston, S.C. Other large employers are also pursuing this idea in regions where they have big concentrations of workers. In some cases, they refer employees to nationally top-performing hospitals for select surgeries."
(Kaiser Health News)
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Macys, Another Cigna-Administered ERISA Health Plan, Sued for Embezzlement, Issuing 'Secret Checks'
"According to the court documents, Macys, through Cigna, sent EOBs telling the hospital that it would not get paid until it provided proof the patient paid their entire out-of-pocket costs, at the same time, according to the complaint, Macys, through Cigna, sent a different EOB to its member patients telling them they owed nothing!... The Macys lawsuit, which was filed on June 21, 2016, comes on the heels of two other recent lawsuits involving Cigna and Cigna Administered ERISA health plans[.]" [REDOAK Hospital, LLC v. Macys Inc., Welfare Benefits Plan, No. 4:16-cv-01783 (S.D. Tex. filed June 21, 2016.]
(AVYM Healthcare Revenue Consultants)
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Here's Why HR Pros Can Be Personally Liable for FMLA Blunders
"[Because] the FMLA was initially adopted as an amendment to the FLSA ... the court applied the FLSA's control or 'economic reality' test to the claim [the employer's] director of HR was [herself] an employer and found two key reasons to support that claim: [1] The director of HR controlled [the employee's] schedule and conditions of employment, and [2] She had the power to fire [the employee].... Therefore, she could be personally liable for FMLA violations." [Graziadio v. Culinary Institute of America, No. 15-888 (2d Cir. Mar. 17, 2016)]
(HR Benefits Alert)
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CBO Cost Estimate for H.R. 5447, Small Business Health Care Relief Act of 2016
"H.R. 5447 would amend the Internal Revenue Code to define a qualified small employer health reimbursement arrangement (QSEHRA) as an arrangement where an employer pays directly for or reimburses medical expenses of an employee and his or her dependents.... The staff of the Joint Committee on Taxation (JCT) estimates that enacting H.R. 5447 would raise both revenues and outlays by $363 million over the 2016-2026 period. JCT therefore estimates that enacting the bill would have no effect on federal budget deficits over the 2016-2026 period."
(Congressional Budget Office [CBO])
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HHS Targets Young Adults in Efforts to Improve Marketplace Risk Pool
"The [CMS] fact sheet focuses on efforts to improve coverage for young adults. Although ... the uninsured rate among young adults has fallen by more than half, young adults are still more likely than the general population to remain uninsured.... [This] undermines the individual market risk pool, as younger individuals tend to be healthier and, under the ACA's limited age rating, to cost less to cover in proportion to the premiums they pay than older enrollees"
(Timothy Jost, in Health Affairs)
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Impacts of the ACA's Medicaid Expansion on Insurance Coverage and Access to Care (PDF)
12 pages. "[Medicaid] Expansion states realized a 9.2 percentage point reduction in the number of uninsured adults (a 49.5 percent decline in the uninsured rate). Non-expansion states realized a 7.9 percentage point reduction in the uninsured rate among uninsured adults (a 33.8 percent decline in the uninsured rate)."
(Assistant Secretary for Planning and Evaluation [ASPE], U.S. Department of Health and Human Services [HHS])
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[Opinion]
ERIC Statement About New Health Care Tax Proposed by House GOP
" 'We are concerned that the Task Force paper proposes creating a new tax on benefits, and justifies this by suggesting that taxing health insurance will make health insurance cost less,' said James Gelfand, Senior Vice President of Health Policy, ERIC.... 'The policy rests on the myth that employer-sponsored health insurance is overly generous -- that working families' benefits need to be reduced, and that more costs need to be shifted to employees.' "
(The ERISA Industry Committee [ERIC])
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Benefits in General
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Fact Sheet: Social Security and Medicare Trustees Report
"Taken in combination, Social Security's retirement and disability programs have dedicated resources sufficient to cover benefits for nearly two decades, until 2034. The Medicare Hospital Insurance Trust Fund will have sufficient funds to cover its obligations until 2028, two years earlier than was projected last year, but still 11 years later than was projected in the last report issued prior to passage of the Affordable Care Act."
(U.S. Department of the Treasury)
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Executive Compensation and Nonqualified Plans
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2016 CEO Pay Trends (PDF)
22 pages. "The data in this report examines CEO pay for S&P 500 companies ... over the last five fiscal years. In that time, the U.S. stock markets have recovered from previous lows during the financial crisis, and in tandem with the recovery, reported CEO pay increased every year -- the largest period of growth coming between 2012 and 2013 when reported pay was 10.5% larger at the median. This report also visualizes shifts in how companies award CEO pay."
(Meridian Compensation Partners, LLC)
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Press Releases
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David Rhett Baker, J.D., Editor and Publisher
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BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2016 BenefitsLink.com, Inc. All materials
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