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[Official Guidance]
Text of CMS Enrollment Manual for FFM and FFM-SHOP (PDF)
167 pages, effective as of October 1, 2016. "This manual provides operational policy and guidance on key topics related to eligibility and enrollment activities within the FFM and FF-SHOP, as well as within the SBM-FP, which use the federal platform for eligibility and enrollment platforms.... The information provided in this document applies to organizations and entities that may be involved in or assist with enrolling a QI or SHOP enrollee into a QHP and/ or QDP using the FFM or FF-SHOP eligibility and enrollment functions."
(Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
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What's a 'Limited Purpose' FSA?
"A general purpose FSA allows account holders to pay for a long list of IRS-approved expenses, including prescription medications, copays, most dental treatments, and other medical related needs. If a person has an HSA, they are not eligible to also have a general purpose FSA. An LPFSA allows account holders to receive reimbursement for eligible dental and vision expenses. A person with a high deductible health plan with an HSA is eligible for an LPFSA."
(DataPath)
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Employers Confident Public Health Insurance Exchanges Will Be an Option for Pre-65 Retiree Coverage Within Two Years
"More than half (56%) of U.S. employers are confident that public health insurance exchanges will be a viable alternative to group health plans for pre-65 retirees by 2018 ... 72% of employers plan moderate to significant changes in pre-65 retiree health benefits over the next four years.... [E]mployers expect a 4.1% cost increase for pre-65 retiree health care after plan changes or 5.7% without plan changes in 2016. This compares with an expected 2.0% cost increase for Medicare-eligible retiree health care after plan changes or 3.3% before plan changes this year."
(Willis Towers Watson)
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[Advert.]
Unique Fringe Benefits to Engage Employees

July 27 webinar. Employers are working to become more and more creative in offering fringe benefit packages that are non-traditional, that will help them recruit and retain the best employees.
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Justice Department Will Seek to Block Two Health Insurance Mergers
"Antitrust officials are concerned that Aetna's $37 billion deal with Humana, and Anthem's $48 billion pursuit of Cigna, will harm competition in the health insurance industry ... The deals would have decreased the number of the largest insurers to three, from five.... If the lack of regulatory approval scuttles their deal, Anthem will need to pay a $1.85 billion breakup fee to Cigna, according to the merger agreement. Aetna will be required to give $1 billion to Humana under those same circumstances[.]"
(The New York Times; subscription may be required)
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How Reinsurance Limited Health Insurers' Financial Losses in the ACA's First Year
"[O]verall, health insurers' operating profits in 2014 from selling insurance (not including profits from investments) were 1 percent of premiums, or $3.7 billion. In previous years, overall operating profits ranged from 2.5 to 3 percent, or $8 billion to $9 billion. A portion of the drop in profits was caused by increased losses in the individual market, which averaged -4.2 percent, or $2.5 billion, compared with -3.1 percent or $1 billion loss the prior year."
(The Commonwealth Fund)
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How Has the ACA Affected Health Insurers' Financial Performance?
"This issue brief uses newly available data to understand how health insurers fared financially during the ACA's first year of full reforms. Overall, health insurers' financial performance began to show some strain in 2014, but the ACA's reinsurance program substantially buffered the negative effects for most insurers. Although a quarter of insurers did substantially worse than others, experience under the new market rules could improve the accuracy of pricing decisions in subsequent years."
(The Commonwealth Fund)
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Health Insurance Premiums on California Exchange to Rise by Average of 13%
"After last year's 4% rate increase, California's Obamacare insurance exchange rates appear to be catching up to the rest of the country. The two biggest carriers are raising rates by much more than the average 13.2% increase. Blue Shield said its average increase was 19.9% and Anthem said it would increase rates an average of 17.2%."
(Bob Laszewski's Health Care Policy and Marketplace Review)
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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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