Health & Welfare Plans Newsletter

December 28, 2016

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[Guidance Overview]

New ACA FAQs Cover Special Enrollment, Women's Preventive Care, and a Cure for the HRA That Ails You (If You're Small Enough)
"Under HIPAA, group health plans generally must allow current employees and dependents to enroll in the group health plan if the employee or dependents lose eligibility for coverage in which they were previously enrolled. This FAQ clarifies that an individual is entitled to a special enrollment period if they lose individual market coverage.... [The Health Resources and Services Administration (HRSA)] updated its guidelines on December 20, 2016. The updated guidelines build on many of the existing preventive care for women and include screening for breast cancer, cervical cancer, gestational diabetes, HIV, and domestic violence, among other items. The services identified in the updated guidelines must be covered, without cost-sharing, for plan years beginning on or after December 20, 2017."
Benefits Bryan Cave

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[Guidance Overview]

21st Century Cures Act: Qualified Small Employer HRAs
"The exception for QSE HRAs is only available to small employers. ALEs must still treat HRAs that provide medical benefits as group health plans. In addition, the exception does not apply to any arrangement (such as a cafeteria plan) which is funded by employee contributions or salary reductions."
Compliance Dashboard

21st Century Cures Act: Welcome Versatility in the Small Group Market
"For employers looking for a quick fix to avoid the responsibilities of offering group health insurance, the new law is not a complete solution. Rather, employers using the new HRA rules are required to provide an annual notice that defines which employees are eligible and discloses any available HRA funds to the health insurance exchange. And employers must include the HRA value on the employee's W-2 and provide a 1095-B to each employee (and disclose the 1095-B information to the IRS)."
Frenkel Benefits

Less Competition Isn't Driving Up ACA Prices
"Almost a third of all counties in the United States have just one insurer in the marketplace for people buying individual coverage for 2017.... But there's a surprising bottom line: Although prices are going up in almost all areas, they're not significantly higher than they are for people living in areas served by multiple insurers ... [One consultant suggests] that didn't happen because insurers had to file their initial 2017 rates to regulators earlier this year, before they knew exactly where competitors were dropping out."
National Public Radio

The Anthem/Cigna Merger Trial: Sifting Through the Evidence
"The government has put on a strong case that the merger will produce significant market concentration in the sale of insurance plan services to large national employers. The merging parties' best hope relies on potential large cost savings resulting from their ability to extract price concessions from hospitals and physicians. Less clear, however, is whether those savings are either legally cognizable or sufficient to offset the harms resulting from increased market power."
Health Affairs

The Future of the ACA, Part 2: Implications of a Partial Repeal
"If such a bill were enacted under President Trump, the insurance market would be left with the more popular but expensive elements of the ACA, but without the funding mechanisms to offset such costs. The likely result would be the dreaded 'death spiral' scenario ... Even in the midst of such uncertainty, however, the move towards population health management initiatives and the assumption of financial risk by providers is likely to continue."
Sheppard Mullin

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BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2016 BenefitsLink.com, Inc. All materials contained in this newsletter are protected by United States copyright law and may not be reproduced, distributed, transmitted, displayed, published or broadcast without the prior written permission of BenefitsLink.com, Inc., or in the case of third party materials, the owner of that content. You may not alter or remove any trademark, copyright or other notice from copies of the content.

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