Health & Welfare Plans Newsletter

February 20, 2017

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Defined Contribution Account Manager
Nova 401(k) Associates
Telecommute

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Planned Retirement Consultants & Administrators, LLC
in NJ

Assistant General Counsel - Retirement Plans
Nationwide Insurance
in OH

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Webcasts and Conferences

Wellness Plans PART 1 – An Employer Roundtable: What’s Working and What’s Not
March 2, 2017 in MD
Worldwide Employee Benefits Network [WEB] - Baltimore Chapter

14th Annual Health Plan and Payer Summit
April 30, 2017 in DC
World Congress

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[Official Guidance]

Text of CMS Addendum to 2018 Letter to Issuers in the Federally-Facilitated Marketplaces (PDF)
89 pages, Feb. 17, 2017. "This Addendum to the 2018 Letter to Issuers changes the dates for the QHP certification timeline ... The dates in [this Addendum] also supersede all other references to corresponding dates with in the text of the 2018 Letter to Issuers, as well as any applicable guidance. All other parts of the 2018 Letter to Issuers remain unchanged by this document."
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

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[Official Guidance]

Text of CMS Draft Bulletin: Revised Timing of Submission and Posting of Rate Filing Justifications for the 2017 Filing Year for Single Risk Pool Coverage; Revised Timing of Submission for Qualified Health Plan Certification Application (PDF)
"CMS is releasing this draft bulletin for comment on the proposed revised uniform timeline for submission and public release of information about rate filings for single risk pool coverage ... The proposed timelines specified [in this bulletin] would apply to the rate filings issuers will submit in 2017 (2017 filing year) for single risk pool coverage (including both QHPs and non-QHPs) with plan or policy years beginning on or after January 1, 2018."
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

[Official Guidance]

Text of CMS Summary of Key Dates for Calendar Year 2017 (PDF)
Rev. Feb. 2017. "The dates in Table 1 ... generally supersede Table 1.1 Timeline for QHP Certification in the FFMs on pages 7 and 8 from the 2018 Letter to Issuers released on December 16, 2016. Table 2 reflects the proposed revisions to the Unified Rate Review timeline, as reflected in the February 17, 2017 Draft Bulletin: Revised Timing of Submission and Posting of Rate Filing Justifications for the 2017 Filing Year for Single Risk Pool Coverage. CMS also released an Addendum to the 2018 Letter to Issuers to reflect the current PY18 QHP certification timeline consistent with Table 1[.]"
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

[Guidance Overview]

New Deadlines Give Insurers More Time to Decide on 2018 Marketplace Participation
"The initial deadline for filing QHP applications and rate table templates for coverage that includes a QHP for 2018 is delayed substantially from May 3, 2017 to June 21, 2017. After that date, deadlines are compressed and generally moved backwards from the earlier calendar.... Oddly, a few dates in the schedule are moved up. Insurers will have until August 4 to petition to change their service areas, earlier than the initial deadline of August 9. The final deadline for insurers to petition to make changes in their QHP applications will be August 16, moved up from August 21. And the end of the limited window during which insurers can correct data errors identified by the states or HHS is advanced from October 13 to October 7."
Timothy Jost, in Health Affairs

[Guidance Overview]

CMS, IRS Address Affordable Care Act Issues in Transition
"The proposed [CMS] regulatory changes aim to promote more continuous coverage of individuals, particularly healthier individuals, with the intent of improving the risk pool in exchange plans and supporting competitive and stable individual and small group markets.... The IRS has announced that it will not reject individual income tax returns this year because of a failure by individuals to provide information about whether they have obtained coverage under the ACA's individual mandate."
Ballard Spahr LLP

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HHS Expresses Interest in Pre-Existing Condition Exclusions
"In addition to the stabilization proposals listed in the regulations, HHS expresses interest in implementing rules similar to the [pre-ACA] rules that allowed plans to deny coverage for pre-existing conditions if the covered individual experienced a gap in creditable coverage: ... Beginning in mid-2017, HHS will institute pre-enrollment verification of all special enrollment events. Accordingly, employers should be cognizant of the fact that they may be called upon to provide timely, written verification of an individual's loss of employer-sponsored group health coverage."
Littler

Healthcare Benefits in 2017: What Employers Have to Say
"2016 marked a milestone for healthcare consumerism, with the amount of organizations offering HDHPs jumping from 28% four years ago to 39% in last year's survey to 53% in this year's survey.... With this rise in HDHPs came an increase in the number of employees being enrolled in a Health Savings Account [HSA], Healthcare Reimbursement Arrangement [HRA], or Flexible Spending Account [FSA] ... 51.5% of respondents' employees are enrolled in one or more of these plans/arrangements."
Healthcare Trends Institute

Among Low-Income Respondents With Diabetes, High-Deductible Versus No-Deductible Insurance Sharply Reduces Medical Service Use
"Compared with privately insured respondents with diabetes with [no deductible], privately insured lower-income respondents with diabetes with [a low deductible ($1,000/$2,400)] report significant decreases in service use for primary care, checkups, and specialty visits (27%, 39%, and 77% lower, respectively), and respondents with [a high deductible (>$1,000/$2,400) ] decrease use by 42%, 65%, and 86%, respectively."
Diabetes Care

Text of Sixth Circuit Opinion: State of Ohio Not Exempt from ACA Transitional Reinsurance Program Payment Requirement (PDF)
15 pages. "Congress has demonstrated an ability explicitly to exempt state and local governments from certain requirements in the past, and it chose not to do so with respect to the Program. We therefore conclude that Congress intended the Transitional Reinsurance Program to apply to the States with the same force that it applies to private employers.... We conclude that the tax imposed under the Transitional Reinsurance Program is a non-discriminatory tax applied evenly to public and private group health plans. Application of the Program to the State of Ohio does not violate the intergovernmental tax immunity doctrine." [Ohio v. U.S., No. 16-3093 (6th Cir. Feb. 17, 2017)]
U.S. Court of Appeals for the Sixth Circuit

[Opinion]

The Future of the ACA: Actuaries Focus on the Individual Health Insurance Market
"A recent report from the nation's top actuaries ... offers an unvarnished explanation of the impact of the relevant actuarial principles that informed the ACA and that must be negotiated in the process of its replacement.... The actuarial principles expounded in the paper appear to transcend law and politics and any ACA replacement plan that fails to take them in account may face significant, if not insurmountable, hurdles in achieving its objective."
Mintz Levin

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BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2017 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 those materials. You may not alter or remove any trademark, copyright or other notices from copies of the content.

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