Headlines about "Health plans - design"
Gathered from the web by the editors at BenefitsLink.com.
Small Businesses Could Buy Health Insurance for Nearly 10 Million Workers through ACA's Small Business Health Insurance Exchanges
"The reform law grants states considerable flexibility in designing their exchanges, such as allowing them to combine their small business and individual exchanges, limiting enrollment to companies with 50 or fewer employees or opening to firms of up to 100 employees through 2015, or reducing the ability of insurers in the exchange to charge premiums on the basis of age beyond what the law allows." (The Commonwealth Fund)
You don't have to be an 800-pound gorilla to create a better health plan for employees ? but it sure helps
Self-funded companies can do a lot to improve employee health through wellness programs and creating 'micro health delivery systems' ... with goals tailored to the firm's employee population. (Thompson - Smart HR Manager)
Effects of Pharmacy Benefit Carve-in on Utilization and Medical Costs (PDF)
"A study finds that plan sponsors offering health care benefits that include a carved-in pharmacy benefit are likely to experience significant medical cost savings over carving out the pharmacy benefit." (Benefits Magazine)
White House May Look to Compromise on Contraception Decision
The White House may be open to compromising on a new rule that requires religious schools and hospitals to provide employees with access to free birth control, a senior strategist for President Obama said on Tuesday morning. (The New York Times)
Milliman's Monthly Benefit News and Developments, February 2012 (PDF)
The newsletter provides a summary of the previous month's legislative, regulatory, and judicial information on employee benefits and upcoming key dates. (Milliman)
Essential Benefits, Summaries Among Implementation Issues in the News
"n this pair of stories, CQ HealthBeat offers the latest news on the health law's benefts summary rule and one state insurance commissioner's views on essential benefits." (Kaiser Health News)
Essential Health Benefits Bulletin Passing Job to States Draws Fire
"The public was invited to formally comment on the bulletin but in an unusual step, the bulletin comments were not collected through the typical regulations.org site. Instead stakeholders and interest groups were directed to an e-mail address." (HealthLeaders Media)
Employers and the Exchanges under the Small Business Health Options Program: Examining the Potential and the Pitfalls
"To attract employers, the exchanges must be able to keep costs affordable and limit the burden posed by the insurance process; perform administrative functions; manage enrollment periods; and, perhaps most important, protect against 'adverse selection,' which would lead to a disproportionate number of sicker individuals in the exchanges." (The Commonwealth Fund)
Aging Workforce Values Vision Benefit, Doesn't Use It Fully
"[According to results from the annual Employee Perceptions of Vision Benefits survey] Baby Boomers (ages 45 to 64) were only slightly more likely than younger employees to enroll in their vision benefit (79 percent vs. 75 percent)." (Society for Human Resource Management)
Less than Half of Employers Ready to Distribute Health Care Reform Summary of Benefits & Coverage Materials
"Key findings show that while 81% of employers plan to update their SPDs for plan design and Affordable Care Act (ACA) changes this year, they continue to wrestle with cost containment and resource strain for the implementation and review process required to execute SPD changes." (HighRoads)
IRS's Updated Version of Taxable Fringe Benefit Guide
"This publication offers helpful insight into the IRS's views regarding the taxation, withholding, and reporting requirements for many fringe benefits. And unlike many other IRS summaries, it includes citations to statutes, regulations, cases, and guidance that make it useful as a gateway reference." (Thomson Reuters/EBIA)
[Guidance Overview] Maintaining 'Grandfathered Plan' Status for Group Health Plan Critical to Avoiding New Mandate on Coverage for Contraceptives
"Multiple religious organizations have expressed opposition to the Section 2713 mandate, including the U.S. Conference of Catholic Bishops, the National Association of Evangelicals, and the Union of Orthodox Jewish Congregations of America, among many others. Given the limited options available for avoiding the new mandate for nongrandfathered group health plans, those employers who will not be able to comply with the new rules due to their religious beliefs but who wish to continue offering group health plans to their employees must pursue other courses of action." (Hinshaw & Culbertson LLP)
[Opinion] An Affront Catholics Agree On
"Liberal and conservative Catholics don't agree on much, but they're both outraged by a new rule on contraception coverage." (Los Angeles Times)
State Legislation and Actions Challenging Certain Health Reforms, 2011-2012
"In response to the federal health reform law, now known as the Affordable Care Act (ACA), and separate state reform initiatives, some members of at least 45 state legislatures have proposed legislation to limit, alter or oppose selected state or federal actions. In general many of the opposing measures, in 2010 and 2011: Focus on not permitting, implementing or enforcing mandates (federal or state) that would require purchase of insurance by individuals or by employers and impose fines or penalties for those who fail to do so. Seek to keep in-state health insurance optional, and instead allow people to purchase any type of health services or coverage they may choose. Contradict or challenge specific policy provisions contained in the 2010 federal law." (National Conference of State Legislatures)
[Opinion] Comments of American Academy of Actuaries on HHS' Research Brief Entitled 'Actuarial Value and Employer-Sponsored Insurance' (PDF)
"The American Academy of Actuaries' Health Practice Council appreciates the opportunity to provide comments on the recently released [HHS] research brief, 'Actuarial Value and Employer-Sponsored Insurance.' . . . There are additional factors that should be considered when interpreting the results and formulating policies to regulate [actuarial value] calculations for [employer-sponsored insurance]: . . ." (American Academy of Actuaries)
[Opinion] Comments of American Academy of Actuaries on HHS' Essential Health Benefits Bulletin (PDF)
"[T]here are a few implications of allowing the flexibility to create multiple benefit sets that should be considered. Such flexibility in benefit design could create confusion for consumers; result in situations in which insurers design benefit packages to minimize certain risks; and have a material effect on premium rates, particularly in the individual market. . . . Clarification of the use of the terms 'actuarial equivalence' and 'substantially equal' as used in the context of essential health benefits is needed as well." (American Academy of Actuaries)
Administration and Catholics Tangle Over Mandatory Contraception Coverage
The administration will not reconsider the decision, White House spokesman Jay Carney said yesterday, according to the Associated Press. (AP via Washington Post)
Domestic Policy Council Director's Statements on White House Blog About Contraceptive Mandate
"Over half of Americans already live in the 28 States that require insurance companies cover contraception: Several of these States like North Carolina, New York, and California have identical religious employer exemptions. Some States like Colorado, Georgia and Wisconsin have no exemption at all." (The White House Blog, written by Cecilia Mu?oz, Director of the White House Domestic Policy Council)
Seven Companies With Unique Employee Health Benefits
"Home-improvement retailer Lowes established a partnership with the Cleveland Clinic in Ohio to offer heart surgery procedures at no cost to full-time employees and dependents enrolled in its self-insured medical plan. Lowe's covers all medical deductibles and coinsurance amounts, as well as travel and lodging expenses for the patient and a companion." (Mother Nature Network)
[Opinion] Protestants and Jews Declare to White House: We Stand With Catholics
"[M]ore than 40 non-Catholic religious organizations including Protestant-affiliated colleges, National Association of Evangelicals, Focus on the Family, Assemblies of God, Northwest Nazarene University, and Eastern Mennonite University, sent a letter to the White House demanding religious protection against the newly issued HHS contraceptive mandate." (Becket Fund)
Anger Brewing on the Left About Mandatory Contraceptive Coverage for Employees of Religious Employers
"Megan McArdle, senior editor of the Atlantic, wrote yesterday that it might be in Americans' interest to be more flexible with faith-based organizations because they provide such a depth of social services (publicly funded in many cases, of course) . . . ." (Washington Post)
[Guidance Overview] Agencies Outline Plans for Issuing Rules Under Affordable Care Act
"[An] imminent final rule will establish the requirements of the Summary of Benefits and Coverage (SBC) disclosure that health insurers and group health plans must provide to consumers to enable them to better compare benefits and coverage. The CMS issued a proposed rule on this topic in August 2011. A final rule, which will also 'set standards for the definitions of terms used in health insurance coverage, including specific terms' provided in the Affordable Care Act, is expected to be issued shortly." (Employee Benefits Counsel Blog)
Larger Employers Increasingly Covering Cost of Gender Changes
"[J]ust like depression, having gender identity disorder is diagnosed by doctors, and the American Medical Association asserts that when discriminatory financial barriers are placed between the transgender community and proper health care by dismissing treatments as 'cosmetic' or 'experimental' -- even when covered for other patients with other recognized medical conditions -- more expensive problems can develop as a result, such as depression, substance abuse problems and stress-related illness." (Employee Benefit News)
Catholic Bishops Revolt Against Birth Control Rules
"There's a battle going on between U.S. Catholic bishops and the Obama administration over its recent directive requiring religious institutions to offer coverage for contraception in their health care plans. Some have announced they will not comply with the mandate. Others are calling on parishioners to . . . speak out against what they call an intrusion against religious liberty." (National Public Radio)
[Opinion] Health Care Mandates Violate Our Religious Rights
"This mandate treats a healthy pregnancy as a disease in need of 'prevention,' like breast cancer or AIDS or other conditions that require safe, effective prevention and treatment. But pregnancy is not a disease; it is a gift from God. . . . Never in the history of this country has the government forced citizens to purchase a product that violates core moral and religious beliefs." (Concord Monitor)
[Opinion] Obamacare's Contraception Mandate Tramples on Religious Liberty
"Exemption of religious institutions from the Obamacare contraception mandate does not involve a clash of the constitutional rights of a religious employer with the constitutional rights of its employees regarding contraception (as enunciated by the U.S. Supreme Court in Griswold v. Connecticut, 1965) or abortion (Roe v. Wade, 1973). Such an exemption in no way limits the freedom of employees of those religious institutions to obtain contraceptive services, to obtain insurance covering contraceptive services from a source other than their employer, or to seek employment with other than a religious employer." (The Heritage Foundation)
[Guidance Overview] ACA Terminology Related to Essential Health Benefits, Minimum Essential Coverage and Minimum Value (PDF)
"This memorandum addresses [three terms that] are or will be very important to employers in understanding their obligations under the ACA. Attached to this memorandum is a chart addressing the application of each of these terms to different types of employer-sponsored coverage." (Crowell Moring via American Benefits Council)
A Guide to The Supreme Court's Review of The 2010 Health Care Reform Law
"[T]his Kaiser Family Foundation brief serves as a primer on the pending case, which challenges the constitutionality both of the law's individual mandate that requires most Americans to obtain health insurance and of provisions requiring states to expand eligibility for their Medicaid programs. The brief provides an overview of . . . the key constitutional questions, and the legal arguments made by the parties involved . . . and the potential implications of the Court's decisions.' (Kaiser Family Foundation)
Patients in Consumer-Driven Health Plans Show More Cost-Conscious Behavior (PDF)
"[T]hose in [consumer-driven health plans] were more likely to say they had checked whether their plan would cover care; asked for a generic drug instead of a brand name drug; talked to their doctor about treatment options and costs; talked to their doctor about prescription drug options and costs; developed a budget to manage health care expenses; checked a price of service before getting care; and used an online cost-tracking tool." (Employee Benefit Research Institute)
[Opinion] Cleveland Clinic: 'Why We Won't Hire Smokers'
"Job candidates are told that the offer is subject to a nicotine-free urine test. If a candidate tests positive for nicotine, the offer is rescinded, and he or she is offered a free tobacco-cessation program and may reapply in 90 days. . . . At Cleveland Clinic, we have a unique perspective on the burden of chronic disease. We not only treat disease, but we also play a vital role in educating patients and employees about lifestyle choices. It is only right to practice what we preach." (USATODAY.com)
[Opinion] Not Hiring Smokers Crosses Privacy Line
"Treating smoking, in essence, like illegal drug use takes . . . employers down a dangerous road, one that extends far too deeply into the private lives of prospective workers." (USATODAY.com)
[Opinion] Comments of American Benefits Council on HHS 'Essential Health Benefits' Bulletin (PDF)
"[T]he Bulletin does not expressly reaffirm . . . that insured large group health plans and self-insured group health plans may continue to utilize a good faith effort to comply with a reasonable interpretation of the term 'essential health benefits' as provided in interim final regulations issued in June 2010. To avoid any confusion, we request . . . that the Department issue clarifying guidance that reaffirms that plan sponsors and issuers may continue to use a good faith effort . . . ." (American Benefits Council)
Public-private Pay Gap Varies Greatly By Education Level
"Federal civilian workers with only a high school diploma or less fared much better than private sector employees with the same: They earned 21 percent more wages, 72 percent higher benefits and 36 percent more in total compensation. . . . In contrast, among employees with a professional degree or doctorate, federal workers earned 23 percent less in wages and 18 percent lower total compensation, while receiving about the same benefits as the private sector employees with identical degrees." (GovExec.com)
[Opinion] Disregarding Religious Beliefs: Obama's Radical Power Grab on Health Care
"There would have been no controversy at all if President Obama had simply exempted religious institutions and ministries. But the administration insisted that the University of Notre Dame and St. Mary's Hospital be forced to pay for the privilege of violating their convictions. Obama chose to substantially burden a religious belief, by the most intrusive means, for a less-than-compelling state purpose -- a marginal increase in access to contraceptives that are easily available elsewhere." (Michael Gerson in the Washington Post; free registration required)
Catholic Clergy Come Out Swinging Against HHS Regulation Mandating Cost-Free Contraceptives
"Catholics around the country got an earful on Sunday from the pulpit over a new health insurance policy by the U.S. Department of Health and Human Services that forces employers to cover contraception and abortion as part of preventative care regardless of religious beliefs. The use of abortion and contraceptives violates Catholic teachings." (CNN Belief Blog)
[Opinion] Comments of Galen Institute on Medical Loss Ratio Requirements
"The MLR rules as drafted discriminate against Health Savings Accounts (HSAs) and similar high-deductible health plans in a number of ways. These accounts provide employers, employees, and individuals with an option to purchase coverage with a larger deductible so that the polices function more like traditional 'insurance' -- covering medical expenses above a certain threshold. . . . The Galen Institute respectfully requests that HHS exempt HSAs and other high-deductible health plans from the MLR requirement . . . ." (Galen Institute)
[Guidance Overview] Summary of HHS' Essential Health Benefits Bulletin
"While the Bulletin is of primary interest to health insurance issuers in the individual and small group market, self-funded group health plans may also be affected because group health plans are prohibited from lifetime caps on essential health benefits and after 2014, will also be prohibited from imposing annual dollar limits on essential health benefits." (Groom Law Group)
Baby Boomers Are Reaching Age 65, But Are They Actually Retiring?
"Health care is another issue that is causing many baby boomers to delay retirement . . . especially for those who are under the age of 65 and not yet eligible for Medicare. For pre-Medicare retirees, although 80 percent of employers offer a pre-Medicare subsidy, 51 percent of those employers have a subsidy cap . . . ." (BenefitsPro)
[Opinion] The End of Health Insurance Companies
"Here's a bold prediction for the new year. By 2020, the American health insurance industry will be extinct. Insurance companies will be replaced by accountable care organizations -- groups of doctors, hospitals and other health care providers who come together to provide the full range of medical care for patients." (The New York Times; free registration required)
How Will the Affordable Care Act Affect Small Businesses and Their Employees? (PDF)
"This fact sheet explains the changes that are likely to take place with reform, when they go into effect, and which businesses will be affected." (The Henry J. Kaiser Family Foundation)
Cost-Controlled Health Coverage Called 'Global Payment'' Plans Gaining Ground
"In just three years, a new way of paying for medical care has spread rapidly across Massachusetts, and now more than 1.2 million people are covered by plans that put providers on a budget in an effort to restrain health spending. This means that about one in five Massachusetts residents are being treated by doctors working under these new cost-conscious arrangements, a Globe survey of insurers found . . . ." (The Boston Globe)
Saving Company Retiree Health Plans
"Bankruptcy judges usually let companies terminate such plans, figuring the move will make it more likely that creditors will be paid and that the company's chances of turning itself around will be enhanced if it can shed millions or even billions of dollars in retiree obligations at the stroke of a pen. Retirees, who are unsecured creditors, always are vulnerable." (The Wall Street Journal)
Local Ohio Businesses Keep Employees Happy with Wide Range of Perks
"Companies in the Dayton area work to keep their employees happy, offering benefit packages that include health and disability insurance, 401(k) retirement plans, and paid vacation and holidays. Some businesses take it a step further, showering their staff with luncheons, treats in the break room, and free trips to sporting events and amusement parks." (Cox Ohio Publishing)
Tracking Employment-Based Health Benefits in Changing Times
"Most Americans obtain their health care coverage through an employment-related plan. The National Compensation Survey (NCS) provides measures of access, participation, and features for those plans This article discusses some of the issues that the implementation of the Patient Protection and Affordable Care Act will present for the NCS." (U.S. Bureau of Labor Statistics)
[Guidance Overview] Practitioners' Forum Discussion: Evans v. Sterling Chemicals, Inc.
"In Sterling, the Fifth Circuit held that an asset purchase agreement that included a provision in which the purchaser committed to providing post-retirement medical and life insurance coverage to acquired employees at the same levels provided under the seller's plans constituted an amendment to the purchaser's employee welfare plans." (Compensation Planning Journal via The Bureau of National Affairs, Inc.)
Judge Says Same-Sex Health-Coverage Ban Biased
"A federal judge signaled Thursday that she's likely to strike down a federal law that denies long-term health coverage to the same-sex domestic partners of state employees in California, saying it appears to be based on prejudice against gays and lesbians." (The San Francisco Chronicle)
Device Makers Urge Coverage of Weight-Loss Surgery
"Advocates say it will give obese patients a complete arsenal for fighting the condition that can spur a host of life-threatening illnesses and help save billions of dollars in health care costs for employers and the government." (Reuters via Employee Benefit News)
[Guidance Overview] American Health Benefit Exchanges
"In 2014, individuals and small business will be able to purchase private health insurance through state-based Exchanges. This document reflects information and guidance issued through statute, rule, or communications from the federal government concerning the activities and options as they related to the development of a health benefit exchange." (National Conference of State Legislatures)
Following Benchmark Proposal, HHS's List of Largest Small Group Products by State
"This information is intended to complement HHS' December 16, 2011 bulletin, which proposed a benchmarking approach for defining essential health benefits." (Practical Law Company)
Employers Should Offer Health Care Options
"In choosing employee health benefits, businesses have two main options for fully insured plans - a 'preferred provider organization' or a 'health maintenance organization.'" (World Publishing Co.)
CCIIO Illustrative List of the Largest Three Small Group Products by State (PDF)
"This document provides illustrative information to complement the bulletin on essential health benefits (EHB) under the Affordable Care Act released on December 16, 2011. Specifically, it provides a list of the products with the three largest enrollments in the small group market in each State using data from HealthCare.gov. It provides the names of the three largest products in each State ranked by enrollment. In addition, we are providing a list of the top three nationally available Federal Employee Health Benefit Program (FEHBP) plans based on enrollment. This information is being provided to facilitate a better understanding of the intended approach to EHBs." (U.S. Department of Health & Human Services, Office of Center for Consumer Information and Insurance Oversight)
[Guidance Overview] Do Benefit Plan Recoupment Claims Trigger Internal Appeal Rights?
"The issue turns on the significance of a claim for refund or 'recoupment' by a group health plan after services have been rendered and benefits paid. In the end, the court in this case decides that the refund request does not trigger any additional obligations under the ERISA claims regulations." (Roy Harmon III, Health Plan Law)
Health Care Reform Update: What's Essential about 'Essential Health Benefits' (PDF)
"The definition of EHB is especially important for small group health coverage, whether offered through or outside of an Exchange; however, this definition is also significant for all types of group health plans subject to ACA, including self-insured plans and plans in the large group market . . . ." (Alston & Bird LLP)
Important New Understanding about Essential Benefits? Not Everyone Thinks So
"[HHS] released a document intended to preview the kinds of benefits most health plans must offer starting in 2014. But one consumer advocate said it does not provide nearly enough information to be helpful." (The Henry J. Kaiser Family Foundation)
[Opinion] State of The ... Health Care Reform
"President Obama's largest legislative accomplishment to date was the passage of the health care reform law, which has been going into effect in stages, with regulations currently being written for the most substantial changes due to take effect in 2014. So it is odd the President mentioned health care only briefly, and in passing, in his State of the Union address last night." (Forbes)
[Opinion] Obamacare 'Contraceptive' Mandate Made in Bad Faith
"Since the FDA approves, as 'contraceptives,' drugs such as Plan B and Ella that may cause early-stage abortions, the federal government could force nearly every employer in America to pay for abortions and sterilizations. Colleges and universities providing insurance to their students will face the same requirement." (BostonHerald.com)
Seniors Decide Retirement Doesn't Suit Them, Keep Working
"Baby Boomers are starting to . . . work past conventional retirement age, a trend fueled by an uncertain economy, improved health in older life and an understanding that staying engaged leads to a better sense of well-being. . . . The percentage of people who work and people who want to work . . . for 65 and older was 17.9% [in 2011] compared with 10.8% in 1985. For 75 and older, the rate jumped from 4.3% in 1990 to 7.5% in 2011. (USATODAY.com)
Self-Insured Group Health Plans: Stop-Loss Insurance and Adverse Selection (PDF)
Published October 4, 2011. 'In the course of considering changes to its Stop-Loss Model Act, the National Association of Insurance Commissioners (NAIC) has received formal comments containing substantive inaccuracies regarding self-insured group health plans, stop-loss insurance, and how smaller self-insured group health plans may contribute to adverse selection in the health insurance marketplace. Similar comments have beenmade by federal regulators responsible for implementing the Affordable Care Act (ACA). This White Paper identifies and corrects several inaccurate comments in order to assist policy-makers at both the state and federal level to properly assess legislative/regulatory proposals related to self-insured group health plans." (Self-Insurance Insurance Institute of America, Inc.)
[Guidance Overview] HHS Extension of Compliance Date for Contraceptives Coverage for Certain Nonprofit Employers
"The delayed implementation rule does not expand the scope of religious employers who are exempt from the requirement to cover contraceptives under earlier guidance." (Practical Law Company)
Litigation and Compliance Risks for Plan Sponsors in the New Health Reform Environment
"This article addresses five aspects of [PPACA] that could result in significant costs to a plan sponsor if steps are not taken to ensure compliance: plan design mandates, internal and external claims review, enhanced notification requirements, nondiscrimination, and play or pay." (Paul Hastings LLP)
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