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Healthcare Plan Management

Engaging Consumers in Changing Health Behaviors

This article from Buck Consultants summarizes relevant concepts and findings from the fields of psychology, decision research, and social marketing and identifies best practices in developing consumer engagement to aid employers  in creating health care programs and tools to control costs and improve workforce health and productivity.

Self-Insured Health Plans: State Variation and Recent Trends by Firm Size, 1996–2013

A new EBRI analysis finds a growing percentage of workers in self-insured health plans nationwide. In 2013, 58.2 percent of workers with health coverage were in self-insured plans, up from 40.9 percent in 1998  .However, the data show that this trend is being driven by large employers (with 1,000 or more workers), and not small employers (those with fewer than 50 workers).

Utilization Patterns and Out-of-Pocket Expenses for Different Health Care Services Among American Retirees

Data reported in EBRI’s February 2015 Issue Brief finds that the recurring, more-predictable health costs in retirement tend to remain stable throughout retirement: Expenses such as doctor visits, dentist visits and usage of prescription drugs.  However, the non-recurring, less-predictable costs increase with age—overnight hospital stays, overnight nursing-home stays, outpatient surgery, home health-care and usage of special facilities.

2015 Retirement Health Care Costs Data Report

A new report from Healthview Services suggests health care costs will consume a rising percentage of Social Security benefits for future retirees.  The 2015 Retirement Health Care Costs Data Report draws upon claims data from year-end 2014, the company’s actuary and physician-reviewed cost projection methodology and a wide range of additional data sources. Year-over-year comparisons are between year-end 2013 and year-end 2014 data sets.

Utilization Patterns and Out-of-Pocket Expenses for Different Health Care Services Among American Retirees

This February Issue Brief from EBRI discusses how we spend our health dollars are we age.  The study separates the more predictable health care expenses in retirement for older Americans (ages 65 and above) from the less predictable ones. Based on utilization patterns and expenses, doctor visits, dentist visits and usage of prescription drugs are categorized as recurring health care services. Overnight hospital stays, overnight nursing-home stays, outpatient surgery, home health care and usage of special facilities are categorized as non-recurring health care services.

Gallup and Healthways Redefine ‘Wellness’

A February 4, 2015 article in Gallup’s Business Journal highlights a new approach to wellness advocated by Gallup and its partner, Healthways. The two have coined the term “well-being” to supplant wellness and have broadened the definition to encompass five measureable, interdependent elements.

National Trends in the Cost of Employer Health Insurance Coverage, 2003–2013

A December 2014 Issue Brief from The Commonwealth Fund, finds that premiums for employer-sponsored health insurance grew at a slower rate after passage of the Affordable Care Act. However, due to even slower growth in the incomes of U.S. families, consumers are spending more of their salaries on their employer health insurance. The Commonwealth Fund’s report also takes a futher look into the slower growth of premium contributions and deductibles vs. the sluggest growth in median family income.

EBRI Report on the 2014 Health Benefits Survey

The December 2014 issue of EBRI’s Notes discusses findings from the SHRM/EBRI 2014 Health Benefits Survey and how open enrollment might be affected by PPACA and the 2018 excise tax. The survey was conducted in February and March 2014 to better understand changes to health coverage in 2015.

Infographic: Employer Responsibility Under the Affordable Care Act

Many employers face penalties if they don’t make affordable healthcare coverage available to their employees. The Obama Administration announced “transition relief” under which the penalties will go into effect in 2015 for employers with 100 or more employees and in 2016 for employers with 50 or more workers. This November 2014  infographic from the Kaiser Family Foundation  illustrates how to determine employer penalties.

Analysis Shows Upward Trend in U.S. Healthcare Cost Increases in 2014

In 2014, U.S. companies and their employees saw a slight uptick in the rate of U.S. healthcare cost increases, according to an analysis by Aon Hewitt.  The summary includes costs by plan type from 2010-2014, comments on managing dependent eligibility and subsidies and private health exchanges.

Preparing for a Health & Welfare Plan DOL Audit

This November 2014 article in Benefits Magazine, published by the International Foundation of Employee Benefits Plans, takes an ERISA health and welfare plan step by step through a DOL audit, from the initial notification and request for documents through the investigative process.

2014 Inside Benefits Communication Survey

The 2014 Inside Benefits Communication Survey, a collaborative research effort from the National Business Coalition on Health and Benz Communications, is a national survey that explores how companies are making investments in benefits communications and the return on those efforts.  The survey’s data was collected from more than 300 high-level business professionals and provides greater insight into how companies are planning and implementing benefits communication.

2014 Telemedicine Survey Executive Summary

This November, 2014 survey by law firm Foley & Lardner focuses on the rising interest in telemedicine.  The survey, while small in scale (just 57 respondents) was conducted among healthcare executives throughout the US in September and October 2014.  Among the issues the survey covered are the effect the ACA has had on telemedicine advancements as well as the challenges surrounding payment for healthcare providers for the service.

Surge in Employees’ Share of Health Costs

An article from the Society of Human Resource Management dissects a 2014 UBA Health Plan Survey and discusses how employers continue to shift more of the financial burden of health coverage to employees through out-of-pocket cost increases and reductions in family benefits.

Examining Private Exchanges in the Employer-Sponsored Insurance Market

This September 2014 report by the Kaiser Family Foundation identifies the different types of private exchanges and projects the potential size of the private exchange market, which the report says has the potential to reshape the employer-sponsored health insurance landscape in the coming years.  The report examines important implications, including the potential for cost stability to employers and more choice among health plans for consumers.

IRS Notice 2014-49: Further Guidance on Look-Back Measurement Procedures

The IRS issued guidelines on September 18, 2014, for application of the look-back measurement process for employers in two specific situations: when an employee transfers from one position to another within the same company but with different look-back measurement periods or when an employer changes the look-back measurement period for a position.

Top Five ACA Issues Employers Should Be Following

This September 16, 2014, briefing from law firm Epstein Becker Green highlights the top five ACA issues that it believes employers should be following.  Issues include litigation, employer mandate reporting and the looming Cadillac tax.

Towers Watson 2014 Health Care Changes Ahead Survey Report

Towers Watson’s 2014 Health Care Changes Ahead Survey yields insight into how companies are changing their health care strategies to comply with health care reform, combat escalating costs, avoid the business risks associated with the 2018 excise tax and improve employee engagement.

Private Exchanges and the Rise of Retail Health Coverage

This report from PricewaterhouseCooper’s Health Research Institute is based on data from the organization’s 2014 Health and Well-Being Touchstone Survey. (A link to the full survey is also available on this site under Benefits Research & Surveys.)  The report discusses the four types of private exchanges and names the major players in each. It also illustrates factors that influence a company’s interest in moving to a private exchange and touches on the pros and cons of such a move.

Commentary/Analysis of IRS Draft 1094 and 1095 Forms and Instructions

This web page on Practical Law provides helpful discussion and explanation of the IRS’ recently issued draft forms 1094 and 1095 in connection with reporting that employers must provide to the IRS under Sections 6055 and 6066 of the Affordable Care Act.  The article  explains which employers, including those that are self-insured, must file the forms and what sections need to be completed.

EBRI Report on HSA Quality of Care

With an ever-growing number of workers covered by health savings account (HSA) plans, this September 2014 Issue Brief from EBRI examines how HSA health plans—compared with traditional managed care plans—do in terms of health care quality.  The results of the study were based on data collected over a 5-year period from a single large employer in the Midwest with an HSA-eligible health plan for all employees.

IRS Q&A on Information Reporting by Health Care Coverage Providers

This page on the IRS website provides information in Q&A format on information that healthcare coverage providers must report to the IRS under section 6055. Reporting is voluntary for 2014; for 2015, the information is required in early 2016.

IRS Draft Forms 1094 and 1095 with Instructions for ACA Information Reporting

This chronological (newest to oldest) listing of draft tax forms on the IRS website contains links to the various 1094 and 1095 forms associated with the Affordable Care Act. The 1094 and 1095 forms were posted August 28, 2014. The instructions provided with the forms are directed at Exchanges that must report enrollees in qualified health plans as well as at employers and others that provide minimum essential coverage or are subject to the employer mandate.

IRS Announces 2015 Rates for ‘Affordable Coverage’ Under ACA

Under the terms of the Affordable Care Act, large employers are required to provide affordable coverage beginning in 2015 or potentially face penalties. For 2014, the definition of affordability was set at 9.5% of the employee’s income. For plan year beginning in 2015, IRS Rev. Proc. 2014-37 sets the new limit at 9.56% of employee income.

Wellness Programs After the Affordable Care Act (Part II)

This article is Part II of a Benefits Law Alert published by Nixon Peabody LLP, with Part I posted on August 8, 2013.  Part I of the series discussed the wellness regulations released under the Affordable Care Act, which went into effect in 2014. Part II discusses compliance with other laws that govern employee wellness programs.

2014 Benefits Strategy & Benchmarking Survey Report

This report, published in June 2014 from Arthur J. Gallagher & Co., provides an interesting look at data collected from 1,833 organizations across the country when they were surveyed about their current and future employee benefits strategies.

Ten Ways to Help Your Employees Make Good Healthcare Decisions

Admit it—sometimes it’s difficult for all of us as plan sponsors to understand all of the healthcare changes, rules and regulations.  But imagine how our employees feel.  This article from PLANSPONSOR offers ten relatively easy and sensible steps to take to communicate the puzzle that is healthcare benefits.

Employee Benefits: Today, Tomorrow, and Yesterday

This Julie 2014 Issue Brief summarizes EBRI’s 35th policy forum held in Washington, DC, on Dec. 12, 2013. The symposium provided expert perspectives on the workplace and work force of the past, the challenges of today’s multi-generational workplace, and the difficulties and opportunities of the future.

Hobby Lobby Decision Breaks New Ground

This alert from Nixon Peabody covers the Supreme Court’s controversial ruling in the Hobby Lobby case.  Read background on the case, the ruling and the far reaching effects for the future.

HSA Savings: Potential Accumulations

A July 2014 analysis in EBRI’s Notes shows that a person contributing for 40 years to an HSA could save up to $360,000 if the rate of return was 2.5 percent, $600,000 if the rate of return was 5 percent, and nearly $1.1 million if the rate of return was 7.5 percent, and if there were no withdrawals.

Text of U. S. Supreme Court Opinion in Burwell v Hobby Lobby

The U.S. Supreme Court ruled in its opinion of June 30, 2014, that a for-profit corporation has free exercise of religion rights, making it lawful for the corporation to be exempt from laws to which it has religious objections.

CMS Fact Sheet: Exchange and Insurance Market Standards for 2015 and Beyond

This CMS Fact Sheet summarizes the final rules regarding consumer notices, quality reporting and enrollee satisfaction surveys, the Small Business Health Options Program (SHOP), standards for Navigators and other consumer assisters, and policies regarding the premium stabilization programs, among other standards.

Final Master FAQs from CMS on Health Insurance Market Reforms and Marketplace Standards

This 7-page document from the Center for Medicare & Medicaid Studies provides guidance in Q&A format on the implementation of the essential health benefits and actuarial value, guaranteed availability, minimum essential
coverage, and transitional policy extensions as established by the Affordable Care Act to reform the insurance market.

2014 ADP Annual Health Benefits Report

ADP released its second annual Health Benefits Report. Subtitled “2014 Benchmark and Trends for Large Employers,” the report is based on ADP’s analysis of its own client base and tracks premium, eligibility and participation rates from 2010 to 2014.  Among its findings: participation has consistently been higher among older workers than among younger. The report also notes that between 2010 and 2014, premiums increased 15% but rose only 1.7% between 2013 and 2014.

Private Insurance Exchanges Continue to Evolve

This article by Carol Harnett appeared in the April 9, 2014, edition of HR Executive Online. The Q&A format makes for a good “primer” on the topic of private exchanges and explores issues that employers should consider before making the jump to this new model for group benefits.

Incentives to Shape Health Behaviors

This February 2014 article published in the Journal of Workplace Behavioral Health examines the use of incentives to shape health behavior and looks at the differences between “patient-centered” and “person-centered” approaches. The authors conclude that while it isn’t possible to create incentives that will be appealing to everyone, a person-centered approach would  allow individuals to self-match to incentives and engage them in the decision-making process. This could lead to better outcomes.

Value-Based Benefit Design Seen as a Tool to Change Behavior

A study of a large employer by the Academy of Managed Care Pharmacy looking at drug adherence among two populations–those with diabetes and those with high cholesterol–concludes that a value-based benefit design offering zero copay for generic drugs improved adherence.

EBRI Report on Contributions to HRAs and HSAs, 2006-2013

This report published in the February 2014 issue of EBRI Notes looks at the level of employer-employee contributions to HRAs and HSAs between 2006 and 2013. Based on its 2013 EBRI/Greenwald & Associates Consumer Engagement in Health Care Survey, this report shows that the percentage of employers who contribute to these plans has increased and that employees with family coverage contributed to the accounts at a steady level while contributions by those with single coverage fell.

IRS Final Regulations on ACA’s Employers’ Shared Responsibility Provide a One-Year Transition to Full Compliance for Large Employers

On February 12, 2014, the IRS published final rules covering employers’ shared responsibility under ACA.  Large employers, those with 100 or more employees, will be subjected to penalties if they fail to cover 70% of full-time employees in 2015. The coverage threshhold moves to 95% in 2016. Employers with 50-99 employees have until 2016 to comply.

Explanation of the Affordable Care Act’s December 2013 and January 2014 FAQs

This Aon Hewitt Bulletin discusses the provisions in the December 19, 2013, and January 9, 2014 FAQs released by HHS, DOL and Treasury in connection with implementation of the Affordable Care Act.  Topics covered include cost sharing, wellness, preventive services and the transitional reinsurance fee.

Summary of Final Mental Health Parity Regulations

This Towers Watson Insider offers analysis of the final regulations governing the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) and, in particular, how the MHPAE interacts with PPACA.

Explaining Health Care Reform: Risk Adjustment, Reinsurance, and Risk Corridors

The Kaiser Family Foundation offers a clear and detailed explanation of the Affordable Care Act’s risk adjustment, reinsurance and risk corridor provisions, which are intended to promote insurer competition on the basis of quality and value and promote insurance market stability, particularly in the early years of reform.  Using text and, side-by-side comparisons and other graphics, the article offers a basic primer on these provisions.

2013 EBRI/Greenwald & Associates Consumer Engagement in Health Care Survey

This Dec. 2013 Issue Brief from EBRI presents findings from its Consumer Engagement in Health Care Survey (CEHCS) done in conjunction with Greenwald & Associates. The CEHCS was an online survey of 3,853 privately insured adults ages 21−64 designed to provide nationally representative data regarding trends in account-based health plans and high-deductible health plans

ACA’s 2015 Transitional Reinsurance Fees

This Dec. 30, 2013, Towers Watson publication provides information on HHS’ announcement of the fee and payment schedule for the Transitional Reinsurance Fee assessed on insurers and plan sponsors to stabilize premiums in the individual market. The fee for 2015 has been set at $44 per covered life; self-insured and self-administered plans are exempt for 2015.

Modification of FSA Use-It-Or-Lose-It Rule

This IRS announcement on October 31, 2013, explains modification of the use-it-or lose-it rule for FSAs. Employees may carry over $500 of unused amounts from 2013 to 2014, provided the plan sponsor amends the plan to permit participants to do so.

ACA’s Impact on Wellness Programs

This Alert from law firm Nixon Peabody is the first of two dealing with compliance issues for employer-provided  wellness programs. This issue deals with how the ACA’s final rules amended and expanded the HIPAA nondiscrimination and wellness provisions.  These final rules apply to all group health plans, regardless of whether they are grandfathered or non-grandfathered, insured or self-insured, for plan years beginning on or after January 1, 2014.

FMLA – Fact Sheet #28F – Qualifying Reasons for Leave

This Fact Sheet on the DOL website clarifies that for purposes of FMLA the definition of spouse includes a same-sex spouse if the marriage is recognized under the laws of the state in which the employee resides.

Private Exchange Options for Employers

Towers Watson offers an overview of how “next generation” private exchanges provide alternatives to employers to provide health care benefits to current employees, non-Medicare eligible retirees, Medicare eligible retirees, COBRA participants and seasonal and part time workers.

Model COBRA Notice Updated for ACA

The DOL has provided a revised model COBRA Notice for use by single employer health plans. The new model includes language to make beneficiaries aware of alternative coverage available through ACA’s marketplaces.

PPACA’s Out-of-Pocket Maximums and Preventive Services

This analysis from Towers Watson examines the implications of the 20 questions included in the DOL’s Frequently Asked Questions #15.  The analysis focuses on out-of-pocket limits for 2014, preventive services without cost sharing and changes that may be necessary for most plans in order to be compliant.

PPACA’s Out-of-Pocket Maximums and Preventive Services

This analysis from Towers Watson examines the implications of the 20 questions included in the DOL’s Frequently Asked Questions #15. The analysis focuses on out-of-pocket limits for 2014, preventive services without cost sharing and changes that may be necessary for most plans in order to be compliant.

Impact of ACA’s 90-Day Enrollment Waiting Period Rules

This March 2013 commentary from Aon Hewitt discusses the ACA’s proposed regulations limiting enrollment waiting periods for group health plans to no more than 90 days. The article also highlights the fact that after 2014 there will no longer be a need to issue HIPAA Creditable Coverage Certificates.

Summary of HIPAA Privacy Rule

The Department of Health and Human Services provides a summary of the HIPAA privacy rule on its website.

Impact of ACA’s 90-Day Enrollment Waiting Period Rules

This March 2013 commentary from Aon Hewitt discusses the ACA’s proposed regulations limiting enrollment waiting periods for group health plans to no more than 90 days. The article also highlights the fact that after 2014 there will no longer be a need to issue HIPAA creditable coverage certificates.

Final Rule for Health Insurance Market Reforms

This overview on the Department of Health and Human Services website explains the final rules on health insurance market reforms: Guaranteed Availability of Coverage; Fair Health Insurance Premiums; Single Risk Pool; Guaranteed Renewability of Coverage; Catastrophic Plans; and Updating Rate Review.

Essential Health Benefits: Fact Sheet

The Department of Health and Human Services issued final rules on February 20, 2013, outlining standards for coverage of essential health benefits (EHB) and the determination of actuarial value (AV). This fact sheet provides an overview.

2013/2014 Towers Watson NGBH Employer Survey on Purchasing Value in Health Care

The 18th annual Employer Survey on Purchasing Value in Health Care, a survey by Towers Watson and the National Business Group on Health, examines how “best performing” companies in the study, those with average trend of 2.2%, have managed to contain costs for themselves and their employees.

Affordable Care Act Implementation Timeline

This page on the government website devoted to healthcare reform, provides a timeline of when provisions of the Affordable Care Act go into effect. There are also links to additional information for consumers.

Proposed New Wellness Program Rules

This report by Aon Hewitt discusses proposed rules on wellness programs under ACA and their interaction with HIPAA’s nondiscrimination rules.

Are Private Health Insurance Exchanges the Wave of the Future?

This EBRI Issue Brief examines the growing interest among employers in private health insurance exchanges as an alternative to the traditional model of employer-sponsored healthcare benefits. The article provides a good explanation of how private exchanges might operate.

FMLA – DOL’s Online Access to Information About Rights and Responsibilities

This page on the DOL’s Wage and Hour Division website is part of the elaws program. This Family and Medical Leave Act Advisor provides information about the basic rights and responsibilities of employees and employers under FMLA. It includes information about the 2012 expansion of rights for military families and airline flight crews.