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Healthcare Plan Management

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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 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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Summary of HIPAA Privacy Rule

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

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.

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.

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.

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.