Category Archives: Health plans

EEOC Urged to Align Wellness Standards With HIPAA/ACA Rules

The U.S. Equal Employment Opportunity Commission’s failure thus far to issue clear guidance on permissible wellness incentives threatens to undermine employers’ development of wellness programs at a time when their importance is growing, business groups warned the EEOC at a…

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Updated SBC Template Requires Coverage & Value

Employer-sponsored health plans and insurers are required to make two changes to the summary of benefits and coverage, which must be distributed to all health plan participants under health reform. They must add statements of whether their coverage: (1) provides…

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Colorado House Passes Bill Scrutinizing and Limiting Stop-loss

On April 22, the Colorado House of Representatives passed legislation regulating stop-loss through minimum attachment points, and requiring stop-loss insurers to give the commissioner information about their self-insuring clients with 100 and fewer full-time equivalents. The bill also would give…

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Reductions in Transitional Reinsurance Fee Are Possible but Unlikely

Employers might pay less than $63 per covered life per year under health reform’s transitional reinsurance fee rules, but that would require a surplus in the fund, a U.S. Department of Labor official told an employer plan industry group on…

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Urban Institute Criticizes Use of Stop-Loss Insurance by Small Employers

If small companies self-insure their health plans and in doing so can get stop-loss coverage with very low attachment points, they could siphon healthy lives away from the new insurance market designed by health reform to insure millions of new…

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Apply Now for HIPAA-standard Health Plan Identifier

Health plans now may begin applying for the standard health plan identifier required by HIPAA, CMS has announced. The online application was posted March 29 on CMS’ Health Plan and Other Entity Enumeration System (HPOES). Most HIPAA-covered health plans, including employer…

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Congress Sees Self-funded Health Plans’ Financial Strength

Companies that self-fund health benefits are larger than companies that fully insure health benefits and their solvency is just as good as companies that fully insure, a government report required by the health reform law indicates. The reform law requires…

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States Try to Impose Tougher Stop-loss Limits on Self-insured Health Plans

Recently, four bills were introduced in state legislatures that would make self-funding less attractive by limiting stop-loss coverage for self-insured health plans. Many such proposals would raise minimum specific deductibles above the standard $20,000 seen in most enacted laws. This…

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Questions and Answers on Reform’s Transitional Reinsurance Fee

Employers are understandably nervous about the transitional reinsurance fee, which health insurers and employer health plans must pay from 2014 through 2016. The fee will be collected by HHS, even though the states will tailor their own risk adjustment programs….

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Reform Rule on Maximum Waiting Period Details Some 90 Day-plus Scenarios

Employer group health plans must eliminate waiting periods of more than 90 days before enrolling otherwise eligible employees (or dependents) into health coverage, under proposed rules issued on March 18 by the federal agencies implementing health reform. For Clear Full-time…

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