Determining whether group health coverage provides “minimum value” is key to avoiding penalties under health reform’s premium tax credit program, so employers will likely welcome new proposed rules that further explain MV criteria. The proposal, to be published May 3…
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…
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…
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…
The health reform law provides that entities called “Navigators” will assist consumers and small businesses in researching health insurance exchanges — but stop-loss insurers for self-funded health plans won’t be one of them. Those insurers, as well as individuals and…
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…
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….
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…
With thousands of pages of new laws and rules, there must be thousands of new reasons for employees to sue for health benefits not delivered properly in the wake of near-complete enactment of health reform starting in 2014, one could…
Employer-sponsored plans that are secondary to Medicare are not subject to health reform’s expensive transitional reinsurance fee, nor are health flexible spending arrangements, health savings accounts and most health reimbursement arrangements. On March 11, 2013, the U.S. Department of Health…