Tag Archives: Health plans

Prohibited Restrictions and Rescission Clarified in Agency FAQs

Compliance with preventive health service requirements and other mandates of the health care reform law, along with disclosure obligations involving mental health parity requirements for health plans, were addressed in frequently asked questions issued by the U.S. Departments of Labor,…

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Impact on Life Duration & Quality Drives Drug Value

A prescription drug’s ability to prolong life is a top factor health plans are using when fixing benchmark prices for drug reimbursement, followed by the drug’s ability to improve the patient’s quality of life, health care stakeholders said at an…

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How Health Plans Help Providers Convert to Quality & Value Models

Health care providers need help moving to value-based reimbursement and adopting accountable care models, and insurers and health plans often provide the best support, health plan executives told a recent conference. They discussed best practices for helping providers adopt value…

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Supreme Court Seeks New Accommodation in Birth Control Case

Religious non-profit employers that are not eligible for a church exemption seemed more likely to change the process of opting out of the Affordable Care Act requirement that health plans cover contraceptives and family planning services without cost-sharing. In a two-page…

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Follow-up McCutchen ruling shrinks plan recovery

A federal district court in Pennsylvania denied a large part of US Airways’ attempted recovery from the estate of plan participant James McCutchen, citing inconsistencies between the company’s plan document and summary plan description. If a plan’s official plan document…

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HHS Launches Phase 2 HIPAA Privacy Audits

The U.S. Department of Health and Human Services has officially launched its long-awaited Phase 2 HIPAA audit program, the head of HHS’ Office for Civil Rights said at a March 21 conference. The process has begun with the emailing of…

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Transform Market Rules to Stop Drug Price Gouging, AHIP Execs Advise

Runaway prescription drug pricing poses a threat to health plan solvency and to the financial well-being of individuals, because a distorted market allows profit-seeking entrepreneurs to game the system with anti-competitive pricing, health plan executives told attendees at AHIP’s national…

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Fiduciary Duties Are Myriad, So Safeguards Matter

Monitoring the performance of service providers, making required disclosures to participants and beneficiaries, keeping good records and filing reports with the government are just a few of the important functions a fiduciary must ensure are properly executed, an enforcement official…

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Court: Employers Can Condition Health Benefit on Wellness Participation

An employer may require its workers to participate in a wellness program in order to receive health insurance benefits, a federal district court has ruled, dismissing a lawsuit brought by the U.S. Equal Employment Opportunity Commission. Granting summary judgment for…

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IRS Extends ACA Employer Reporting Due Dates

Employers will have 60 more days to send notices to participants and beneficiaries, and about 90 more days to send notices to the IRS about health coverage offered and employees’ health coverage status, the IRS announced Dec. 28. IRS Notice…

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