cmonfils | January 22, 2012
The Obama administration announced today that it will require all employers, including religious organizations, to comply with a new mandate in the health law providing free contraception in any health insurance they provide to women without a co-payment.
cmonfils | January 20, 2012
Living in Florida means not worrying about getting a good parking place when I’m shopping. In fact, the weather is so beautiful in Florida this time of year that I purposefully park far away. It allows the ol’ pedometer a chance to click a few extra times as I work off the eggnog consumed over the holidays and also allows me to enjoy a little sun on my face and the sight of palm trees swaying in the breeze. But we all know the weather in Florida isn’t always so pleasant. Hurricanes agree with all those Disney tourists that Florida is a favorite place to visit. The most recent one in our area, Wilma, came from the southwest with a vengeance. It slammed us – uprooting trees, knocking down power lines, sending roof tiles as projectile missiles through the air. Then it cleared. And the weather was sunny and calm. And for a short amount of time, all was well. But it was only the eye of the storm – with even more damaging hurricane winds churning behind it.
cmonfils | January 20, 2012
As employees take on more responsibility for paying for health care, voluntary benefits can provide much-needed additional coverage. EBN spoke to a number of voluntary benefits providers to get their thoughts on the major trends they see coming in 2012. Not surprisingly, all the trends and influences in the HR world at large – health care reform, employer cost-shifting, technology and communications – affect the voluntary benefits industry as well. Here, we provide a summary of key trends, along with charts and data to help employers plan their voluntary benefits strategy going forward.
cmonfils | January 20, 2012
Excela Health entered the Great Recession as the largest mental health provider for the Pennsylvania county that’s home to its three hospitals.
A year and a half later, as the recession drew to a close, Excela began to refer and transfer outpatient mental health patients to primary-care doctors and community clinics to stem losses.
cmonfils | January 20, 2012
January 19, 2012 – A delegation of SIIA members and lobbyists met today with senior officials with the U.S. Department Health & Human Services to address how final regulations establishing how a transitional reinsurance program mandated by the ACA will affect the self-insurance industry. (more…)
cmonfils | January 18, 2012
Employer’s Guide to Self-Insuring Health Benefits January 2012 | Vol. 19, No. 4
As illustrated here, ERISA did not preempt the Washington Mental Health Parity Act.
Even though it correctly applied an insured ERISA plan’s coverage restrictions on neurodevelopmental therapy for children over six years old, the administrator’s refusal to pay a 10-year-old dependent’s mental health treatment violated a state law that bound insurers and HMOs. (more…)
cmonfils | January 18, 2012
Employer’s Guide to Self-Insuring Health Benefits January 2012 | Vol. 19, No. 4
The U.S. Department of Labor (DOL) on Dec. 5 proposed new enforcement and oversight rules targeting Multiple Employer Welfare Arrangements (MEWAs). Officers who ran sham MEWAs were using plan funds improperly, absconding with funds and disappearing to set up fraudulent entities in other states, DOL Assistant Secretary Phyllis Borzi said. Under the proposed rules: (1) MEWAs would register with DOL before starting business in a state; (2) they would file the Form M-1 with DOL, regardless of their size; (3) DOL could issue cease-anddesist orders against MEWAs without prior notice or hearings, if they commit fraud and abuse; and (4) DOL would gain fast-track power to seize assets from a MEWA when there is probable cause that the plan is financially unstable. This would enable DOL to preserve plan assets before they’re totally dissipated, she said. (more…)
cmonfils | January 18, 2012
Employer’s Guide to Self-Insuring Health Benefits January 2012 | Vol. 19, No. 4
Sponsors and administrators of employer-sponsored health plans will spend lots of 2012 in implementing the health reform law, because there’s still a lot of uncertainty that will decide the fate of self-funded health plans in particular. Plans will have to raise annual limits on essential benefits (as defined by reform rules) to $2 million starting next Sept. 23. Plans won’t have to pay new fees to fund comparative effectiveness research in 2012. But 2012 will be the year plans learn the payment frequency of and the method used to calculate the fees they will start paying in 2013. Similarly, plans won’t have to start issuing summaries of benefits and coverage (SBCs) to all participants, but they will be waiting and watching for rules about the SBC to develop, so they know how to satisfy that requirement. (more…)
cmonfils | January 17, 2012
Breast-feeding avengers may be coming to a workplace near you.
Women want to be able to breast feed their babies when and where they want to. Witness the “nurse-ins” at Target stores on the West Coast last week that were prompted by a shopper who was mocked for breast feeding by employees at one Target. Moms, however, also want to be able to breast feed when they’re on the clock.
cmonfils | January 17, 2012
With little fanfare and little attention from the media, the Obama Administration recently issued proposed rules to crackdown on health insurance scams that use ERISA to avoid state law enforcement and regulatory actions.
Since the 1974 enactment of ERISA — the federal law governing employee pension and health benefit plans — crooks have used it to promote health insurance scams. There have been bipartisan Congressional attempts to address this problem, e.g., the passage of the 1982 amendments to clarify state authority and the 1996 HIPAA amendments to increase penalties for health fraud. But until the passage of the Patient Protection and Affordable Care Act (ACA), the federal government has had limited administrative authority to fight health insurance scams.
cmonfils | January 15, 2012
A small-business group fighting President Barack Obama’s health-care law asked the Supreme Court on Wednesday to add two plaintiffs to its lawsuit after possible problems arose with an initial plaintiff.
cmonfils | January 15, 2012
Industry files brief on issue of severability; Insurance market reforms and coverage requirement cannot be separated
AHIP and BCBSA today filed an amicus brief in the U.S. Supreme Court stating that certain insurance market reforms in the Affordable Care Act (ACA) are inextricably linked to the law’s personal coverage requirement and have to be severed from the ACA if the Court finds the coverage requirement unconstitutional.
cmonfils | January 15, 2012
2013 may be the most significant year in health care policy ever.
But we have to get through 2012 first.
Once the 2012 election results are in there will be the very real opportunity to address a long list of health care issues.
If Republicans win, the top of the list will include “repealing and replacing” the Affordable Care Act. If Obama is reelected, but Republicans capture both houses of Congress, we can still expect a serious effort to change the law. Then there is the granddaddy of all problems, the federal debt. The 2012 elections could well prepare the way for entitlement reform—particularly for Medicare and Medicaid. Even if Obama is reelected, the 2013 agenda will include a serious debate about Republican ideas to change Medicare into a premium support system and block grant Medicaid to the states.
cmonfils | January 15, 2012
Insurance companies spent millions of dollars trying to defeat the U.S. health-care overhaul, saying it would raise costs and disrupt coverage. Instead, profit margins at the companies widened to levels not seen since before the recession, a Bloomberg Government study shows.
cmonfils | January 13, 2012
Blue Cross and/or Blue Shield (BCBS) organizations along with their affiliates enrolled 94.4 million people as of September 30, 2011, more than 30% of the population in the United States and more than 50% of those commercially insured. Linked together through the Blue Cross and Blue Shield Association (BCBSA), the Blues are a national federation of 38 independent Blue Cross and Blue Shield companies. Most Blues organizations operate individually and in a single local market. However, that may shift as plans come to terms with changes brought about by health care reform. In this report Mark Farrah Associates examines membership changes that occurred at BCBS entities from September 2010 to September 2011 and looks at financial data as of December 2010.
