cmonfils | May 9, 2012
www.myhealthguide.com
MyHealthGuide Source: Fred Hunt, Active Past President, and Anne Lennan, Society of Professional Benefit Administrators (SPBA), 5/2/2012,www.SPBATPA.org
Recently, SPBA responded to a Stop-Loss Request for Information (RFI) requested by the IRS, Department of Labor EBSA, HHS CMS. The response was designed as a layman background, context and explanation to provide the “big picture” and assist the government in understanding what may be more technical responses from others. Below is an excerpt from the response and key points. (more…)
Category: CMS, HHS, IRS, Stop Loss |
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cmonfils | May 9, 2012
| In November 2011, the IRS, DOL and HHS issued Part VII of their Frequently Asked Questions About Affordable Care Act Implementation (“FAQs”). In particular, the FAQs provide guidance on the Mental Health Parity and Addiction Equity Act (“MHPAEA”) requirement that the limits applicable to mental health and substance abuse benefits offered through a group health plan cannot be more restrictive than the financial, treatment, and non-quantitative limits of the plan’s medical and surgical benefits. |
Category: DOL, Health Care Legislation, HHS, IRS, Mental Health Parity, PPACA |
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cmonfils | May 8, 2012
The Departments of Treasury, Health and Human Services, and Labor are soliciting input from group health plans and their sponsors regarding the use of stop loss insurance. Stop loss insurance protects against catastrophic or unpredictable health insurance claims and provides coverage to self-insured group health plans once a certain level of risk has been assumed by the plan. According to the request for information, the agencies lack sufficient data on the incidence or terms of stop loss insurance among self-insured employers’ group health plans. The concern, as discussed in the request, is that small employers with healthy employees might self-insure and purchase stop-loss insurance policies with relatively low attachment points (the specified dollar amount above which the stop-loss coverage pays for claims) to avoid triggering certain requirements under the Affordable Care Act. According to the agencies, “this practice, if widespread, would worsen the risk pool and increase premiums in the fully insured small group market, including in the Small Business Health Options Program (SHOP) Exchanges that begin in 2014.”
Category: HHS, Stop Loss |
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cmonfils | May 8, 2012
The Internal Revenue Service has issued three new guidance documents related to certain requirements the Affordable Care Act imposes on employer-provided health plans. The Department of Health and Human Services (HHS) also issued a bulletin regarding verification of access to employer-sponsored coverage.
Category: Health Care Legislation, HHS, IRS, PPACA, Self-Funding |
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cmonfils | May 3, 2012
By Ron E. Peck, Esq.
Self-funding a health benefit plan brings with it many risks and rewards. Before an employer can decide whether to self-fund, however, they must first understand what self-funding is. You may be surprised to learn that more than half of insured Americans are members of a self-funded health benefit plan. Yet, most self-funded plan members likely have no idea that they are self-funded, or if they are aware, they have no idea what that means. (more…)
Category: DOL, ERISA, Health Care Legislation, HHS, PPACA, Self-Funding, Stop Loss |
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cmonfils | May 1, 2012
www.siia.org
The Self-Insurance Institute of America, Inc. (SIIA) today obtained an advance copy of a Request for Information (RFI) notice regarding stop-loss insurance to be officially issued by The Departments of Labor, Treasury and Health and Human Services on May 1. The Departments’ stated intent for the request for comments is to contribute to the Departments’ understanding of the current and emerging market for stop-loss products. (more…)
Category: DOL, HHS, Self-Funding, Stop Loss |
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cmonfils | April 25, 2012
In February, the Departments of Labor, Treasury, and Health and Human Services issued final regulations implementing the new summary of benefits and coverage requirement under the Patient Protection and Affordable Care Act. The agencies also released a separate document providing additional guidance on the SBC requirement, which includes a template for the summary, instructions, sample language, a guide for coverage example calculations and the uniform glossary.
http://ebn.benefitnews.com/news/ppaca-dol-hhs-sbc-group-health-coverage-2723290-1.html?mstr_chnnl=ebn_health_care_reform
Category: DOL, Health Care Legislation, HHS, PPACA, SBC |
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cmonfils | April 25, 2012
Employer’s Guide to Self-Insuring Health Benefits April 2012 | Vol.19, No.7
ERISA allegations against a claims administrator advanced partly because plan terms had not defined the difference between a medical emergency and nonemergency services. A hospital had alleged that the claims administrator improperly classified emergency room (ER) visits in order to pay claims at lower out-of-network rates. (more…)
Category: ERISA, Health Insurance, HHS, Medicare, Self-Funding |
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cmonfils | April 25, 2012
Employer’s Guide to Self-Insuring Health Benefits April 2012 | Vol.19, No.7
State insurance exchanges will play a pivotal role deciding which large employers pay “shared responsibility” (pay-or-play) assessments based on their determination that health plans’ premium burdens on workers are unaffordable or insufficient. For small employers, on the other hand, they will present a streamlined way of shopping for affordable small-group coverage for workers. The insurance exchanges will certify health plans, set up websites comparing plans, determine eligibility for enrollment and provide consumer assistance. They will calculate and collect premiums from employers, according to a newly issued final HHS rule. (more…)
Category: Health Insurance, HHS |
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cmonfils | April 25, 2012
Employer’s Guide to Self-Insuring Health Benefits April 2012 | Vol.19, No.7
By Adam V. Russo, Esq., Contributions by Ron E. Peck, Esq.
Led by health reform, 2012 is ushering in a set of new health benefits disputes over whether workforce realignments (from full-time to part-time) constitute discrimination against affected employees, Attorney James Napoli tells the Guide. He also says disputes will center around whether Independent Review Organizations (IROs) are recognized as fiduciaries. Under reform, IROs will have the authority to review claim disputes de novo and their binding rulings will overturn plan determinations. In another column, Contributing Editor Adam Russo and Attorney Ron Peck describe current issues (including reform) that impact plans’ ability to administer benefits. They discuss fiduciary duty in a case in which a court upheld a drug benefit administrator’s decision not to share discount information with a plan sponsor. And they discuss the conflicted position of plans in states that have collateral source and anti-subrogation rules. (more…)
Category: ERISA, Health Care Legislation, Health Insurance, HHS, PPACA, Self-Funding, Stop Loss |
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cmonfils | April 24, 2012
A heart surgery group practice agreed to pay $100,000 to settle federal allegations that it chronically neglected standard HIPAA requirements such as risk assessment, training and business associate contracts, the U.S. Department of Health and Human Services (HHS) announced April 17.
Category: Arizona, HHS, HIPAA |
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cmonfils | April 24, 2012
Partnership for Patients to accelerate progress in hospitals
The Department of Health and Human Services (HHS) posted online today an updated National Action Plan to eliminate healthcare-associated infections for public comment. The update confirms progress in the effort to make healthcare safer and less costly by reducing preventable complications of care, including healthcare-associated infections (HAIs).
Category: HHS |
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cmonfils | April 24, 2012
Health care law expands second round, program will save up to $42.8 billion
People with Medicare are already saving money on durable medical equipment (DME) through the Medicare competitive bidding program, according to a report released today by Health and Human Services Secretary Kathleen Sebelius.
Category: HHS, Medicare |
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cmonfils | April 24, 2012
NEW YORK (CNNMoney) — The nonpartisan Government Accountability Office urged the Obama administration on Monday to end a new $8 billion experiment aimed at improving a key Medicare program.
http://money.cnn.com/2012/04/23/news/economy/Medicare_advantage/?source=cnn_bin
Category: HHS, Medicare |
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cmonfils | April 20, 2012
A standard health plan identifier proposed by the U.S. Department of Health and Human Services (HHS) could cost health plans a total of up to $1.3 billion to implement.
Category: Health Care Legislation, HHS, HIPAA, Third Party Administrators |
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