Posted By cmonfils on December 16, 2011
San Francisco’s Health Care Security Ordinance has been amended to require more of certain employers with workers in the City and County of San Francisco. The amendments will take effect January 1, 2012.
The Ordinance requires many employers to spend a specified minimum amount toward certain health care expenses for their employees working in the City and County of San Francisco. (For more information on the Ordinance, see our article, San Francisco Health Care Law Survives ERISA Preemption.)
Category: California, Health Care Legislation |
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Posted By cmonfils on December 16, 2011
from Spencer’s Benefits Reports: For the last few years, states have been leading the way toward more comprehensive health care coverage to ensure that more people have or can obtain health insurance. With the passage of federal health care reform, states will have increasing responsibilities in regard to employer-provided health insurance benefits. Spencer’s Benefits Reports continues to provide regular updates about state health care reform.
Category: California, Health Care Legislation, Indiana, Louisiana, Minnesota, New York |
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Posted By cmonfils on December 16, 2011
Federal officials hope to crack down more effectively on operators of “multiple employer” health plans that have defrauded small businesses and their workers of hundreds of millions of dollars, often leaving them stuck with unpaid medical bills, according to new rules proposed Monday by the Obama administration under the health care legislation.
Category: DOL, Health Care Legislation |
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Posted By cmonfils on December 16, 2011
At most companies, employee health insurance premiums vary only by family size and type of plan. At a small percentage of firms, however, another variable is taken into account: salary. At these companies, workers’ premiums are pegged to how much they earn. Workers who earn less, pay less.
Now, as employers look toward 2014 — when companies that don’t offer affordable coverage to their workers may begin to face penalties — experts say more are considering this strategy.
Category: Health Insurance |
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Posted By cmonfils on December 16, 2011
Two new requirements imposed by the health care reform act (ACA) make the issue of self-funding and the need for stop loss insurance more compelling for plan sponsors.
First, ACA adds new federal taxes on health insurer providers beginning in 2014. These new taxes will add to state insurance premium taxes and make the savings from self-funding more compelling for many fully insured medical plans. Second, the ACA requirement to remove annual and lifetime limits beginning in 2014 will increase interest in stop loss coverage for self-funded groups without stop loss coverage in force. Medical stop loss insurance is a layer of coverage designed to protect self-funded plan sponsors from the risk of unpredictable, high-cost claim activity.
Category: Health Care Legislation, Stop Loss |
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Posted By cmonfils on December 16, 2011
Five years ago Alexandria Extrusion Co. invited nurses, dieticians, personal trainers — and even spiritual leaders — onto its factory floor to help workers battle obesity, diabetes, smoking and high blood pressure.
Since then the manufacturer has ramped up its wellness program, giving gym discounts, buying bikes for workers and hosting contests with prizes to bring accountability and financial rewards to both workers and the company.
Category: Health Insurance, Wellness |
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Posted By cmonfils on December 16, 2011
As 2011 comes to a close, questions about President Obama’s highly publicized Patient Protection and Affordable Care Act linger for many small businesses still reeling from the nation’s worst economic crisis in decades. Companies large and small are struggling to turn red balance sheets to black and recoup losses sustained over the last three years. Some employers fear that federally mandated health care reform may only add to their fiscal burden without alleviating any of the current financial strain.
Category: Health Care Legislation, PPACA |
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Posted By cmonfils on December 16, 2011
The Catholic Church says new federal regulations requiring employers to provide no-cost prescription birth control as part of their health insurance plans infringe on their religious liberty.
“If we comply, as the law requires, we will be helping our students do things that we teach them, in our classes and in our sacraments, are sinful — sometimes gravely so,” Catholic University President John Garvey wrote in The Washington Post. “It seems to us that a proper respect for religious liberty would warrant an exemption for our university and other institutions like it.”
http://www.npr.org/blogs/health/2011/12/02/143022996/catholic-groups-fight-contraceptive-rule-but-many-already-offer-coverage
Category: Health Insurance |
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Posted By cmonfils on December 16, 2011
Did you know that tobacco use in the United States costs an estimated $197 billion a year in lost productivity and health care costs? Add to that second-hand smoke, which costs an additional $10 billion in losses. Tobacco use contributes to one of every five deaths, and smokers die an average of 13 years earlier than nonsmokers.
Category: Health Insurance, Wellness |
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Posted By cmonfils on December 15, 2011
On July 1, 2011 the Texas Supreme Court finally settled the long-standing issue of whether an injured plaintiff may recover the amount of medical expenses charged by doctors or the amount actually paid or incurred. Trial lawyers have long argued that plaintiffs should be entitled to recover the amount charged to them by doctors and hospitals, which is usually significantly more than the discounted amounts paid by subrogated insurers or compensation carriers. Defendants have, of course, argued just the opposite. This new standard for proving medical expenses is having the effect of bringing plaintiffs’ counsel and subrogated carriers together, because we have something the trial lawyers want and need. (more…)
Category: Subrogation, Texas |
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Posted By cmonfils on December 15, 2011
The CMS said in a proposed rule that it recommends delaying data collection (PDF) in a reform law provision intended to expose financial relationships between drug and device manufacturers, GPOs and providers.
The agency said in the proposed rule that manufacturers and GPOs should not be required to start collecting information about their financial relationships with physicians and teaching hospitals on Jan. 1.
http://www.modernhealthcare.com/article/20111214/NEWS/312149973?AllowView=VW8xUmo5Q21TcWJOb1gzb0tNN3RLZ0h0MWg5SVgra3NZRzROR3l0WWRMZmFWdndGRWxiNUtpQzMyWmFwNW5nWUpidWk
Category: CMS, Health Care Legislation, Medicaid, Medicare |
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Posted By cmonfils on December 14, 2011
For the seventh straight year, most top-quality health plans are nonprofit, according to the latest rankings by the National Committee for Quality Assurance.
The rankings are rekindling calls for federal regulators to require that plans sold on the healthcare reform law’s state-based insurance exchanges make transparent to consumers whether they’re for-profit or nonprofit. The Alliance for Advancing Nonprofit Health Care spearheaded that request in recent comments to the Department of Health and Human Services.
Category: Health Care Legislation, Health Insurance, HHS |
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Posted By cmonfils on December 14, 2011
As part of the changes made by health care reform, Section 6051(a)(14) of the Internal Revenue Code requires employers to report on Form W-2 the aggregate cost of employer-sponsored health coverage provided to employees. Though the reporting requirement doesn’t apply until employers furnish W-2s for calendar year 2012, employers need to make sure that they have procedures in place now so that they can capture the relevant information during 2012.
Category: Health Care Legislation, Health Insurance |
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Posted By cmonfils on December 14, 2011
Background
Five years ago, in the Pension Protection Act of 2006, Congress provided that Tribal [Church] employee benefit plans would not be treated as “governmental” [church] unless all the participants are individuals “substantially all of whose services … are in the performance of essential governmental [church] functions but not in the performance of commercial activities (whether or not an essential government [church] function).” This requires Tribal [Church] employee benefit plans covering any ”commercial” employees to fully comply with the requirements of the Employee Retirement Income Security Act of 1974 (ERISA) and the Internal Revenue Code of 1986 (IRC) in the same manner as private sector business employer plans.
Category: ERISA |
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Posted By cmonfils on December 14, 2011
A significant conflict among the circuits exists as to whether extrinsic evidence (evidence that was not part of the administrative record) can be admitted into evidence when a claim denial for ERISA-regulated employee benefits is reviewed under the de novo standard. In some circuits, extrinsic evidence is usually allowed, in others sometimes allowed, and in still others, never allowed.
Category: ERISA, Health Insurance |
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