Posted By cmonfils on December 14, 2011
For the first half of 2011 top health plans saw a combined net increase of over 2 million members from December 2010. While aggregated fully-insured business continued to experience losses, the administrative services only (ASO) segment gained over 2.6 million members during the period from December 2010 to June 2011. Commercial, Senior and Medicaid segments all saw enrollment growth during the first six months of 2011. As employers, consumers and government entities bear more of the medical costs and financial risks associated with health care, the leading health plans continue to see year-over-year profitability improvement.
Category: Health Insurance |
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Posted By cmonfils on December 14, 2011
Employers and plan administrators with multiple employer welfare arrangements (MEWAs) that had not been required to file a Form 5500 for their MEWA may have to if a proposal by the Department of Labor’s (DOL) Employee Benefits Security Administration (EBSA) is adopted.
Category: DOL, Form 5500 |
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Posted By cmonfils on December 14, 2011
After so much ink spilled and heartache over health reform, plan sponsors might think the dust has settled and say: “The coast is clear. We can come out of hiding.” But if you thought that all this effort has totally clarified health reform (and if you think you know just what to do to comply), you’d be mistaken, sadly mistaken.
http://smarthr.blogs.thompson.com/2011/12/09/6-health-reform-issues-loom-over-plan-sponsors-in-2012/
Category: Health Care Legislation, Plan Sponsor |
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Posted By cmonfils on December 13, 2011
WASHINGTON (AP) — In a surprise move with election-year implications, the Obama administration’s top health official overruled her own drug regulators and stopped the Plan B morning-after pill from moving onto drugstore shelves next to the condoms.
The decision by Health and Human Services Secretary Kathleen Sebelius means the Plan B One-Step emergency contraceptive will remain behind pharmacy counters, as it is sold today — available without a prescription only to those 17 and older who can prove their age.
http://www.benefitspro.com/2011/12/07/sebelius-says-no-to-over-the-counter-morning-after?utm_source=BenefitsProNewsAlert&utm_medium=eNL&utm_campaign=BenefitsPro_eNLs
Category: Health Care Legislation, HHS |
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Posted By cmonfils on December 13, 2011
www.myhealthguide.com
MyHealthGuide Source: Todd Leeuwenburgh, Editor, Employer Health Benefits, Thompson Publishing Group, 12/9/2011, www.Thompson.com
Case: US Airways, Inc. v. McCutchen, 2011 WL 5557411 (3rd Cir., Nov. 16, 2011)
Editor’s Note: In the11/28/2011 of this Newsletter, we published a review of this case by Agnes Mendoza-Ben-Yosef, BNA Pension & Benefits Daily Article via The Gibson Firm, LLC. We are now providing another view by Mr. Leeuwenburgh. (more…)
Category: 3rd, Reimbursement |
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Posted By cmonfils on December 13, 2011
www.myhealthguide.com
MyHealthGuide Source: Terrance Killilea, Pharm.D. and Scott Haas, 12/6/2011, www.wellsfargo.com
Pharmacy benefit managers (PBMs) are contractors hired by health plans to administer health plan pharmacy benefits, and PBMs that practice spread pricing, charge plan sponsors (employers) more for prescription drugs than what’s actually paid to the pharmacy. (more…)
Category: Plan Sponsor, Self-Funding |
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Posted By cmonfils on December 13, 2011
PepsiCo Inc. employees across the country can get free travel to Johns Hopkins Hospital for surgeries under a new benefit the soda giant is now offering.
http://www.bizjournals.com/baltimore/news/2011/12/08/pepsi-offers-workers-benefit-of.html
Category: Plan Documents, PPOs |
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Posted By cmonfils on December 12, 2011
Apparently, inspired by the recent Supreme Court decision in CIGNA v. Amara, the Third Circuit has held that the “appropriate equitable relief” qualifier in the grant of civil remedies under ERISA’s Section 501(a)(3) allows for the application of equitable defenses to plan reimbursement claims in – shall we say – “appropriate” situations. (I reviewed the lower court’s opinion previously.)
Category: 3rd, Subrogation |
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Posted By cmonfils on December 12, 2011
The insurance industry is terrified that the Supreme Court will strike down the individual mandate to buy insurance next year while leaving the rest of the healthcare reform law intact.
For insurers, the death of the mandate alone — one of many plausible outcomes in the blockbuster case — is the nightmare scenario, one Republican healthcare lobbyist told The Hill.
Category: Health Care Legislation, Supreme Court |
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Posted By cmonfils on December 12, 2011
The United States Court of Appeals for the Fifth Circuit, reversing a lower court decision, has ruled that ERISA does not preempt certain state statutory and common law claims for negligent misrepresentation and other unfair and deceptive practices.
Category: 5th, ERISA |
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Posted By cmonfils on December 12, 2011
During World War II, the U.S. government put wage controls on businesses so workers on the home front wouldn’t earn more than their military counterparts on tightly controlled salaries. But with so much of the workforce overseas, the competition for talent became fierce. So companies beefed up their compensation packages with benefits like health insurance, which weren’t subject to wage controls. And the rest, as they say, is history.
Category: Health Care Legislation |
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Posted By cmonfils on December 12, 2011
I find Walmart to be a wholly disconcerting place. I just find it very strange that it sells tires, toothpaste, turkeys, tinsel and t-shirts all under the same gigantic roof — and markets this as a good thing. One-stop shopping is one thing, but sheesh.
Anyway, Walmart has confused me once more, with two recent developments. Last month, the nation’s largest retailer and private employer announced it would stop providing health benefits to its part-time workforce. Then, just days later, the retail giant quietly issued an RFI (acquired by Kaiser Health News) seeking a partner to provide more health clinics in its stores — offering medical services that wouldn’t be covered for its part-time employees.
Category: Health Insurance, News |
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Posted By cmonfils on December 12, 2011
Should the arguments heard by the high court regarding the health law be televised on C-SPAN? And should certain justices step away from the case? These are among the key questions that continue to buzz around the health law’s day in court.
The New York Times: Supreme Court TV? Nice Idea, But Still Not Likely
A couple of weeks ago, the Supreme Court agreed to hear a constitutional challenge to President Obama’s health care law. The case is a once-in-a-generation blockbuster, and the court underscored its importance by scheduling five and a half hours of oral arguments, the most in any case since 1966. The day after the announcement, Brian P. Lamb, the chairman of C-Span, wrote to Chief Justice John G. Roberts Jr. with a modest request. “We believe the public interest is best served by live television coverage of this particular oral argument,” Mr. Lamb said. The request is, of course, doomed. Yet it is hard to say why (Liptak, 11/28).
http://www.kaiserhealthnews.org/Daily-Reports/2011/November/29/supreme-court-and-health-law.aspx
Category: Health Care Legislation, Supreme Court |
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Posted By cmonfils on December 12, 2011
Just a little more than an hour after some House Democrats recently demanded an inquiry into Supreme Court Justice Clarence Thomas’s ethics, Senate Republicans stepped up the pressure on Justice Elena Kagan to take herself out of the court’s decision on the health-care reform act.
Category: Health Care Legislation, PPACA, Supreme Court |
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Posted By cmonfils on December 12, 2011
WASHINGTON — The average premium for a family’s employer-based health insurance in 2010 was nearly $14,000, which represents a 50% increase since 2003, according to a study from the Commonwealth Fund.
If the rate of growth continues, the average annual total premium for a family in 2020 could be nearly $24,000, according to the report. That total includes both what the employer and the employee pay.
Category: Health Insurance |
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