Posted By cmonfils on February 26, 2012
Summary
In August 2011, the Department of Health and Human Services (HHS) published Guidelines on Women’s Preventive Services that will require non-grandfathered health insurance plans to cover certain recommended preventive services for women, including contraceptive services, without charging a co-pay, co-insurance or a deductible beginning in August of 2012. The Guidelines are based on recommendations to the Department from the Institute of Medicine, which relied on independent physicians, nurses, scientists, and other experts as well as evidence-based research to draw conclusions and formulate its recommendations. The Guidelines provide for an exemption for certain religious employers, which is modeled on an option available in some of the 28 states that already require coverage of contraception.[1] Additionally, the Administration announced that non-profit, religious employers who do not currently offer contraceptive coverage would not have to comply with the requirement for a year and new regulations would be developed and finalized by the end of the year to accommodate religious concerns while ensuring access to this benefit.
Category: Health Care Legislation, Health Insurance, HHS |
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Posted By cmonfils on February 26, 2012
New Mexico has one of the highest uninsured populations in the nation. To provide access to healthcare for small businesses and qualified individuals unable to keep or maintain health insurance in the commercial marketplace, the New Mexico Legislature created the New Mexico Health Insurance Alliance (NMHIA), a non-profit organization.
Category: Health Insurance, New Mexico |
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Posted By cmonfils on February 26, 2012
Over 13.3 million people were enrolled in Medicare Advantage (MA) plans as of February 2012, 27% of the 49.3 million people eligible for Medicare, according to data from The Centers for Medicare and Medicaid Services (CMS). Aggregated enrollment in MA plans increased by 1.151 million members between February 2011 and February 2012. Roughly 18% of MA enrollment is from employer group health plans (EGHPs). This brief, using enrollment data through February 1, 2012, takes a look at how companies have performed in the Medicare Advantage Market.
Category: CMS, Medicare |
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Posted By cmonfils on February 26, 2012
Note: The following commentary appears in the February 20, 2012 edition of Business Insurance Magazine as part of its special spotlight report on self-insurance for the middle market.
Small and midsize companies are looking at self-insurance as a cost-effective health care benefits solution as Patient Protection and Affordable Care Act deadlines approach. Michael W. Ferguson serves as chief operating officer for the Self-Insurance Institute of America Inc., looks at facts and myths surrounding the decision to self-insure.
Category: Self-Funding |
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Posted By cmonfils on February 26, 2012
If the individual mandate under health care reform is struck down, it will render the employer mandate meaningless, the American Benefits Council (ABC) argues in an amicus brief to the U.S. Supreme Court.
Category: Health Care Legislation, Health Insurance |
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Posted By cmonfils on February 26, 2012
Health and Human Services Secretary Kathleen Sebelius announced today that consumers will soon begin receiving unprecedented information on the value of their health insurance coverage, and some will receive rebates from insurance companies that spend less than 80 percent of their premium dollars on health care.
Category: Health Insurance, HHS |
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Posted By cmonfils on February 26, 2012
Health and Human Services Secretary Kathleen Sebelius announced today that the Affordable Care Act provided approximately 54 million Americans with at least one new free preventive service in 2011 through their private health insurance plans. Secretary Sebelius also announced that an estimated 32.5 million people with Medicare received at least one free preventive benefit in 2011, including the new Annual Wellness Visit, since the health reform law was enacted.
Category: Health Care Legislation, Health Insurance, PPACA |
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Posted By cmonfils on February 24, 2012
Dear friend,
Recently, one of my best friends was diagnosed with cancer and he is doing his best to beat this deadly disease and raise his two young children. I figured that the least I could do, in addition to being a great godfather to his daughter while he is in the hospital, was to raise money and awareness for patients fighting just like him.
On August 4th and 5th, I will be riding my bike for 192 miles from Sturbridge, MA to Provincetown, MA at the end of Cape Cod. To make this a successful ride, I need to raise thousands of dollars so I am reaching out to my family, friends, and colleagues in the industry to help me achieve my goal. My goal is that with your help we can raise $20,000!
The link at the end of this email will take you to my Pan-Mass Challenge Profile and the credit card page to support my ride. All you need do is fill in the required fields, click continue, verify their information and then click “Make the Donation Now”. Any amount will help so please donate if you can.
Last year’s gift to the Jimmy Fund of the Dana-Farber Cancer Institute represented 100% of all donations and brought the 32 year total to $338 million.
My best friend, his family, and I thank you for your support.
CLICK THIS LINK TO DONATE: https://www.pmc.org/egifts/AR0141
Category: News |
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Posted By cmonfils on February 24, 2012
www.hcaa.org
Last week federal regulators issued a mid-winter flurry of new guidance and updates, with even President Obama personally issuing some of the guidance. This alert summarizes the new changes relating to:
- Final regulations on the “summary of benefits and coverage” (“SBC”) rules;
- New, non-binding Frequently Asked Questions (“FAQs”) on several topics, including how to determine who is a “full-time” employee for “pay or play” purposes; and
- A softening of the rule on whether certain employers with religious affiliations must provide contraceptive coverage.
(more…)
Category: DOL, Health Care Legislation, Health Insurance, HHS, SBC |
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Posted By cmonfils on February 24, 2012
www.siia.org
February 24, 2012 – A United States District Court in Michigan has scheduled a hearing for June 7, 2012 to consider SIIA’s lawsuit challenging the state’s recently-enacted Health Insurance Claims Assessment Act. SIIA believes the Act is preempted by the Employee Retirement Income Security Act (ERISA). (more…)
Category: ERISA, Michigan |
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Posted By cmonfils on February 24, 2012
www.siia.org
February 20, 2012 – The state of Michigan has filed its response to SIIA’s lawsuit seeking a federal court to rule that the state’s recently enacted health care claims act is preempted by the Employee Retirement Income Security Act (ERISA). According to the association’s legal counsel, arguments presented in the state’s response were largely anticipated and did not effectively counter SIIA’s complaint. (more…)
Category: ERISA, Michigan |
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Posted By cmonfils on February 24, 2012
www.myhealthguide.com
MyHealthGuide Source: Todd Leeuwenburgh, Editor, Employer Health Benefits, Thompson Publishing Group, 2/14/2012, www.Thompson.com and Blog Entry
If the individual mandate under health care reform is struck down, it will render the employer mandate meaningless, the American Benefits Council (ABC) argues in an amicus brief to the U.S. Supreme Court. (more…)
Category: Health Care Legislation, Supreme Court |
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Posted By cmonfils on February 24, 2012
www.myhealthguide.com
MyHealthGuide Source: Mike Ferguson, Chief Operating Officer, Self-Insurance Institute of American (SIIA), , 2/15/2012, Blog Entry
As more smaller and midsize companies look to self-insurance solutions to control escalating group health care costs in the wake of passage of the Patient Protection and Affordable Care Act, this proactive risk management approach has attracted increased negative attention from traditional health insurance industry and state regulators who warn of various calamities. (more…)
Category: Self-Funding |
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Posted By cmonfils on February 19, 2012
Coordination Of Benefits January 2012 Vol. 20 No. 1
Virtually all employer-sponsored health plans in effect today provide that the benefits they pay are subject to reimbursement from both fault and no-fault auto liability insurance proceeds. Indeed, in just about every reported case we have seen, federal courts have ruled in favor of self-funded ERISA health plans allowing recovery of the benefits they paid by from no-fault auto liability policies. A very interesting decision by a U.S. District Court in Michigan tells us that the result is not the same if the employer’s ERISA health plan is insured. The case is Horrell v. CEC Entertainment, Inc., 2011 WL 4954031 (W.D. Mich., Oct. 19, 2011). (more…)
Category: ERISA, Michigan, Reimbursement, Self-Funding, Subrogation |
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Posted By cmonfils on February 19, 2012
Coordination Of Benefits January 2012 Vol. 20 No. 1
Just about every self-funded ERISA health plan provides that it is entitled to subrogation and reimbursement of the benefits paid by the plan from tort settlement or judgment proceeds. In addition, just about every such plan requires the plan participant to sign a subrogation and/or reimbursement agreement. Attorneys who represent plan participants seeking to recover damages from third parties are learning that if a tort settlement/judgment does not exceed plan benefits paid, they are at risk of not being paid fees for their work. (more…)
Category: ERISA, Self-Funding, Signed Subrogation Agreements |
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