Posted By cmonfils on December 21, 2011
Self-Insurer December 2011 Issue and Volume 38
831 (b) Captives Lead New Captive Formations
By Tom Cifelli, Managing Director, Captive Experts
831 (b) captives are known as small insurance companies under the US internal revenue code. This special U.S. tax on operating income and taxes only investment income.
831 (b) captives account for a high percentage of total new captives being formed in recent years because they offer smaller successful companies and their owners significant operating, asset protection, wealth transfer and other advantages. Read more on this below. (more…)
Category: News |
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Posted By cmonfils on December 21, 2011
Dec. 19 (Bloomberg) — The Obama administration avoided a potentially brutal lobbying battle over the medical benefits insurers must cover under the U.S. health- care overhaul when it decided last week to hand the decision off to states.
The Dec. 16 ruling, coming less than a year before the presidential elections, gives states the power to set coverage levels for the policies uninsured people will buy through regulated marketplaces, called exchanges, starting in 2014. Business groups will argue for a narrow set of benefits to save costs while consumer advocates push for expanded coverage.
http://www.businessweek.com/news/2011-12-19/obama-insurance-decision-passes-hot-potato-to-states.html
Category: Health Care Legislation, Health Insurance |
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Posted By cmonfils on December 21, 2011
WASHINGTON – In a major surprise on the politically charged new health care law, the Obama administration said yesterday that it would not define a single uniform set of “essential health benefits’’ that must be provided by insurers for tens of millions of Americans.
Instead, it will allow each state to specify the benefits within broad categories.
http://www.bostonglobe.com/news/nation/2011/12/17/won-define-required-health-care-benefits/m1SeNZf3fHD5MBDsmeMPXO/story.html
Category: Health Care Legislation, Health Insurance |
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Posted By cmonfils on December 21, 2011
Self-Insurer December 2011 Issue, Volume 38
By Michael Friedman and John Eggertsen
The subtleties of subrogation Analysis, or when drafting plan Language it is not so simple to say what you mean in a way a court will understand it.
For those who stick with this discussion of the Court’s assessment of the subrogation and reimbursement provisions in Two ERISA Plans, it will become abundantly clear that courts will review such provisions with the proverbial fine tooth comb, and that careful and explicit drafting is required in order for a plan administrator to enforce a plan’s rights. (more…)
Category: 9th, ERISA, HIPAA, Reimbursement, Subrogation |
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Posted By cmonfils on December 21, 2011
Submitted electronically via Notice.Comments@irscounsel.treas.gov
Internal Revenue Service
CC:PA:LPD:PR (Notice 2011-73)
Room 5203
PO Box 7604
Ben Franklin Station
Washington, DC 20044
Re: Notice 2011-73: Request for Comments on Health Coverage Affordability Safe Harbor for Employers (Section 4980H)
Sir or Madam:
We write to provide comments on behalf of the American Benefits Council (“Council”) in response to Notice 2011-73 (“Notice”) regarding a proposed health coverage affordability safe harbor (“Affordability Safe Harbor”) for employers under section 4980H of the Internal Revenue Code of 1986, as amended (“Code”). The Council is a public policy organization representing principally Fortune 500 companies and other organizations that assist employers of all sizes in providing benefits to employees. Collectively, the Council’s members either sponsor directly or provide services to health and retirement plans that cover more than 100 million Americans. (more…)
Category: Health Care Legislation, Health Insurance |
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Posted By cmonfils on December 21, 2011
www.siia.org
December 15, 2011 – The Self-Insurance Institute of America, Inc. (SIIA) today filed an “initial” amicus brief with the Texas State Supreme Court in the case of GPA Holdings, Inc. v. Baylor Health Care Systems. This initial brief supports GPA’s request that the Supreme Court consider arguments to reverse an adverse judgment issued by the Fifth District Court of Appeals. Should the Court agree to hear arguments, SIIA will file a secondary, more comprehensive brief. (more…)
Category: ERISA, News, Self-Funding, Third Party Administrators |
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Posted By cmonfils on December 16, 2011
The Self-Insurer November 2011 Issue & Volume 37
By: John Hickman, Esq., Alston & Bird, LLP
New Fees for Group Health Plans Loom on the Horizon
The Affordable Care Act (ACA or the “Act”) imposes two new temporary fees with respect to group health plans that go into effect in the near future:
- A Fee to fund comparative effectiveness research that, in the case of calendar year plan years, it is first due for plan years starting on or after January 1, 2012, and
- Starting in 2014, a “contribution” in an amount to be determined by the Department of Health and Human Services (HHS) and collected at the state level that is part of the temporary reinsurance program established under ACA to help ensure the financial stability of the individual insurance market as further reforms go into effect (including the guaranteed issue requirement) and the Affordable Insurance Exchanges (“Exchanges”0 become operational. (more…)
Category: Health Care Legislation, Health Insurance, HHS, HIPAA, PPACA, Third Party Administrators |
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Posted By cmonfils on December 16, 2011
The Self-Insurer November 2011 Issue & Volume 37
From the Bench By Thomas Croft, Esq.
(Goyen v. Vail Corp., No. 10-cv-02392, in the United States District Court for the District of Colorado, September 26, 2011).
If it weren’t for the recent brouhaha spawned by the NAIC’s criticisms of stop loss insurance, this case would be somewhat akin to an announcement that no tsunami occurred today—greatly reassuring, but somehow not so newsworthy.
The plaintiff plan participant sued her employer and its TPA in state court for benefits denied under the Plan, relying on state law causes of action. The defendants removed the case to federal court and then moved to dismiss on the grounds of ERISA pre-emption. The Court converted the motion to a motion for summary judgment. Plaintiff argued that the Plan’s purchase of what the court termed “stop-gap insurance” rendered it no longer self-funded, such that ERISA’s “deemer clause” did not operate to insulate the Plan from state law based claims under the Supreme Court’s ruling in FMC Corp. v. Holiday, 498 U.S. 52 (1990). (more…)
Category: Colorado, Self-Funding, Stop Loss |
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Posted By cmonfils on December 16, 2011
2011 was the year in which employers began to amend their plans to comply with the health care reform law.
The initial changes were modest and relatively simple to put into place. For example, few employers had difficulty amending their plans to extend coverage—as the law requires—to employees’ adult children up to age 26; previously, employers typically ended coverage at age 18 or 19, or 23 or 24 in the case of full-time college students.
Category: Health Care Legislation, HHS, PPACA |
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Posted By cmonfils on December 16, 2011
The best and the worst development of 2011 concerning health care reform, two benefit experts say, involved the same issue: a reform law requirement that employers provide to employees a summary of their benefits and coverage.
http://www.businessinsurance.com/article/20111211/NEWS03/312119992?tags=%7C307%7C278#
Category: Health Care Legislation |
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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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