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Employer-sponsored health plans and insurers are required to make two changes to the summary of benefits and coverage, which must be distributed to all health plan participants under health reform. They must add statements of whether their coverage: (1) provides minimum essential coverage; and (2) meets the minimum value requirements. The specific language to be […]
Employers might pay less than $63 per covered life per year under health reform’s transitional reinsurance fee rules, but that would require a surplus in the fund, a U.S. Department of Labor official told an employer plan industry group on April 18 in Washington, D.C. Even though possible, such a reduction would be contingent on: […]
If small companies self-insure their health plans and in doing so can get stop-loss coverage with very low attachment points, they could siphon healthy lives away from the new insurance market designed by health reform to insure millions of new lives, the Urban Institute warned in a April 2013 report. The Institute explained that low […]
The health reform law provides that entities called “Navigators” will assist consumers and small businesses in researching health insurance exchanges — but stop-loss insurers for self-funded health plans won’t be one of them. Those insurers, as well as individuals and other entities with too close a financial relationship to such insurers, would be excluded from […]
Recently, four bills were introduced in state legislatures that would make self-funding less attractive by limiting stop-loss coverage for self-insured health plans. Many such proposals would raise minimum specific deductibles above the standard $20,000 seen in most enacted laws. This and other measures are intended to rein in self-insured plans, observers in the self-insured industry […]
Employers are understandably nervous about the transitional reinsurance fee, which health insurers and employer health plans must pay from 2014 through 2016. The fee will be collected by HHS, even though the states will tailor their own risk adjustment programs. It must be paid annually. Plans will probably make their first payment for 2014 a […]
Employer group health plans must eliminate waiting periods of more than 90 days before enrolling otherwise eligible employees (or dependents) into health coverage, under proposed rules issued on March 18 by the federal agencies implementing health reform. For Clear Full-time Hires, It’s 90 Days Group health plans and health insurers in the group plan setting […]
With thousands of pages of new laws and rules, there must be thousands of new reasons for employees to sue for health benefits not delivered properly in the wake of near-complete enactment of health reform starting in 2014, one could be forgiven for thinking. Health reform certainly does appear to be somewhat of a litigation […]
Employer-sponsored plans that are secondary to Medicare are not subject to health reform’s expensive transitional reinsurance fee, nor are health flexible spending arrangements, health savings accounts and most health reimbursement arrangements. On March 11, 2013, the U.S. Department of Health and Human Services published its final regulation on the transitional reinsurance fee, which takes effect […]
A reform requirement that all insurers must offer four levels of health coverage to small businesses would be delayed until 2015 under proposed rules scheduled to be published March 11 in the Federal Register. Under the U.S. Department of Health and Human Services proposal, small employers may get one choice of health coverage in 2014. […]