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An important component of health reform implementation is the imposition of an “essential benefits” package (of health goods and services that insurers of groups and individuals must cover). Under the Patient Protection and Affordable Care Act (PPACA), that benefit package will be de rigueur (1) for policies sold on exchanges and (2) insurers of small […]
Critics say health reform is part of a disturbing trend of the government displacing free markets, and they note that it looks unlikely to curtail spiraling health costs. Well, now Rep. Sean Duffy (R-Wis.) – a freshman House member – has introduced a bill that would repeal the Patient Protection and Affordable Care Act (PPACA) […]
There are 50 states and a few territories, and now there could be that many versions of essential benefit plans under federal health reform. That’s because the U.S. Department of Health and Human Services (HHS) is shunning a centralized approach to dictating “how much health coverage is enough;” that is, what needs to be covered […]
One simple line requiring that group health plans and insurers describe “continuation of coverage provisions” in summaries of benefits and coverage (SBCs) actually raises several complex issues for COBRA administrators. The health care reform law requires that group health plans and insurers accurately describe in SBCs the benefits and coverage under the applicable plan or […]
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), […]
Using a new power under the Affordable Care Act (ACA) for the first time, the U.S. Dept. of Health and Human Services (HHS) has now ordered an insurance company to lower its rates. Since September 2011, HHS has been flagging any insurer that raises premiums on small businesses and individuals by 10 percent or more. […]
Fast on the heels of the latest pertinent appeals court ruling, the U.S. Supreme Court definitively announced on Nov. 14 it will decide the question of whether Congress exceeded its powers to regulate commerce when it required people to buy health insurance as part of health reform (or in the converse, whether the individual mandate is allowed […]
In a Nov. 8 decision, the U.S. Court of Appeals for the District of Columbia Circuit affirmed a lower court’s ruling that the U.S. Congress may require all individuals to get health coverage (the individual mandate). A circuit-court split on whether the individual mandate stands or falls makes it more likely the Supreme Court will […]
The summary of benefits and coverage (SBC), while still a work in process, will improve plan participants’ ability to comparison-shop for coverage. That fills a currently unmet need, federal regulators told a recent conference. They were responding to concerns that the SBC — mandated by the health reform law — is redundant, confusing or even […]
As the government fulfills its promise to create an essential benefit package, employers can be forgiven for thinking the government’s putting a competitor plan out there to lure plan members away from employer-sponsored plans. And it is tempting for them to just say: “Fine! You asked for it; no more funding health benefits!” But paradoxically […]