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Two appeals court rulings with differing views on the availability of premium subsidies for policies purchased through state-based health insurance exchanges establish a circuit split that sets the stage for the U.S. Supreme Court to step in. One court ruled that federal subsidies should be available only in states that run their own exchanges; another […]
The U.S. Supreme Court ruling that “closely held” for-profit companies can — on religious grounds — opt out of a federal requirement to provide certain contraception coverage is rife with implications for self-insured and other employer-sponsored health plans. The ruling is unlikely to lead to a wide variety of religiously inspired opt-outs, benefits attorneys held, […]
Closely held corporations with religious objections cannot be required to provide contraception coverage under health care reform regulations because that would violate the owners’ rights under the Religious Freedom Restoration Act, the U.S. Supreme Court today ruled in Burwell v. Hobby Lobby, No. 13-354 (Sup. Ct., June 30, 2014). The ruling could force the Obama administration […]
Employers now can get an extra 30 days on top of the 90 days by which employers must have offered health coverage to eligible workers, under new final rules on orientation periods issued by the U.S. Departments of Labor, Health and Human Services and the Treasury. The final rules, published on June 25 in the Federal […]
The medical cases that are bad news to self-funded plans are also bad news to stop-loss insurers. So the latest report by stop-loss insurer Sun Life Financial on the top 10 catastrophic health conditions it sees is instructive for self-funded plans. Two categories of cancer, end-stage renal disease and two categories complications related to newborns […]
On May 22, CMS issued guidance (registration required) describing how plans, third-party administrators and insurers will pay reinsurance contributions required under health care reform for the next three years. The guidance says a contributing entity can complete all required steps for the reinsurance contributions process on Pay.gov, including registration, submission of the annual enrollment count and remittance of […]
Employer-sponsored health plans and insurers got a double dose of compliance advice on May 16 from the Centers of Medicare and Medicaid Services in the form of a set of Frequently Asked Questions. The first FAQ clarifies that insurers in the individual and small group market may not impose waiting periods on specific essential health benefits. […]
The jury’s still out on the impact of health care reform on employment‐based health benefits, but predictions of mass instability are certainly not materializing, reform experts said May 15 at a policy forum sponsored by the Employee Benefits Research Institute in Washington, D.C. The Affordable Care Act will not trigger a rapid exodus from employer-sponsored […]
Due to some ambiguity in model government language explaining the interplay of the Affordable Care Act with COBRA coverage, the Obama administration has both proposed an update to model COBRA notices and provided a new special enrollment opportunity for COBRA qualified beneficiaries (QBs) to enroll in marketplace coverage. Last year, the U.S. Department of Labor […]
Employers have cited complying with the Affordable Care Act as their number one concern in surveys, and that wouldn’t be the case if there weren’t taxes and money penalties backing it up. This is true even though the government postponed until 2015 penalties for failure to comply with the ACA’s play-or-pay mandates, temporarily reducing the […]