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Fast-moving events have advanced state-level proposals aimed at regulating stop-loss, which would make it more expensive for small employers to self-insure health benefits, and put power over self-funding in the hands of state insurance commissioners. Utah law now requires stop-loss insurers to cover incurred and unpaid claims if a small employer plan terminates — an unprecedented requirement. […]
The U.S. Equal Employment Opportunity Commission’s failure thus far to issue clear guidance on permissible wellness incentives threatens to undermine employers’ development of wellness programs at a time when their importance is growing, business groups warned the EEOC at a May 8 hearing. “We urge you to recognize the comprehensive regulatory framework that already exists” […]
On April 22, the Colorado House of Representatives passed legislation regulating stop-loss through minimum attachment points, and requiring stop-loss insurers to give the commissioner information about their self-insuring clients with 100 and fewer full-time equivalents. The bill also would give the insurance commissioner authority to unilaterally raise minimum stop-loss attachment points based on medical price […]
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: […]
It is clear based upon the U.S. Supreme Court decision in U.S. Airways v. McCutchen that ERISA health plans should consider modifying their plan provisions to expressly negate the application of the common fund rule in the future. This decision represents a victory and a reminder. The McCutchen ruling (No. 11-1285 (U.S. Ct., April 16, […]
Clear plan document terms in ERISA group health plans are the best defense against legal claims asserting broad equitable remedies, the U.S. Supreme Court reinforced in an April 16 decision. In its holding, the Court affirmed that equitable theories, such as make-whole, common fund, unjust enrichment and double-recovery doctrines should not be allowed to override […]
Health plans now may begin applying for the standard health plan identifier required by HIPAA, CMS has announced. The online application was posted March 29 on CMS’ Health Plan and Other Entity Enumeration System (HPOES). Most HIPAA-covered health plans, including employer group health plans, must obtain an HPID by Nov. 5, 2014, except that “small health […]
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 […]
Companies that self-fund health benefits are larger than companies that fully insure health benefits and their solvency is just as good as companies that fully insure, a government report required by the health reform law indicates. The reform law requires reports on the prevalence, solvency and quality of self-funded plans, with the stated goal of […]
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 […]