Spencer Benefits Reports NetNews – May 29, 2015

 

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News

May 29, 2015

 

High deductibles leaving the underinsured with thousands in medical debt

In 2014, 23 percent of adults 19 to 64 years of age who were insured all year had such high out-of-pocket costs and deductibles relative to their incomes that they were underinsured, according to a report by the Commonwealth Fund. This represents a doubling of the proportion of underinsured since 2003. The report also states that the share of continuously insured adults with high deductibles tripled from 3 percent in 2003 to 11 percent in 2014. These high deductibles led to high medical debt for a large proportion of underinsured…

        (Read Intelliconnect) »

House panel examines administrative actions in the implementation of ACA

Executive actions relating to the Patient Protection and Affordable Care Act (ACA) may signify a critical assault on representative democracy, according to House Ways and Means Oversight Subcommittee Chairman Peter Roskam, R-Ill., at a May 20 subcommittee hearing on the “Use of Administrative Actions in ACA Implementation.” In his opening statement, Roskam said that the issue is not whether the administration is implementing the health care law; rather, it is whether the administration is undermining the rule of law…

        (Read Intelliconnect) »

May 28, 2015

 

Self-insured, large group health plans don’t escape from annual limitation rule

All non-grandfathered group health plans, including non-grandfathered self-insured and large group health plans, must comply with the maximum annual limitation on cost-sharing under Section 1302(c)(1) of the Patient Protection and Affordable Care Act (ACA), according to the latest set of frequently asked questions (FAQs) from the Departments of Labor, Health and Human Services and the Treasury (the Departments). This clarification also applies to non-grandfathered high-deductible health plans (HDHP). The Departments will apply this clarification only for plan or policy years that begin in or after 2016…

        (Read Intelliconnect) »

Majority of companies planning to make changes to pre-65 retiree strategies

Challenges and opportunities created by the Patient Protection and Affordable Care Act (ACA) are prompting 66 percent of companies to consider altering their pre-65 retiree health strategies over the next few years, according to a recent survey from Aon Hewitt. Of those, 35 percent are favoring sourcing health coverage through the public exchanges under a defined contribution approach. Twenty-eight percent are considering eliminating pre-65 retiree coverage and subsidies altogether…

        (Read Intelliconnect) »

Employer’s equitable defenses no bar to multiemployer funds’ unpaid contribution claims

A district court erred when it permitted an employer to raise equitable defenses, including laches and estoppel, to defeat the efforts of nine multiemployer pension and welfare funds to collect allegedly delinquent plan contributions, the Sixth Circuit U.S. Court of Appeals has ruled in
Operating Engineers Local 324 Health Care Plan v. G&W Construction Company

        (Read Intelliconnect) »

May 27, 2015

 

Seventh Circuit once again denies Notre Dame’s injunction in contraceptive mandate case

The Seventh Circuit U.S. Court of Appeals held that the University of Notre Dame was not entitled to a preliminary injunction barring its insurer and third party administrator from providing contraception coverage to university students and employees under the Patient Protection and Affordable Care Act (ACA) contraception mandate. On remand from the United States Supreme Court, the Seventh Circuit held that the accommodation provided by EBSA Form 700 adequately removed Notre Dame from complicity in what Notre Dame called the “sin of contraception.” The court reasoned that because only a third party administrator and Notre Dame’s insurer were engaged in the provision of contraceptives, no religious objection by Notre Dame was sufficient to prevent continuation of that coverage. The case is
University of Notre Dame v. Burwell (No. 13-3853)…

        (Read Intelliconnect) »

 

Spiraling prescription costs may leave families stuck with “Cadillac plans” by 2018

According to projections by actuarial services firm Milliman, a typical American family of four covered by an employer-sponsored preferred provider organization (PPO) health plan is likely to incur health care costs surpassing $25,000 by 2016. Costs for this typical family of four have nearly tripled since 2001…

        (Read Intelliconnect) »

 

Health care spending for diabetics under employer insurance rose fastest for children

According to a study from the Health Care Cost Institute (HCCI), per capita health care spending for children with diabetes covered by employer-sponsored insurance (ESI) grew faster than for any other age group with diabetes, rising 7 percent from 2011 to 2012 and 9.6 percent from 2012 to 2013. Spending for all privately insurance people with diabetes rose 4 percent in 2013, and it was nearly $10,700 higher than for those without diabetes…

        (Read Intelliconnect) »

 

May 26, 2015

 

Medical loss ratio rule a big gain for consumers

According to the Urban Institute, the medical loss ratio (MLR) regulation in section 1001 of the Patient Protection and Affordable Care Act (ACA) has achieved its purpose of increasing value to consumers who purchase health plans. The MLR regulation required that insurers meet a minimum MLR, which is the amount an insurer pays out for covered expenses of its enrollees. The MLR rule limits the share of premium revenue that may be used for overhead or counted as profit, therefore passing along better values to consumers. This report is part of the Urban Institute’s long-term project to study the effects of the ACA…

        (Read Intelliconnect) »

District court must rethink fiduciary status of ERISA plan manager, Fifth Circuit rules

A federal district court erred in finding that the manager of an employee welfare benefit plan was an ERISA fiduciary with statutory standing to recover third-party settlement funds paid to a plan participant who was injured in an automobile accident, the U.S. Court of Appeals for the Fifth Circuit ruled. Contrary to the district court’s conclusion, the “plan management agreement” at issue did not give the manager independent power to investigate and prosecute claims. Thus, the agreement failed to show that the manager had discretion over the plan or its assets. Accordingly, the district court’s decision was reversed and the matter was remanded for further consideration, beginning with a reexamination of the manager’s standing. The case is
Humana Health Plan, Inc. v. Nguyen (No. 14-20358)…

        (Read Intelliconnect) »