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Fundamental Series 14: Fiduciary requirements
June 1, 2015 WEBCAST
(SunGard Relius)

Dudenhoeffer Decision: One Year Later
June 10, 2015 WEBCAST
(New York City Bar Association)

The Virtual Visit: How Telehealth Is Reshaping Care Delivery
June 12, 2015 WEBCAST
(National Institute for Health Care Management Foundation)

Inside the Beltway
June 16, 2015 WEBCAST
(Drinker Biddle & Reath LLP)

View All Webcasts and Conferences

EEOC Issues Long-Awaited Proposed Rule on Employer Wellness Programs
"The references in the proposed rule regarding the requirement to provide notice and the use of incentives, apply only to wellness programs that are part of or provided by a group health plan or by a health insurance issuer offering group health insurance in connection with a group health plan. In addition, the proposed rule explains that compliance with rules concerning voluntary employee health programs does not ensure compliance with all the antidiscrimination laws the EEOC enforces." (Littler)

[Advert.]

Opt-Out Incentives and Other Cost Cutting Measures for Health Plans

Employers have toggled deductibles and co-payments, and they have implemented wellness programs and consumer driven health care programs. But what if you gave employees with access to other coverage money to opt out of your coverage? BenefitsLink discount .

Court Finds Health Plan Had Claims for Equitable Relief and Conversion Against Participant's Personal Injury Attorney
"[T]he overwhelming weight of Supreme Court and other circuit court authority supports the availability of a claim for equitable relief against the [attorney representing the health plan participant who successfully recovered damages from a party who had injured the participant], where [the health plan] seeks a declaration as to its reimbursement and recovery rights under the Plan for specifically identifiable funds -- the settlement proceeds up to the amount of ... medical benefits paid -- in the possession and control of the [attorney], where it is alleged that the [attorney] had notice of the plan's subrogation to [the participant's] rights of recovery.... [Further, in this case the health plan] has alleged sufficient facts to state a [state law] claim for conversion." [Barnhill Contracting Company v. Oxendine, No. 7:14-CV-211-FL (E.D.N.C. May 12, 2015)] (U.S. District Court for the Eastern District of North Carolina)

Feds Say That In Screening Colonoscopies, Anesthesia Comes With No Charge
"Although the health law made it clear that the colonoscopy itself must be free for patients, it didn't spell out how anesthesia or other charges should be handled. That lack of clarity allowed insurers to argue at first that if polyps were identified and removed during the colonoscopy, the procedure was no longer a screening test and patients could be billed. In 2013, regulators clarified that patients couldn't be charged for polyps removed during a screening colonoscopy because it was an integral part of the procedure. With this week's guidance, the government has made it clear that consumers don't have to pick up the tab for anesthesia during a colonoscopy either." (Kaiser Health News)

Transforming Diabetes Management: New Directions for Employers (PDF)
"This report ... provides an in-depth look at the kinds of forward-thinking approaches some companies are taking across the US and suggests ways others might integrate innovative elements in their own programs. These include encouraging employees to access necessary primary care and seek care in appropriate settings based on risk factors and level of need, offering customized incentives and rewards for long-term participation and outcomes in diabetes management programs, promoting value-based benefit design to steer employees into effective and efficient health plans or provider practices, and encouraging medication adherence." (Northeast Business Group on Health [NEBGH])

Latest Healthcare Experiment by Employers: Private Exchanges
"Private exchange enrollment has reached 6 million out of 160 million folks who get health insurance through their employers, and that's expected to increase to 13 million to 15 million by 2020 ... Ted Nelson, global vice president, benefits, for Hilton put up a slide showing a vending machine. 'I would have said three years ago that health care is different; it's not buying snack food; but from our experience, people really like having choices.' He says an employee survey showed an 84% satisfaction rate with the switch to Aon Hewitt's private exchange." (Forbes)

Health Insurance Exchange (HIX) Compare: Data on Marketplace Plans from Every State & District of Columbia
"The HIX Compare dataset provides information on benefit design and cost-sharing for health plans offered in all 50 states and the District of Columbia.... For 2015, ... the HIX Compare dataset [has been expanded] to include benefit design and cost sharing information for three [cost sharing reduction (CSR)] Plan variations[.]" (Robert Wood Johnson Foundation)

Health Insurer Responses to Medical Loss Ratio Regulation: Increased Efficiency and Value to Consumers (PDF)
21 pages. "Although rising MLRs are a strong indicator that the policy has had its intended effect, how the health insurance industry responded to the provision and achieved the increase has varying implications for insurers and consumers. The increased average MLRs may have been achieved through a number of mechanisms, singly or in combination." (Robert Wood Johnson Foundation)

Big Change Coming Soon for High Income Medicare Beneficiaries
"Higher-income Medicare beneficiaries have been paying more for their Medicare Parts B and D coverage for several years ... The current structure sets $160,000 for single filers and $320,000 for married couples filing jointly as the upper limit of Tier 3. Effective Jan. 1, 2018, $160,000 and $320,000 respectively are the beginning of Tier 5, the top tier. The impact is that many more people will be in tiers 4 and 5, resulting in an upswing of Medicare beneficiaries paying the largest possible IRMAA rates in 2018. That can translate into up to $3,621 per person or $7,242 per couple more in Medicare payments annually year over year without receiving any more benefits." (Investment News)

Health Plans Poised to Ask for Higher Premiums for 2016
"Costs for health plans in 2014 were higher than expected due to fewer young enrollees signing up for [ACA] plans during the first year that the major provisions of the law took effect requiring people to have coverage or pay a fine ... [It's] unlikely that plans will receive much of the money they had expected from the ACA's risk corridors program, which was intended to help cover insurers' losses in the event they ended up with a sicker-than-average population. Too many plans had to cover high medical bills, leaving too few plans to pay into the fund for the program[.]" (Bloomberg BNA)

Rate Review: How to Challenge Unreasonable Health Insurance Premium Increases
"Based on interviews with advocates from several states, [the authors] explain how to: [1] Prepare for rate review; [2] Decide which insurers' filings to review and whether to use outside expertise; [3] Evaluate insurers' assumptions about future medical costs; [4] Challenge the amount insurers claim they need to have in reserve; and [5] Involve consumers in the rate review process." (Families USA)

Small Employers Frustrated as Washington State Rejects Association Health Plans
"[W]hile the Washington Education Association (WEA) health trust won approval, dozens of other associations and trusts with plans covering hundreds of thousands of small-business employees and their households have either been denied or are in limbo, awaiting a decision. Of Washington state's more than 60 association and trust plans, 11 are approved, nine are under review and the rest have been rejected.... Associations and trusts for years have been the most popular insurance option for Washington's small employers because their products generally were cheaper than the health insurance available on the open market." (Kaiser Health News)

A Closer Look at the SEC's Proposed Pay Versus Performance Disclosure Rules (PDF)
10 pages; article provides a detailed analysis of the rules, with commentary. "These proposed disclosure rules do nothing to address the relationship between potential/realizable pay and performance, which investors have already signaled is important to them and is something that Boards should be considering... Shareholders are likely to be confused with the new disclosures. Due to the unusual and confusing way in which the rules seek to compare pay and company performance, we expect many issuers to include supplemental disclosures. The SEC's proposed disclosure requirements do not relate pay and performance in a logical manner, and companies will seek to explain that relationship and why the required disclosure does not adequately demonstrate alignment." (ExeQuity)

Q&As on the SEC Proposed Pay-for-Performance Rules
Questions addressed include: Which companies are subject to the pay-for-performance disclosure under the proposed rules? In what filings does the disclosure appear? Will the disclosure be subject to a say-on-pay advisory vote? What is the format for the disclosure? How many years of information must be disclosed? Which executives are covered by the disclosure? Why did the SEC choose fair value of equity at vesting to calculate "executive compensation actually paid?" What are the rules for pension value disclosures? How is cumulative TSR calculated? (Towers Watson)

Third Circuit Adopts Catalyst Theory for Attorney Fee Awards in ERISA Cases
"The court decided that a party can achieve success on the merits without any judicial action.... [and] that the defendants' voluntary payment of interest was sufficient to make the claimants eligible for attorney fees ... The Third Circuit failed to recognize the chilling effect its ruling will likely have on settlement of ERISA claims once a lawsuit is filed. Also lost on the court is the potential increase in lawsuits involving questionable ERISA claims by attorneys hoping to secure a nominal settlement and then demanding fees as a result." [ Templin v. Independence Blue Cross , No. 13-4493 (3d Cir. May 8, 2015)] (Wilson Elser)

Gary Kushner Nominated for the 2015 Lewis Shattuck Small Business Advocate of the Year Award Kushner & Company

Lincoln Financial Offers QLAC Status on Deferred Income Annuity Providing Advisors Additional Tool To Address Client Longevity Income Needs Lincoln Financial Group

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