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Tag: Healthcare Insurance

The Affordable Care Act and Wellness Programs

On June 3, 2013, the Departments of the Treasury, Labor, and Health and Human
Services jointly issued final rules regarding proposed amendments to regulations, to
be consistent with the Affordable Care Act (ACA), relating to wellness programs in
group health coverage. The final rules were first proposed on Nov. 26, 2012.
The final rules replace the current HIPAA wellness program rules and also
implement the nondiscrimination provisions made applicable to the individual
market by Section 1201 of the ACA.
The wellness program exception to the prohibition on discrimination under the
existing rules and the ACA applies to group health plans (and any health insurance
coverage offered in connection with such plans), but does not apply to health
insurance coverage offered in the individual market. The final rules apply to all
grandfathered and non-grandfathered fully insured and self-funded group health
plans for plan years beginning on or after Jan. 1, 2014.
As under the current rules, there are two types of wellness programs: participatory
and health-contingent.
Participatory wellness programs either do not provide a reward or do not include
any conditions for obtaining a reward that are based on an individual satisfying a
standard related to a health factor. Participatory wellness programs are not subject
to five key requirements to which health-contingent programs are.
Examples include:
 ​

Programs that reimburse employees for all or part of the cost of fitness center

testing programs.

Diagnostic testing programs that provide a reward for participation and do

not base any part of the reward on outcomes.

​See http://www.dol.gov/ebsa/pdf/fswellnessprogram.pdf for more information

Contact Steven Cosby with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

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NEW STUDY: “UNCERTAINTY” DOMINATES TOP 5 SMALL BUSINESS CONCERNS

Small business owners prominently rank “Uncertainty Over Economic Conditions” and “Uncertainty Over Government Actions” as their second and fourth most serious problems in the quadrennial NFIB report, Problems & Priorities. The top problem remains “Cost of Health Insurance,” which has historically been the No. 1 problem for small employers; 52% labeled it as “critical”. Nearly 40% of those surveyed said that economic uncertainty is the most critical problem, followed by 35% who identified “Energy Costs, Except Electricity” as critical for their firms; another 35% of owners named “Uncertainty Over Government Actions” as their most critical issue.

Read full article here.

Contact Steven Cosby with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

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Bundled Payments Could Cut Medicare Fraud, Experts Say

Health and policy experts are pushing for a system that pays doctors a lump sum for medical care or allows them to share in savings, saying it will save millions of dollars over current fee-for-service payments that can lead to fraud and over-use of medications.  In the new system, doctors would not be entitled to extra pay should they prescribe costlier medication.

Earlier this month, Sen. Elizabeth Warren, D-Mass., raised the issue of lump sum – or “bundled” – payment plans at a hearing for the nomination of Sylvia Mathews Burwell to become secretary of Health and Human Services. A bundled payment demonstration project at Bay State Health in Massachusetts saved $2,000 per Medicare patient for things like hip transplants, she said.

Read full article here.

Contact Steven Cosby with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

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