Tuesday, November 12, 2019

In Brief: HHS Clarifies 'Essential Benefits' Rules

Brought to you by:



(650) 348-6234

The Department of Health and Human Services has released proposed rules regarding the "essential benefits" provision of the health care reform law. The new rules note that starting in 2014, nongrandfathered health plans in the individual and small-group markets must provide coverage for the 10 "essential" services. They are:

  • Ambulatory/outpatient
  • Emergency
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance use
  • Prescription drugs
  • Rehabilitative and habilitative services and devices - e.g., speech, physical and occupational therapy
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including pediatric dental and vision care

The rules also call for plans to provide coverage that meets the "metal" standards (an actuarial value of 60, 70, 80 or 90 percent; actuarial value means the percentage of allowed costs the plan is expected to pay for a standard population).

The federal government has announced a proposed rule that would levy a 3.5 percent surcharge on health insurers that want to participate in the new federally mandated health care exchanges, slated to begin in 2014 under the health care reform law. The fee would cover administrative costs of the exchanges. This applies only to the exchanges that the federal government runs directly; however, states that run their own exchanges likely will charge their own administrative fees.

The Supreme Court has ordered a lower court to rehear a challenge to the Patient Protection and Affordable Care Act, setting up another possible showdown in the nation's highest court. A federal appeals court will reconsider arguments in Liberty University vs. Geithner, in which the university is objecting to the law's mandate on religious grounds.

The cost of brand-name prescription drugs continue to increase at more than six times the rate of inflation of other consumer goods, according to new research by Express Scripts. The study found that a brand-name drug that cost $100 in 2008 would now cost $163.08 (in 2008 dollars). Conversely, a $100 generic drug in 2008 would now cost $60.96 in 2008 dollars.

Although employers usually aren't employees' first source of financial information, they are regarded as valuable resources for retirement help by workers, according to a new study. Two-thirds of adults in a recent TIAA-CREF survey said they trust the financial advice provided by their employer. Additionally, one-fifth of respondents said they have trouble finding useful financial information.

About 20 percent of American adults have visited retail health clinics, up from about 10 percent six years ago, according to a Kalorama Information poll.

The number of diabetes cases in the U.S. skyrocketed between 1995 and 2010, according to the Centers for Disease Control and Prevention (CDC). The agency reported that documented diabetes cases jumped 50 percent or more in 42 states in that time period, with 18 states seeing an increase of 100 percent or more. Oklahoma saw the largest increase at 226 percent.

The new rule that calls for retirement plans to divulge more information on fees has done little to spur action by plan participants, a new survey by the Plan Sponsor Council of America suggests. Nearly 96 percent of plan sponsors responded that they saw no change in participant behavior as a result of the new rules, which took effect this summer. An average of 1.4 percent of participants asked questions regarding the fees. Most plan sponsors said they received no inquiries at all about the new disclosures.

A new analysis by the American Heart Association estimates that a single heart attack can cost an employer more than $52,000 in productivity losses per long-term disability claim. Even if the employee only takes short-term disability, a single claim can cost nearly $8,000 in lost productivity.

Employers are taking a longer look at employee-paid voluntary benefits. According to a new report by Prudential, 71 percent of executives said they expect their company to replace some employer-paid programs with voluntary benefits within the next two years. Sixty-nine percent said they expect to expand their current voluntary offerings.

Recent referendums to legalize the recreational use of marijuana in Colorado and Washington state will have little impact on employer policies, according to a report in Employee Benefit News. In the article, Nancy Delogu and Chris Leh of Littler Mendelson, P.C., note that even though the citizens in those states voted to decriminalize the use of marijuana, employer policies against its use can remain in effect. In fact, the Colorado amendment clearly states that the law does not "affect the ability of employers to have policies restricting the use of marijuana by employees."

Copyright © 2001-2012 United Benefit Advisors, LLC. All Rights Reserved Terms Of Use Privacy Statement