Health Insurance

News & Analysis as of

Parents' Medical History May Make Long-Term Care Insurance More Expensive

Your parents' health could be one of the many factors that long-term care insurance providers take into account when deciding how much to charge you. One large insurer has started rating applicants based, in part, on the...more

IRS Issues 2015 Limits for Qualified Retirement Plans, Health FSAs, and Transportation Fringe Benefits

You know it’s Fall when the leaves turn color, jack-o-lanterns wink in the twilight, the World Series plays on … and the IRS announces new indexed annual limits for employee benefit plans. Sticking to tradition, the IRS...more

Manatt on Health Reform: Weekly Highlights: November 2014

In this week’s news, many states’ Marketplaces have begun to communicate with current enrollees about how to renew their coverage during the 2015 Open Enrollment Period; meanwhile, the federal government announced the...more

Group health plans for same-sex spouses: Equal treatment required or not?

In our recent webinar, McAfee & Taft attorneys shared with you a number of ramifications from the recent U.S. Supreme Court decision that effectively legalized same-sex marriage in Oklahoma. One of the key questions we...more

Affordable Care Act Update: Hospitalization Services Required for Plan to Meet Minimum Value

On November 4, 2014, the Internal Revenue Service (IRS) released guidance (Notice 2014-69) clarifying that certain group health plans that do not provide for hospitalization services or physician services or both will fail to...more

Eighth Circuit Permits Employee to Maintain Age Bias Claim Based on Company's Age-Based Health Care Considerations

With the rising costs of health care benefits for both employers and employees alike, a recent case out of the Eighth Circuit provides an important reminder that even seemingly innocuous cost control measures can have a...more

IRS Increases Maximum Employee Contribution to Health Care FSAs for 2015

The IRS announced yesterday that the maximum annual employee contribution to a health care flexible spending account plan is increasing by $50 to $2,550 for 2015 (up from the $2,500 limit that has applied since 2013)....more

CMS Issues Proposals Related to Payments Under Basic Health Programs

Last week, CMS proposed the payment methodology and data sources for Basic Health Programs (BHPs), which include state-level insurance coverage created by the Affordable Care Act (ACA) for low-income residents. The proposal...more

California Legislation 2014

California Governor Jerry Brown has signed into law a number of bills that will impact the employer community. Healthy Workplaces, Healthy Families Act of 2014—Paid Sick Leave (AB 1522) - On September 10, 2014,...more

Rating Agency Developments

On October 13, Moody’s released is rating methodology for U.S. Health Insurance Companies. On October 10, DBRS published its methodologies regarding the following...more

Airline Industry Alert: RLA System Board Rules That Cessation of Operations as an Air Carrier Resulted in Termination of the CBA

In a recent decision, an RLA System Board of Adjustment has ruled that unilateral termination of a pilot retiree health insurance plan was permissible because the underlying CBA had terminated....more

Do You Offer or Accept Copayment Coupons? OIG says YOU are Responsible for Compliance with Federal Law

In recent years, copayment coupon programs have become standard promotional practices for both large and small pharmaceutical manufacturers. Copayment coupons are typically offered to commercially insured patients in order...more

FIO Focus, No. 65 - IAIS Releases Basic Capital Requirements

Earlier today, at its annual meeting, the International Association of Insurance Supervisors (IAIS) released its first set of capital standards for the insurance industry. According to the IAIS, capital standards are part of...more

Employer Reimbursement of Employee’s Individual Medical Insurance May Subject Employer to Penalty

IRS Notice 2013-54 provides that an employer’s reimbursement of healthcare insurance premiums paid by an employee on an individual health insurance contract of the employee on a pre-tax basis (an “employer payment plan”) may...more

Ninth Circuit Holds That Provider Cannot Sue Nonsignatory Insurer for Breach of Contract

On October 10, 2014, the Ninth Circuit affirmed a grant of summary judgment in favor of Manatt client The MEGA Life and Health Insurance Company. In an unpublished memorandum opinion, the Ninth Circuit held that a health care...more

Doctors, Lawyers and the Controversial Prop 46

What's the most controversial measure on California's November ballot? The insurance regulation bill, Prop 45, may be a good contender – but more than likely the controversy over Proposition 46 will win the contest hands...more

Health Plan Identifiers – November 5, 2014 Deadline

What Is a Health Plan Identifier (HPID)? A health plan identifier is a standardized 10-digit number that is unique to a plan. Who Must Obtain an HPID in the Coming Weeks? Large “controlling health plans”...more

Updated Timeline of Highlights for Employer Group Health Plan Compliance with the Affordable Care Act

Since enactment of the Affordable Care Act (“ACA”), the regulators have promulgated a myriad of regulations implementing the ACA’s requirements for group health plans. Over the past several years, the Obama administration has...more

From Competitors to Co-Adventurers, Seven Hospital Systems Join with Anthem Blue Cross to Shake Things Up in Southern California

Anthem Blue Cross and seven competing hospital systems in Southern California are joining forces to establish a new health plan offering, Vivity.[1] Operating with a combined 14 hospitals and approximately 6,000 physicians,...more

OIG Approves Yet Another Medigap Policy Contract with Preferred Hospital Network

On September 17, 2014, the U.S. Department of Health & Human Services, Office of Inspector General (OIG) issued Advisory Opinion 14-08 [PDF]. This opinion is yet another favorable advisory opinion approving a Medicare...more

Provider Competition Matters—Even for “Reference Pricing”

In a recent blog post, three Federal Trade Commission (FTC) economists splashed some cold water on advocates of “reference pricing” that seem to imply that such pricing “will increase competition between providers.” In the...more

Illinois Blues Won’t Let Hospitals Jointly Negotiate Unless They’re Married

Remember when Hollywood wouldn’t show an unmarried couple in bed together? Blue Cross-Blue Shield of Illinois is taking that approach to contract negotiations. If hospitals want to negotiate jointly with the insurer, they...more

Health Care Update - October 2014

In This Issue: - CMS Publishes Long-Awaited “Health Plan Innovation Initiative” RFI - Implementation of the Affordable Care Act - Other Federal Regulatory Initiatives - Other Congressional...more

IRS Issues New Forms And Instructions Regarding The Employer Mandate Information Reporting Requirements Under The ACA

In order to administer and enforce the rules of the Employer Shared Responsibility Mandate, the Affordable Care Act (ACA) added Sections 6055 and 6056 to the Internal Revenue Code, which require insurance providers and...more

New Cafeteria Plan Change in Status Options

In Notice 2014-55, the Internal Revenue Service (IRS) announced two new situations in which employees may change their health plan elections midyear under their employer’s cafeteria plan. In the first, an employee’s hours...more

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