60% of Employers Plan to Impose Penalties on Employees Who Don’t Take Action to Improve Health — Wellness Programs Move to Sticks from Carrots

In the WSJ article “When Your Boss Makes You Pay for Being Fat”, more employers are taking tough-love measures punishing workers who evade health screenings. But such steps also portend a murky future in which a chronic condition, such as hypertension, could cost workers j
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Arkansas’ unusual Medicaid pledge: ‘The program is not an entitlement program.’

The Arkansas state legislature has officially passed legislation to use Medicaid expansion dollars to buy private insurance for some 250,000 state residents. The bill used to do so contains one of the more unusual provisions I’ve ever seen in  health-care legislation. It requires thos
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Bipartisan Center Offers Plan To Reduce Health Spending

Medicare beneficiaries would have access to better coordinated medical care and the current Medicare physician payment formula would be scrapped as part of a health care cost containment plan the Bipartisan Policy Center unveiled Thursday. The plan offers more than 50 recommendations
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NYC to Seek New Provider for $6 Billion Health-Care Program

New York City will seek a new provider for its $6 billion health-insurance plan that would require workers to pay premiums for the first time, with discounts for participating in wellness programs, Deputy Mayor Caswell Holloway said. The proposal, which requires approval by unions, wo
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Supreme Court Forbids Rewrite Of ERISA Plan

The supremacy of a written ERISA -governed plan still reigns as the U.S. Supreme Court reversed the ruling of an appellate court which had held that a court in equity can ignore unambiguous subrogation reimbursement language, and simply rewrite the terms of an ERISA-governed plan in l
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Dealing with health care appeals – It’s OK to change your mind

With PPACA, we have added an extra component of the appeals process to include an external review. While this is added for health plans, other welfare plans like disability or life, and of course retirement plans, do not have this same requirement. But what happens if, during the cour
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Defining Equitable Relief and Plan Terms

While it may seem boring to those who don’t deal with benefit plans on a daily basis, the Supreme Court’s recent decision in US Airways, Inc. v. McCutchen is somewhat important.  The issues litigated in that case were whether two equitable defenses applied in the context o
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Starting in 2014, the Affordable Care Act will extend health coverage to millions of Americans. This will be done, in part, by offering tax credits to help low- and middle-income Americans afford private coverage. These new tax credits, which will offset a portion of the cost of healt
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Want to cut health costs? Show doctors a price tag.

In November 2009, the Johns Hopkins Hospital in Baltimore did something that hospitals rarely ever do. The hospital began showing doctors the prices of the medical procedures they ordered. For six months, doctors ordering certain lab tests would see the window that you see below that
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Supreme Court’s McCutchen Decision Is Good News for Plan Sponsors

The Supreme Court’s recent decision in US Airways, Inc. v. McCutchen dealt with a narrow issue under ERISA (enforcement of a plan’s reimbursement provision), but the way in which the Supreme Court answered that question is good news for all plan sponsors. The Court’s
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