HHS Issues Proposed Regulations Relating to Standards for Exchange Navigators

On April 3, 2013, HHS issued proposed regulations that would create standards for Navigators and non-Navigator assistance personnel in federally facilitated Exchanges (FFEs) (including state partnership Exchanges) and for federally funded non-Navigator assistance personnel in state-ba
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Obama, Sebelius Discuss ACA Exchanges With Insurance Executives.

WASHINGTON — President Obama met with insurance industry executives at the White House on Friday to coordinate the introduction this fall of the insurance marketplaces at the heart of the national health care law, and to discuss so-called rate shock if the industry sharply raises prem
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Goal of online health exchange marketplace: user friendly

With the implementation of the Affordable Care Act, uninsured Illinois residents will begin searching for health insurance coverage via an online marketplace available in late 2013 for coverage beginning in 2014. State officials have worked with Enroll UX 2014, a public-private partne
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SIIA Amicus Participation Contributes to Positive Judicial Outcome

April 17, 2013 — The United States Supreme Court yesterday handed down a unanimous ruling in the case of U.S. Airways, Inc. v. McCutchen that is widely viewed as a major win for employers who sponsor self-insured group health plans. The Self-Insurance Institute of America, Inc.
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Do Private Exchanges Help or Hinder Self-Insured Plans?

One of the hottest topics for discussion in HR departments is about the private health insurance exchanges that began operating in January 2013 – a full year ahead of state run public exchanges for individuals and small businesses mandated by the Affordable Care Act (ACA). Continue Re
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The Good, The Bad, & The Possibilities of Outcomes-based Incentive Programs

As support for prevention and wellness programs continues to grow, so does the debate on the use of outcomes-based incentive programs. Numerous national surveys have shown that only a minority of health plans currently contain this approach, yet it is a growing trend among employers o
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New HIPAA Omnibus rule: Issues for Employer Plan Sponsors and Group Health Plans

HIPAA’s long-awaited “Omnibus rule” (also referred to in this advisory as the “Rule”), published on January 25, 2013, modifies numerous aspects of the HIPAA regulations concerning privacy, security, enforcement, and breach notification.1  The rule is effective on March 26, 2013, and r
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TPA’s Beware of Fiduciary Liability

I read with interest Steve Polino’s “From the Bench” column in the February 2013 issue of The Self-Insurer and agree that the court finally got it right. Hopefully all TPAs will take note of this Fifth Circuit Court decision and adjust their administrative practices accordingly. While
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Medicare’s designation of nonreimbursable events drives patient safety

Nearly five years after federal health regulators ended Medicare reimbursements for certain hospital-acquired conditions, experts say the feared onslaught of malpractice losses resulting from the change has yet to materialize. Since the Centers for Medicare and Medicaid Service’
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Health reform expected to increase employer costs via increased enrollment

Amid a prediction of spiraling claims costs in the individual market due to the health care reform law, experts say certain employers also face double-digit increases in the coming years. In a report last month, the Society of Actuaries predicted that claims costs in the individual he
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