Lack of Price Transparency Leading Employers to Self-Insure

By Vera Gruessner Some employers are finding it difficult to keep contracting with their health payers due to continually increasing monthly premium costs and a general lack of price transparency across the health insurance industry. As such, the notion of a company self-insuring its
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New Self-Insurance Market Report

Please click the link to see a news release from the Employee Benefit Research Institute (EBRI) highlighting the results of a newly-released marketplace survey on self-insured health plans.  As you will note, it shows an uptick in self-insurance among small and mid-sized employers and
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In answer to DOJ lawsuit, Anthem argues Cigna deal would boost ACA exchanges

By Bob Herman Anthem threw punches back at the U.S. Justice Department’s attempt to block the insurer’s acquisition of Cigna Corp. The response signals Anthem will indeed litigate the case to the end even though many analysts and policy experts say the company is unlikely
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Small businesses need stop-loss policy protections

By Jim Kunz / President, Mega Corp Inc. New Mexico runs on small business. Ninety-five percent of the state’s firms have fewer than 100 employees. Unfortunately, these businesses are struggling. Last year, state regulators began enforcing a 20-year-old law that effectively bars small
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Stop-loss Insurance Policy Purchased by an Employer for its Self-insured Health Plan is not a Plan Asset Under Certain Conditions

MyHealthGuide Source: US Dept. Labor, 10/19/2015, DOL Letter A DOL’s Advisory Opinion says a stop-loss insurance policy purchased by an employer for its self-insured health plan would not be a plan asset under certain conditions. • “It is the view of the Department, based
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Text of Agency FAQs on ACA Implementation: (Part XXIX) and Mental Health Parity Implementation

BenefitsLink.com October 23, 2015 13 Q&As. “Coverage of Preventive Services … Are plans and issuers required to provide a list of the lactation counseling providers within the network?…. My non-grandfathered group health plan or coverage contains a general exclus
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Another Voice: State legislators should undo new self-insurance limit

By Mike Ferguson New York lawmakers are making life harder for many of the state’s businesses and labor unions. This summer, Albany’s finest had the chance to preserve medium-sized firms’ and unions’ ability to “self-insure,” whereby they forego conventional health insurance and pay t
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Remaking Companies for ObamaCare

By Mike Ferguson Most of the 275 million Americans with health benefits probably see the logo on the corner of their insurance card and think that’s who has them covered. But for almost 100 million of them—the majority of Americans who get coverage through work—the true insurer is not
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Size Doesn’t Matter But the Regulators Do

By Adam V. Russo, Esq. (As published in Thompson Information Services’ Employer’s Guide to Self-Insuring Health Benefits)  What is the perfect size for a self-funded plan?  This is one of my favorite questions and I love to ask it at any conference at which I happen to hav
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Texas Prompt Pay Law Not Preempted; Enforceable Against Self-Insured Health Plan TPAs

EBIA Weekly A federal district court has ruled that ERISA does not preempt the Texas Prompt Payment Act as it applies to TPAs of self-insured benefit plans. The state law generally requires “insurers” to pay benefit claims within 30 or 45 days (depending on the claim’s format), or fac
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