Benefit plan design

John Lamb on helping employees that have reached the tipping point on health care spending.

Third biggest U.S. health insurer says the share of health care premiums it spends on patient care rose to 84.1% from 80.7% a year earlier. The insurer finished 2012 with 18.2 million members in its medical plans, an increase of 64,000 over the third quarter.

The IRS and HHS released new regulations Wednesday for the individual mandate portion of PPACA. The proposed regulations shed new light on the process the agencies will take in determining which individuals are subject to the mandate or whether they’re exempt, and whether their insurance coverage is sufficient.

Oklahoma opposed a request by the U.S. that a judge dismiss the state’s lawsuit challenging President Obama’s 2010 health-care reform legislation.

Howard County, Md., will become the first municipality to establish a nonprofit, member-run health co-op to sell individual and small group plans through the insurance exchanges — a move some say could undercut competitors by 30%.

UnitedHealth Group Inc. and other U.S. health insurers will soon have company in Maryland: a nonprofit started by a county government that plans to sell coverage at rates as much as 30% lower than competitors.

With the 113th Congress up and running and the president’s policy schedule filling up by the day, the Kaiser Family Foundation and Harvard School of Public Health polled Americans last week on what they would like the government to set as top health care priorities for the year.

As the health insurance exchange marketplace continues to expand, industry trailblazers and benefits experts are weighing in on what it takes for employers to succeed within this relatively new health care model.

Consulting firm announced Thursday the launch of a private benefits exchange developed by Benefitfocus, available to employers with at least 100 employees.

Mercer announced Thursday that it has launched a private benefits exchange developed by Benefitfocus and available to employers with at least 100 employees.

EBA Contributor Barry Cohn is being kept busy with questions about MLR reimbursements, with clients wondering what to do or asking how much they would be receiving.

Pediatric dental and orthodontic coverage could see significant changes under health care reform, particularly in terms of reimbursement. Evelyn Ireland, the executive director of the National Association of Dental Plans, talks about regulations that might or might not have people smiling.

Many states led by Republican governors have already said they won’t build their own insurance exchanges. That puts the onus on the Obama administration.

The Department of Health and Human Services has laid out 10 categories of benefits that must be included in health insurance plans offered through an exchange.

With health reform moving full steam ahead, most employers will continue to offer employee coverage, but will make alterations to how they provide it, said a speaker at the Workplace Benefits Transitions conference Tuesday.

Health care reform means that many patients can no longer be denied health insurance because of preexisting conditions. But there’s a big catch: Coverage for many Americans without insurance will come at a potentially unaffordable cost.

Less than one week after Obama won a second term in office, dozens of employers already were setting about the business of offsetting the impending business costs of implementing health care reform or other Obama policies they view as unfriendly to their industry.

Aetna and other insurers that initially fought President Obama’s health care overhaul are reversing course and supporting the effort by funding a group planning to spend $100 million to help the uninsured get coverage.

As PPACA is implemented, the number of IT, software and service jobs created could easily boom into the hundreds of thousands.

Provisions associated with PPACA increase the amount an employer can offer for tobacco cessation from 20% of the total cost of health coverage to 50%.