Welfare Benefit Plan ERISA News & Views
January 2012

 
Essential Health Benefits (EHB)
to be determined by States
In a surprising move, the Department of Health and Human Services will not impose a uniform definition of "essential health benefits" (EHB) that individual and small group health insurance plans must provide in order to be offered on state exchanges starting in 2014. Instead, as announced in a bulletin released on December 16, 2011, for 2014 and 2015 HHS will permit each state to define EHB, for coverage offered within that state, by reference to benefits provided under one of four benchmark plans. Read more
New Medical Loss Ratio (MLR) Guidance
Insurance company refunds have been uncommon, having arisen primarily from experience rated contracts and carrier demutualizations. However, under the new MLR provisions, rebates may not be as unusual. The biggest news contained in recent guidance* is in the rules on how rebates may be used and how they should be apportioned between the plan, a trust, the employer, and the employee. Contact ERISA Pros to see if your SPD complies. *MLR Final Regulations, DOL Technical Release, HHS Fact Sheet
Using Behavioral Economics in Employee Benefits
Despite their best intentions, people do not always make rational decisions regarding their health and their health care benefits. Behavioral biases cloud rational judgment. Understanding these tendencies can help organizations design and communicate their health benefit plans to stimulate decisions that will improve outcomes for both itself and its employees.
Behavioral economics is the study of how real people actually make financial choices; it draws on insights from both psychology and economics. It can play an important part in an organization's open-enrollment process where a key goal is to steer employees toward more cost-effective health plan options.
How might an organization leverage its open enrollment materials to encourage its employees to choose one of the better plan options, participate in wellness programs, and make lifestyle changes that have the potential to improve their health? The ordering of options, naming of programs, structuring of incentives, selection of defaults, selection of decision-making factors, and the use of color can be used to influence choice and make a big difference. Read more.
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© 2014 ERISA Pros, LLC, All rights reserved. Information on ERISA Pros' website, its newsletter, “News & Views,” and its blog, “ERISA Wonk,” is published as a general informational source. Information and articles are general in nature and are not intended to constitute legal or tax advice in any particular matter. Blog posts and comments reflect the personal views of their respective authors - not those of ERISA Pros. Transmission of this information does not create an attorney-client relationship. ERISA Pros, LLC is not a law firm and is not giving legal or tax advice. It does not warrant and is not responsible for errors or omissions in the content on its website or in its newsletters. ERISA is a complicated and confusing law. Summary Plan Descriptions (SPDs), Wrap Plan Documents, and Form 5500s require review and updating by qualified ERISA compliance professionals.

 

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