Articles, White Papers and Other Information

Q & A on Medical Loss Ratio Reporting and Rebate Requirements

CCIIO issues technical guidance in the form of Qs and As on the medical loss ratio reporting and rebate requirements. Document Excerpt The purpose of this bulletin is to supplement Q&A #18 in the July 18, 2011 CCIIO Technical Guidance1 and other prior guidance2 regarding the employee counting method for determining market size for purposes […]

Process for a State to submit a Request for Adjustment to Individual Market MLR Standard

CCIIO issues technical guidance on the process for a state to submit a request for adjustment to the individual market medical loss ratio standard. Document Excerpt Section 2718 of the Public Health Service Act (PHS Act), as added by the Patient Protection and Affordable Care Act (PPACA), requires health insurance issuers (issuers) to submit a […]

Fifth Circuit Strikes Down Fiduciary Rule

Finding that the DOL exceeded its authority, the Fifth Circuit strikes down the DOL’s fiduciary rule. Document Excerpt The district court rejected all of these challenges. Finding merit in several of these objections, we VACATE the Rule. Link http://www.ca5.uscourts.gov/opinions/pub/17/17-10238-CV0.pdf

House Committee on Education Contacts DOL re: AHPs

The House Committee on Education and Workforce contacted the Secretary of Labor requesting that the DOL consider the House-passed Small Business Health Fairness Act of 2017 in its regulation of Association Health Plans. Document Excerpt Link https://edworkforce.house.gov/uploadedfiles/final_dol_ahp_submission_with_enclosure.pdf

Supreme Court Rules Retiree Health Benefits Not Vested for Life

The Court found, in a unanimous opinion, that the retiree health benefits ended when the collective bargaining agreement ended. Document Excerpt In this case, the Sixth Circuit held that the same Yard-Man inferences it once used to presume lifetime vesting can now be used to render a collective-bargaining agreement ambiguous as a matter of law, […]

GAO Analyzed Changes in Exchange Benchmark Plans

The GAO has analyzed changes in benchmark plans and premiums from 2015 through 2017. Document Excerpt • In most of the nearly 2,600 counties included in the analysis, the plans identified as benchmark plans, and the premiums for these plans, changed from year to year. For example, in 85 percent of counties, the 2015 benchmark […]

CRS FAQs on the Affordable Care Act

The Congressional Research Service produced this Frequently Asked Questions to assist Congressional staffers in responding to constituents with questions about the Affordable Care Act. Document Excerpt Link https://benefitslink.com/articles/CRS_R43215_12012017.pdf

Executive Order On Health Care

President Trump signs an Executive Order authorizing insurance companies to sell health insurance policies across state lines. The order would require the DOL to issue guidance making it easier to maintain association plans. The order also encourages short-term plans and HRAs. Document Excerpt Link https://www.whitehouse.gov/the-press-office/2017/10/12/presidential-executive-order-promoting-healthcare-choice-and-competition

CBO Estimates of the Cost of Terminating Cost Sharing Subsidies

The Congressional Budget Office released its report on the impact on the budget of terminating the Affordable Care Act’s cost sharing payments. Document Excerpt At the request of the House Democratic Leader and the House Democratic Whip, the Congressional Budget Office and the staff of the Joint Committee on Taxation (JCT) have estimated the effects […]

Supreme Court rules in Favor of Religiously Affiliated Entities

The Supreme Court unanimously ruled in favor of an expanded church plan definition that includes certain plans established by religiously affiliated entitles. Document Excerpt Instead, it added language whose most naturalreading is to enable a plan “maintained” by a principal-purpose organization to substitute for a plan both “established” and “maintained” by a church. And as […]

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