Benefits Blog

Excerpt from Professor Jost's post on Health Affairs Blog:Legal BackgroundThis lawsuit originated in an attempt by the House of Representatives to hold President Obama responsible for what it has viewed as abuses of presidential power. Since 2010, the House of Representatives has been held by a substantial Republican majority. The House has been continually at loggerheads with the President on health care reform. The House has voted over 60 times to repeal the President’s signature policy initiative. On July 30, 2014, the House voted along party lines to file a lawsuit challenging the President’s implementation of the law.

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Excerpt from Professor Jost's post on Health Affairs Blog:On February 25, 2016 the departments released a proposed revised SBC template, proposed individual and group instructions, and a proposed uniform glossary. The proposed template is shorter than the NAIC-recommended SBC template. The documents are exposed for a thirty-day comment period. They will presumably not be effective for marketplace coverage beginning January 1, 2017, but could be effective for plan years beginning with the second quarter of 2017.Pre-Deductible ServicesThe proposed revised template adopts many of the NAIC stakeholder group recommendations and is a distinct improvement over the original NPRM template. It includes a new question—“Are there services covered before you meet your deductible?”—to identify the growing number of health plans that cover some primary care, generic or preferred drugs, and even specialist services before the deductible applies.

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As business needs change, companies reshuffle their human resource deck often. But there is a new elephant in the room called the Affordable Care Act, and very bright spotlights will now be trained on employment moves that some might claim are “discriminatory” under a dusty ERISA provision. Just ask Dave & Buster’s.A court recently declared that a class action (which some had deemed devoid of merit) could proceed against D&B on exactly these ERISA grounds.Key recommendation: know exactly where you stand before making workforce changes because of the ACA.Why?For many employers the Affordable Care Act (ACA) would have required that a traditional major medical health insurance plan be offered—at relatively little cost to employees—to many more employees than those employers historically had offered such coverage. Unless those employers restructured their workforces, the costs would have been crushing.

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Update following EEOC's issuance of final regulations:Well, my prediction below was proven wrong. I made the mistake of thinking a federal regulatory agency would be rational. The EEOC has finalized its wellness incentive regulations, expressly ignoring both the statutory language of the ADA and a recent Federal court decision. Despite its issuance of final regulations, the EEOC's war on wellness is far from over. Doubtless the courts will have to sort it all out.Original post:If you followed, even passively, the slew of Equal Employment Opportunity Commission (EEOC) lawsuits or proposed wellness regulations in 2015, then you know that wellness incentive programs—a key part of many employers' benefits strategy—face a new era of mind-boggling complexity.

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