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	<title>Ken Mensio, CEBS &#187; Health care reform</title>
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	<link>http://www.csibenefits.us/blog</link>
	<description>Current Topics in Employee Benefits</description>
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		<item>
		<title>Employers look to consumer-driven plans to lower health costs</title>
		<link>http://www.csibenefits.us/blog/health-care/employers-look-to-consumer-driven-plans-to-lower-health-costs/#utm_source=feed&#038;utm_medium=feed&#038;utm_campaign=feed</link>
		<comments>http://www.csibenefits.us/blog/health-care/employers-look-to-consumer-driven-plans-to-lower-health-costs/#comments</comments>
		<pubDate>Tue, 23 Aug 2011 14:24:48 +0000</pubDate>
		<dc:creator>Ken Mensio</dc:creator>
				<category><![CDATA[Health Care]]></category>
		<category><![CDATA[Cadillac Tax]]></category>
		<category><![CDATA[CDHP]]></category>
		<category><![CDATA[Consumber Directed Heatlh Plans]]></category>
		<category><![CDATA[employee cost sharing]]></category>
		<category><![CDATA[FSA]]></category>
		<category><![CDATA[HDHP]]></category>
		<category><![CDATA[healt care benefit costs]]></category>
		<category><![CDATA[Health care reform]]></category>
		<category><![CDATA[HRA]]></category>
		<category><![CDATA[HSA]]></category>

		<guid isPermaLink="false">http://www.csibenefits.us/blog/?p=830</guid>
		<description><![CDATA[The rising cost of health care will soon be reflected even more substantially in employee cost-sharing. A new National Business Group on Health survey shows that large employers anticipate their health care benefit costs to climb 7.2% in 2012. To help control those increases ahead of health care reform’s Cadillac tax in 2018, the survey shows employers are planning to use a wide variety of cost-sharing strategies including CDHP premium boosts. <a href="http://www.csibenefits.us/blog/health-care/employers-look-to-consumer-driven-plans-to-lower-health-costs/">Continue reading <span class="meta-nav">&#8594;</span></a>]]></description>
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		<slash:comments>0</slash:comments>
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		<title>11th Circuit on PPACA: Can’t Make &#8216;Em Buy Broccoli</title>
		<link>http://www.csibenefits.us/blog/health-care-reform-2/11th-circuit-on-ppaca-can%e2%80%99t-make-em-buy-broccoli/#utm_source=feed&#038;utm_medium=feed&#038;utm_campaign=feed</link>
		<comments>http://www.csibenefits.us/blog/health-care-reform-2/11th-circuit-on-ppaca-can%e2%80%99t-make-em-buy-broccoli/#comments</comments>
		<pubDate>Fri, 12 Aug 2011 21:50:28 +0000</pubDate>
		<dc:creator>Ken Mensio</dc:creator>
				<category><![CDATA[Health Care Reform]]></category>
		<category><![CDATA[Court of Appeals]]></category>
		<category><![CDATA[Health care reform]]></category>
		<category><![CDATA[individual mandate]]></category>
		<category><![CDATA[Patient Protection and Affordable Care Act (PPACA)]]></category>

		<guid isPermaLink="false">http://www.csibenefits.us/blog/?p=826</guid>
		<description><![CDATA[ A 3-judge panel at the 11th Circuit Court of Appeals has declared the individual health insurance ownership mandate in the Patient Protection and Affordable Care Act (PPACA) to be unconstitutional. <a href="http://www.csibenefits.us/blog/health-care-reform-2/11th-circuit-on-ppaca-can%e2%80%99t-make-em-buy-broccoli/">Continue reading <span class="meta-nav">&#8594;</span></a>]]></description>
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		<slash:comments>0</slash:comments>
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		<title>Benefits of self-funded health plans</title>
		<link>http://www.csibenefits.us/blog/health-care/benefits-of-self-funded-health-plans/#utm_source=feed&#038;utm_medium=feed&#038;utm_campaign=feed</link>
		<comments>http://www.csibenefits.us/blog/health-care/benefits-of-self-funded-health-plans/#comments</comments>
		<pubDate>Fri, 05 Aug 2011 18:19:17 +0000</pubDate>
		<dc:creator>Ken Mensio</dc:creator>
				<category><![CDATA[Health Care]]></category>
		<category><![CDATA[Self Insured Health Plans]]></category>
		<category><![CDATA[Benefit]]></category>
		<category><![CDATA[claims experience]]></category>
		<category><![CDATA[Health care reform]]></category>
		<category><![CDATA[premium tax]]></category>
		<category><![CDATA[self-funded]]></category>
		<category><![CDATA[Self-funded health care]]></category>

		<guid isPermaLink="false">http://www.csibenefits.us/blog/?p=820</guid>
		<description><![CDATA[By Michelle M. Stimson
July 29, 2011
Due to the economic recession and the potential for increased health insurance costs brought about by health care reform, many employers are beginning to view self-funded health care plans as a more attractive option than fully insured plans. These employers recognize the advantages of self-funding, which include cost savings, increased cash flow and more flexibility in benefit decisions, administration and funding. Self-funded plans will be favored under health care reform because, while many provisions of health care reform apply both to fully insured and self-funded plans, there are many provisions of health care reform from which only self-funded plans are exempt. For example, self-funded plans will not have to comply with the new marketing, internet portal, enrollment and provider network and quality accreditation rules. This will mean direct cost savings to the plan, which will pass through to the employer. There are also many state mandates from which self-funded plans are still exempt.
Flexibility of Plan Design
One major advantage of self-funding is the control and flexibility of plan design. Under a self-funded health plan, the employer has the option of either duplicating its current fully insured plan design or redesigning and tailoring the benefits to meet the specific needs of the employer. Of course, as mentioned, health care reform has put some limitations on the extent to which an employer can influence the plan design, but for the most part, the employer has the freedom to eliminate benefits that result in plan abuses or high utilization.
Exemption From State-Mandated Benefits
As previously noted, another benefit of opting for a self-funded arrangement is an employer’s ability to opt out of state mandated benefits, although this benefit has been somewhat limited by health care reform. Since self-funded health care plans are governed by ERISA, they follow federal law and are not required to provide state-mandated benefits, which can be both expensive and unnecessary. Likewise, these employers can set their own limits on benefits where states would otherwise set the limits.
Control of Reserves
Employers sponsoring self-funded plans also enjoy the advantages of controlling reserves. In a fully insured plan, a substantial portion of the premium is held by the carrier as a state-required reserve for claims and inflation. Under a self-funded arrangement, the employer maintains and controls the reserves and has the ability to invest these funds. Moreover, there are no restrictions on reserves, and the employer retains them when claims do not materialize. Under a fully insured arrangement, if an employer’s claims experience is better than expected, only the insurer benefits financially.
Claims Experience
Even where an individual employer has a history of good claims experience, the insurance companies pass on a renewal based upon the entire pool of insureds. Thus, an employer is rated, not based upon its individual claims experience but upon those of other companies that have no relationship to that employer’s company or industry. A self-funded arrangement eliminates this component of maintaining a plan.
Premium Tax
In most states, there is no premium tax for self-funded plans. This results in an immediate savings because approximately two to four percent of an employer’s fully insured health care costs fund this premium tax.
Advantages of Advanced Preparation
It seems clear that health care reform will increase the already high cost of health insurance. With greater flexibility, fewer mandated benefits and potentially lower costs, now is the time for both large and small employers to consider shifting their fully insured plans to self-funded plans. Through innovative ideas and strategic planning, employers can examine their workforce and prepare for the changes coming in 2014.
Source:   Employee Benefit News article used by permission.
 <a href="http://www.csibenefits.us/blog/health-care/benefits-of-self-funded-health-plans/">Continue reading <span class="meta-nav">&#8594;</span></a>]]></description>
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		<title>CSI Benefits Webinar Connection</title>
		<link>http://www.csibenefits.us/blog/webinar-series/csi-benefits-webinar-connection-2/#utm_source=feed&#038;utm_medium=feed&#038;utm_campaign=feed</link>
		<comments>http://www.csibenefits.us/blog/webinar-series/csi-benefits-webinar-connection-2/#comments</comments>
		<pubDate>Wed, 09 Feb 2011 17:43:25 +0000</pubDate>
		<dc:creator>Ken Mensio</dc:creator>
				<category><![CDATA[ERISA]]></category>
		<category><![CDATA[Health Care Reform]]></category>
		<category><![CDATA[Webinar Series]]></category>
		<category><![CDATA[ERISA appeals rules]]></category>
		<category><![CDATA[ERISA's preemption of state law]]></category>
		<category><![CDATA[Health care reform]]></category>
		<category><![CDATA[Live webinar]]></category>

		<guid isPermaLink="false">http://www.csibenefits.us/blog/?p=691</guid>
		<description><![CDATA[Having trouble viewing this posting? Click here CSI Benefits Webinar Connection Enhanced Claims and Appeals Process Under Health Care Reform During this live webinar, we will review the changes under health care reform to ERISA&#8217;s internal claims procedures and external &#8230; <a href="http://www.csibenefits.us/blog/webinar-series/csi-benefits-webinar-connection-2/">Continue reading <span class="meta-nav">&#8594;</span></a>]]></description>
		<wfw:commentRss>http://www.csibenefits.us/blog/webinar-series/csi-benefits-webinar-connection-2/feed/</wfw:commentRss>
		<slash:comments>0</slash:comments>
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		<title>Projection: PPACA to have “moderate effect” on health spending growth rates</title>
		<link>http://www.csibenefits.us/blog/health-care/projection-ppaca-to-have-%e2%80%9cmoderate-effect%e2%80%9d-on-health-spending-growth-rates/#utm_source=feed&#038;utm_medium=feed&#038;utm_campaign=feed</link>
		<comments>http://www.csibenefits.us/blog/health-care/projection-ppaca-to-have-%e2%80%9cmoderate-effect%e2%80%9d-on-health-spending-growth-rates/#comments</comments>
		<pubDate>Tue, 14 Sep 2010 14:54:08 +0000</pubDate>
		<dc:creator>Ken Mensio</dc:creator>
				<category><![CDATA[Health Care]]></category>
		<category><![CDATA[Health Care Reform]]></category>
		<category><![CDATA[CMS]]></category>
		<category><![CDATA[Health care reform]]></category>
		<category><![CDATA[HHS]]></category>
		<category><![CDATA[Patient Protection and Affordable Care Act]]></category>
		<category><![CDATA[PPACA]]></category>

		<guid isPermaLink="false">http://www.csibenefits.us/blog/?p=526</guid>
		<description><![CDATA[U.S. health spending is expected to reach nearly $4.6 trillion by 2019, growing at an average annual rate over the next decade of 6.3%, as opposed to a 6.1% rate anticipated before reform, according to economists at the Centers for Medicare and Medicaid Services.

By 2019, health care is predicted to account for nearly one of every five U.S. dollars spent or about 19.6% of the gross domestic product, 0.3 percentage points higher than projected previously.

"In the aggregate, it appears that the Affordable Care Act will have a moderate effect on health spending growth rates and the health care share of the economy," says Andrea Sisko, lead author of the study and economist at CMS.

At the same time, she explains that "differences in spending patterns, by year and by payer, reflect reform’s many major changes to health care coverage and financing." <a href="http://www.csibenefits.us/blog/health-care/projection-ppaca-to-have-%e2%80%9cmoderate-effect%e2%80%9d-on-health-spending-growth-rates/">Continue reading <span class="meta-nav">&#8594;</span></a>]]></description>
		<wfw:commentRss>http://www.csibenefits.us/blog/health-care/projection-ppaca-to-have-%e2%80%9cmoderate-effect%e2%80%9d-on-health-spending-growth-rates/feed/</wfw:commentRss>
		<slash:comments>0</slash:comments>
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		<title>Most large employers changing health benefit for 2011</title>
		<link>http://www.csibenefits.us/blog/health-care/most-large-employers-changing-health-benefit-for-2011/#utm_source=feed&#038;utm_medium=feed&#038;utm_campaign=feed</link>
		<comments>http://www.csibenefits.us/blog/health-care/most-large-employers-changing-health-benefit-for-2011/#comments</comments>
		<pubDate>Fri, 20 Aug 2010 14:44:18 +0000</pubDate>
		<dc:creator>Ken Mensio</dc:creator>
				<category><![CDATA[Health Care]]></category>
		<category><![CDATA[Health Care Reform]]></category>
		<category><![CDATA[benefit costs increases]]></category>
		<category><![CDATA[health care benefit Costs]]></category>
		<category><![CDATA[Health care reform]]></category>
		<category><![CDATA[prescription drugs benefits]]></category>

		<guid isPermaLink="false">http://www.csibenefits.us/blog/?p=504</guid>
		<description><![CDATA[According to a new survey by National Business Group on Health, more than half (53%) of large U.S. employers plan to revise  their 2011 health care benefit programs in the wake of health care reform legislation and anticipated large benefit cost increases next year. <a href="http://www.csibenefits.us/blog/health-care/most-large-employers-changing-health-benefit-for-2011/">Continue reading <span class="meta-nav">&#8594;</span></a>]]></description>
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		<slash:comments>0</slash:comments>
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		<title>Lowering costs before reform takes effect will pay off in the long run</title>
		<link>http://www.csibenefits.us/blog/health-care/lowering-costs-before-reform-takes-effect-will-pay-off-in-the-long-run/#utm_source=feed&#038;utm_medium=feed&#038;utm_campaign=feed</link>
		<comments>http://www.csibenefits.us/blog/health-care/lowering-costs-before-reform-takes-effect-will-pay-off-in-the-long-run/#comments</comments>
		<pubDate>Wed, 04 Aug 2010 15:04:45 +0000</pubDate>
		<dc:creator>Ken Mensio</dc:creator>
				<category><![CDATA[Health Care]]></category>
		<category><![CDATA[Health Care Reform]]></category>
		<category><![CDATA[controlling heaalth care spending]]></category>
		<category><![CDATA[health care costs]]></category>
		<category><![CDATA[Health care reform]]></category>
		<category><![CDATA[HIPAA]]></category>
		<category><![CDATA[PBM]]></category>
		<category><![CDATA[Prescription Costs]]></category>

		<guid isPermaLink="false">http://www.csibenefits.us/blog/?p=485</guid>
		<description><![CDATA[Change is definitely on the horizon. The recently passed health care reform legislation is designed to ensure virtually all Americans will have access to reasonably priced medical insurance and, as a result, reasonably priced health care.

As companies move toward new rules and mandates, most will find that implementing measures to reduce health care costs now will pay off in the long run.

According to the Congressional Budget Office, total spending on health care in the U.S. has doubled over the last 30 years and now makes up about 16 percent of the gross domestic product
 <a href="http://www.csibenefits.us/blog/health-care/lowering-costs-before-reform-takes-effect-will-pay-off-in-the-long-run/">Continue reading <span class="meta-nav">&#8594;</span></a>]]></description>
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		<slash:comments>0</slash:comments>
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		<title>Key notification and communication requirements in health care reform</title>
		<link>http://www.csibenefits.us/blog/health-care/key-notification-and-communication-requirements-in-health-care-reform/#utm_source=feed&#038;utm_medium=feed&#038;utm_campaign=feed</link>
		<comments>http://www.csibenefits.us/blog/health-care/key-notification-and-communication-requirements-in-health-care-reform/#comments</comments>
		<pubDate>Fri, 30 Jul 2010 16:33:32 +0000</pubDate>
		<dc:creator>Ken Mensio</dc:creator>
				<category><![CDATA[Health Care]]></category>
		<category><![CDATA[Health Care Reform]]></category>
		<category><![CDATA[health care bill]]></category>
		<category><![CDATA[Health Care Law]]></category>
		<category><![CDATA[Health care reform]]></category>

		<guid isPermaLink="false">http://www.csibenefits.us/blog/?p=477</guid>
		<description><![CDATA[You’ve likely been focusing mostly on the plan design and administration requirements of health care reform. But, the law has a series of new notification and communication requirements that start this year and extend over the next several years.

You’ll need to be thinking not only about the strategic communication needs—how to keep employees engaged in their health and managing costs—but also how to meet these legal requirements in a way that adds the most value. (And, creates the least amount of additional work for you and your team.)

Much is still in flux about the changes in health care, but this article captures the key notification requirements and what to look for as regulations are issued.

Seven health care reform notices  <a href="http://www.csibenefits.us/blog/health-care/key-notification-and-communication-requirements-in-health-care-reform/">Continue reading <span class="meta-nav">&#8594;</span></a>]]></description>
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		<slash:comments>0</slash:comments>
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		<title>Health-reform regs overhaul claims appeals process</title>
		<link>http://www.csibenefits.us/blog/health-care/self-insured-health-plans/health-reform-regs-overhaul-claims-appeals-process/#utm_source=feed&#038;utm_medium=feed&#038;utm_campaign=feed</link>
		<comments>http://www.csibenefits.us/blog/health-care/self-insured-health-plans/health-reform-regs-overhaul-claims-appeals-process/#comments</comments>
		<pubDate>Tue, 27 Jul 2010 21:02:14 +0000</pubDate>
		<dc:creator>Ken Mensio</dc:creator>
				<category><![CDATA[Health Care Reform]]></category>
		<category><![CDATA[Self Insured Health Plans]]></category>
		<category><![CDATA[Appeals process regulations]]></category>
		<category><![CDATA[Health care reform]]></category>
		<category><![CDATA[Patient Protection and Affordable Care Act]]></category>
		<category><![CDATA[PPACA]]></category>

		<guid isPermaLink="false">http://www.csibenefits.us/blog/?p=472</guid>
		<description><![CDATA[The Obama Administration released interim final regulations aimed at creating a system of checks and balances for the internal and external appeals processes of health claims.

Governed by the Patient Protection and Affordable Care Act, the interim final rule requires group health plans and insurers to establish a comprehensive appeals processfor patients who appeal decisions on coverage, services and claim payments. The interim final regulations apply to self-funded health plans, but not to grandfathered plans under the PPACA.

The Departments of Health and Human Services, Labor and the Treasury issued the interim final rule, which will take effect on Sept. 21, 2010. <a href="http://www.csibenefits.us/blog/health-care/self-insured-health-plans/health-reform-regs-overhaul-claims-appeals-process/">Continue reading <span class="meta-nav">&#8594;</span></a>]]></description>
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		<slash:comments>0</slash:comments>
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		<title>Gov’t unveils new Patient’s Bill of Rights under PPACA</title>
		<link>http://www.csibenefits.us/blog/health-care/gov%e2%80%99t-unveils-new-patient%e2%80%99s-bill-of-rights-under-ppaca/#utm_source=feed&#038;utm_medium=feed&#038;utm_campaign=feed</link>
		<comments>http://www.csibenefits.us/blog/health-care/gov%e2%80%99t-unveils-new-patient%e2%80%99s-bill-of-rights-under-ppaca/#comments</comments>
		<pubDate>Thu, 24 Jun 2010 15:57:05 +0000</pubDate>
		<dc:creator>Ken Mensio</dc:creator>
				<category><![CDATA[Health Care]]></category>
		<category><![CDATA[Health care reform]]></category>
		<category><![CDATA[Patient Protection and Affordable Care Act]]></category>
		<category><![CDATA[Patient’s Bill of Rights]]></category>
		<category><![CDATA[PPACA]]></category>
		<category><![CDATA[Preexisting condition exclusions]]></category>
		<category><![CDATA[regulations]]></category>

		<guid isPermaLink="false">http://www.csibenefits.us/blog/?p=386</guid>
		<description><![CDATA[Federal regulators released interim final rules implementing a new Patient's Bill of Rights under the Patient Protection and Affordable Care Act. The guidance addresses preexisting condition exclusions, retroactive rescissions, lifetime limits and annual dollar limits.

Source: Employee Benefit News article used by permission

"These rules effectively put in place a basic set of consumer protections known over the years as the 'Patient's Bill of Rights.' This is a concept introduced 15 years ago and supported by both Democrats and Republicans," said Secretary of Health and Human Services Kathleen Sebelius in an e-mail statement.

The Federal Register will publish the rules on June 28. The new regulations, issued by the Departments of Health and Human Services, Labor and Treasury, will take effect for most plans on or after Sept. 23. For calendar year plans, the rules will take effect Jan. 1, 2011.

The interim final rules, which are nearly 200 pages, focus on PPACA provisions that apply to all health plans, including grandfathered health plans. According to consultants at Hewitt Associates, the provisions in the interim final rules adopt the following: <a href="http://www.csibenefits.us/blog/health-care/gov%e2%80%99t-unveils-new-patient%e2%80%99s-bill-of-rights-under-ppaca/">Continue reading <span class="meta-nav">&#8594;</span></a>]]></description>
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