Welfare Benefit Plan ERISA News & Views
September 2012

5% of Population Spends 50% of Healthcare Dollars
% of
% of
1% 22%
5% 50%
10% 65%
20% 80%
30% 90%
50% 95%
Just five percent of the population spends half of the total health care dollars. Understanding them is vital for developing strategies to reduce spending growth. In this brief you will learn more about:
  • health conditions of the highest spenders,
  • the persistence of high spending patterns over time,
  • challenges in the most expensive cases, and
  • the implications for insurance market reforms.
DOL Updates Model CHIP Notice
The DOL has updated its model notice that employers must provide before the start of the plan year to employees that are eligible for group health insurance. The notice provides information about premium assistance available through various state Medicaid or Children's Health Insurance Programs (CHIP).
Why Welfare Benefit Plan Documents Really Matter
"This case underscores the importance of ensuring that the employer has a written welfare benefit plan, and that the plan reflects all of the employer's practices with respect to loss of coverage and COBRA elections. In addition, the terms of a stop-loss policy need to be reviewed against the employer's plan provisions, to ensure that they are consistent." More
House Panel Seeks Documents and Correspondence between White House and IRS on Healthcare Law
A handful of governors have opted not to establish health insurance exchanges that are required by the law. House Committee on Oversight and Government Reform Chairman Darrell Issa has challenged the Obama administration's authority to administer the healthcare law in states that are refusing to cooperate. The IRS is charged with distributing health insurance tax credits through the state exchanges. Issa argues that federally-created exchanges, set up in the resisting states, cannot deliver the tax credits. (Reuters)
Saving Small Group Health Insurance
When the ACA is widely implemented in 2014, the lack of a penalty for dropping group coverage, along with substantial individual tax credits that are available only if an employer does not offer affordable coverage that provides minimum value, are likely to lead many small employers (under 50 employees) to drop their group insurance and, in the process, increase the cost of reform. Many small employers may turn to self-insuring to avoid the regulatory burdens imposed by the ACA. If the small group market is to survive and prosper, SHOP exchanges must undertake administrative remedies. University of Minnesota Law School Research Paper
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© 2017 ERISAPros, LLC, All rights reserved. Information on ERISAPros' 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 ERISAPros. Transmission of this information does not create an attorney-client relationship. ERISAPros, 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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