Store Legal / Corporate Health Insurance Answer Book, Twelfth Edition
Health Insurance Answer Book, Twelfth Edition Health Insurance Answer Book, Twelfth Edition

Health Insurance Answer Book, Twelfth Edition

By John C. Garner
Select Format
Looseleaf
$489.00
Internet
$395.00
Available on Cheetah! Learn More

Looseleaf

Price
$489.00
Qty.
This product is available for the standing order program.
Buy Now

Internet

Price
$395.00
Includes 3-month access for one license. Need a demo or annual access? Contact Sales
Buy Now
Please note, once you complete your purchase, Cheetah registration instructions and login credentials to access your 3-month online subscription will be emailed to you within one business day.
Overview

From designing a cost-effective new health care plan…to administering an existing plan…to complying with the many state and federal rules that govern health benefit plans - you know how difficult it is to manage your company's group health insurance.

With Health Insurance Answer Book, you get expert guidance and practice-based answers to all types of questions about today's health insurance marketplace, including:

  • Are there any guidelines on medical tourism?
  • What are the issues related to implementation of a "full flex" plan?
  • What is the role of an intermediary?
  • Can onsite health clinics save money?
  • Are there any new developments regarding the use of captives for retiree health insurance?
  • What is electronic prescribing?
  • What is comparative effectiveness research?

 

Last Updated 06/12/2018
Product Line Wolters Kluwer Legal & Regulatory U.S.
ISBN 9781454842606
SKU 10044874-7777
Product Line Wolters Kluwer Legal & Regulatory U.S.
SKU 000000000010048426
Table of Contents
  • 1. An Overview of Group Insurance
    • Group Health Insurance
    • The Uninsured
    • Group Insurance
    • Types of Insurance Professionals
    • Intermediaries
    • Blue Cross/Blue Shield Plans
  • 2. State and Federal Laws
    • Legal Factors Affecting Design
    • State Law
    • Federal Law
    • Pregnancy Discrimination Act
    • Family and Medical Leave Act
    • Americans with Disabilities Act
    • Taxation of Group Health Plans
    • Reservists' Benefits
  • 3. Health Care Reform
    • Overview
    • Small Employer Tax Credit
    • Special Programs
    • Grandfathered Plans
    • Dependent Coverage to Age 26
    • Patient's Bill of Rights
    • Preventive Services
    • Guaranteed Availability and Renewal
    • Exchanges
    • Transparency
    • Vouchers
    • Taxes and Fees
    • Penalties
    • Other Rules
  • 4. Eligibility
    • Employees
    • Dependents
  • 5. Types of Medical Plans
    • Traditional Plans
    • Managed Care
    • Health Maintenance Organizations
    • Adverse Selection
    • Legal Standards
    • Evaluating HMOs
    • Preferred Provider Organizations
    • POS
    • Managed Care Backlash
  • 6. Factors Influencing Plan Design
    • Strategies
    • Contributions
    • Covered Expenses
    • Essential Health Benefits
    • Restrictions on Coverage
    • Deductibles, Copayments, and Reimbursement
    • Cost Containment
    • Managed Competition
  • 7. Flexible Benefits
    • Tax Advantages
    • Cost Control
    • Types of Plans
    • Flexible Spending Accounts
    • Mid-Year Plan Changes
    • Flexible Benefit Options
    • Implementation
    • Health Care Reform Changes
    • Simple Cafeteria Plans
  • 8. Consumer-Driven Health Plans
    • Health Savings Accounts
    • Health Reimbursement Arrangements
    • Medical Savings Accounts
    • Consumer-Driven Dental Care
    • Defined Contribution Health Care
  • 9. Plan Implementation and Administration
    • Setting Up the Plan .
    • Reporting and Disclosure
    • Health Care Reform Reporting Requirements
    • Uniform Standards
    • Enrollment
    • Billing
    • Coverage, Renewal, and Changes
    • Termination of Coverage .
    • Computerized Administration .
    • Outsourcing
  • 10. Claim Administration
    • Claims
    • Health Care Reform Changes
    • Coordination of Benefits
    • Billing Codes
    • Third-Party Administrators
  • 11. Health Insurance Portability and Accountability Act
    • Portability
    • Electronic Data Interchange
    • Health Care Reform Changes
    • Privacy
    • Security
  • 12. COBRA
    • The Basics
    • Covered Employers
    • Covered Plans
    • General Requirements
    • Notification Requirements
    • Premiums
    • Election and Grace Periods
    • Qualified Beneficiaries
    • Retiree Medical Coverage
    • Miscellaneous
  • 13. Form 5500
    • Plan Years
    • Administration
    • Completing the Form
    • Electronic Filing
    • Summary Annual Report
  • 14. Nondiscrimination Rules
    • Accident and Health Plans
    • Cafeteria Plans
    • Voluntary Employees’Beneficiary Associations
    • Nondiscriminatory Classification
    • Nondiscrimination Rules for Archer MSAs
    • Comparability Rules for Health Savings Accounts (HSAs)
    • Controlled Group Rules
    • Tax-Exempt Organizations
    • Comparisons
  • 15. Plan Rating and Funding
    • Plan Funding
    • Fully Insured Plans
    • Health Care Reform
    • Alternatives to Fully Insured Plans
    • Deferred Premium Arrangements
    • Shared Funding Arrangements
    • Retrospective Premium Arrangements
    • Reserve Reduction Agreements
    • Minimum Premium Plans
    • Captives
  • 16. Self-Funding
    • Reasons for Self-Funding
    • Decision to Self-Fund
    • Administration
    • The Marketplace
    • Self-Funding and Legal Requirements
    • Stop-Loss Insurance
    • Voluntary Employees’ Beneficiary Associations
  • 17. Vendor Selection
    • Types of Vendors
    • Selection Process
    • Role of the Intermediary
    • Choosing Intermediaries
    • Choosing Other Specific Types of Vendors
  • 18. Managing Health Insurance Costs
    • Factors Affecting Costs
    • Health Care Data
    • Utilization Review and Case Management
    • Additional Cost-Management Strategies
    • Rationing Health Care
    • The Employer's Role
    • Review of Premium Increases
  • 19. Wellness Plans
    • Health Promotion and Wellness
    • Health Care Reform
    • Health and Productivity Management
  • 20. Pharmacy Benefit Management
    • The Basics
    • Pharmaceutical Pricing
    • Pharmacy Benefit Design
    • Cost Control
    • Coverage Disclosure Considerations
    • Cost Considerations
    • The Global Drug Market
    • Pharmacy Benefit Managers
    • Choosing a Pharmacy Benefit Manager
    • Ensuring Quality
    • Cost-Management Concepts
    • Utilization Management Concepts
    • Formularies
    • Prior Authorization Programs
    • Disease State Management
    • Quality Management/Oversight
  • 21. Retiree Health Benefits
    • Regulatory Issues
    • Eligibility and Plan Design
    • Determining and Allocating Costs
    • Retiree Medical Liabilities
    • Pre-Funding
    • Medicare Solutions to Retiree Challenges
    • Early Retiree Reinsurance Program
  • 22. Medicare
    • The Basics
    • Medicare Order of Benefit Determination
    • Medicare Cost Containment
    • Medigap
    • Medicare Advantage
    • Health Care Reform Changes
  • 23. Medicare Part D Benefit
    • Enrollment
    • Employer Incentives to Participate
    • Standard Benefit
    • Pharmacy Network Contracting
    • Formularies and Part D
    • Medication Therapy Management (MTM)
    • Skilled Nursing Facility (SNF)/Nursing Facility (NF) Impact
    • Quality Measures
    • Audit Issues
    • Coordination of Benefit (COB) Issues
  • 24. Quality Assurance
    • Quality Measures
    • Report Cards
    • The Joint Commission and HEDIS
    • Outcomes Measurement
    • Health Care Reform Changes
  • 25. Mental Health
    • Mental Health Benefits
    • Mental Health Parity and Addiction Equity Act
    • Controlling Costs
    • Substance Abuse
    • Managed Mental Health
    • Employee Assistance Programs
    • Outcome Measurements
    • Americans with Disabilities Act
  • 26. Dental, Vision, and Other Benefits
    • Dental Benefits
    • Vision Benefits
    • Hearing Benefits
    • Long-Term Care
    • CLASS Act
  • 27. Communication
    • Developing Communication Strategies
    • Benefit Statements
    • Periodic Benefit Reports
    • Interactive and Online Systems
    • Open Enrollments
  • APPENDIX A. Model COBRA General Notice
  • APPENDIX B. Notice of Unavailability of COBRA Continuation Coverage
  • APPENDIX C. Model COBRA Election Notice upon Occurrence of a Qualifying Event
  • APPENDIX D. Model Certificate of Creditable Coverage
  • APPENDIX E. Sample QMCSO Procedure
  • APPENDIX F. Model Beneficiary Notices of Part D Creditable Coverage Status

 

 

Volumes