
Health Insurance Answer Book, Twelfth Edition
Internet
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 |
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Product Line | Wolters Kluwer Legal & Regulatory U.S. |
ISBN | 9781454842606 |
SKU | 10044874-7777 |
Product Line | Wolters Kluwer Legal & Regulatory U.S. |
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SKU | 000000000010048426 |
- 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