Health Insurance Answer Book, Tenth Edition / Edition 10

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More About This Textbook

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?

Health Insurance Answer Book brings you up to date on legislative and regulatory developments and on industry changes in this area. Recent highlights include:

• Results from the latest surveys of plan design and plan costs
• Information on a flurry of new regulations under health care reform
• The latest information on compliance with reporting and disclosure requirements
• Discussion of compliance issues related to flexible benefit plans
• A completely rewritten chapter on communication
• Information on the latest trends in wellness programs
• And much more!

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Product Details

  • ISBN-13: 9780735591578
  • Publisher: Wolters Kluwer Law & Business
  • Publication date: 1/4/2011
  • Edition number: 10
  • Pages: 1234

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

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