Expert guidance on today’s health insurance marketplace! Health Insurance Answer Book, Tenth Edition by John C. Garner List Price: $355.00   Eligible for Free Standard Shipping on U.S. Prepaid Orders Imprint: Aspen Publishers ISBN: 9780735591578 Format: Hardcover Publication Cycle: Updated annually Last Updated: 11/20/2012 Available: Item ships in 3-5 Business Days

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! View the Highlights for this title. 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 Benefits Law Journal Davis E Morse For over 20 years, the most respected and accomplished employee benefits professionals have shared their expertise, as well as formulas for success and cautionary tales, exclusively in the pages of Benefits Law Journal . Each quarterly issue offers in-depth analysis of new legislation, regulat more... Add to cart   |  Price: $545.00  |  PIN: 9900038000  |  Format: Paperback  Imprint: Aspen Publishers  Multistate Guide to Benefits Law, 2013 Edition John F. Buckley The 2013 Multistate Guide to Benefits Law is the single, easy-to-use resource that is absolutely essential for staying in compliance with the increasingly complex regulatory framework of state benefits law. Only the 2013 Multistate Guide to Benefits Law's unique chart format enables you to more... Add to cart   |  Price: $399.00  |  ISBN: 9781454810469  |  Format: Paperback  Imprint: Aspen Publishers  Social Security and Medicare Answer Book, Fourth Edition David A. Pratt Social Security and Medicare Answer Book provides the specific guidance you need so you can ensure your clients receive maximum benefit under the law. Get answers to vital questions such as: Does the health care reform legislation change the benefits under Part B? How has the Social Security more... Add to cart   |  Price: $355.00  |  ISBN: 9780735591462  |  Format: Hardcover  Imprint: Aspen Publishers  Flexible Benefits Answer Book, Sixth Edition Ashley Gillihan Flexible Benefits Answer Book includes detailed coverage of today's most important topics and issues, including: Health Care Reform Health Flexible Spending Accounts Health Reimbursement Arrangements Health Savings Accounts Adoption Assistance Plans Transportation Reimbursement Plans HI more... Add to cart   |  Price: $355.00  |  ISBN: 9780735582002  |  Format: Hardcover  Imprint: Aspen Publishers  Employee Benefit Plan Review Steven A. Meyerowitz Employee Benefit Plan Review is a monthly journal designed to alert employee benefits professionals to developments and trends in the field. It covers the entire spectrum of benefit plans: Retirement plans 401(k) plans Health and disability plans International benefits Work and family init more... Add to cart   |  Price: $359.00  |  PIN: SS00136808  |  Format: Journal  Imprint: Aspen Publishers  U.S Master Employee Benefits Guide, 2013 Edition Lauren Bikoff, Kathleen Kennedy-Luczak, Melanie King, Linda Panszczyk, Elizabeth Pope, Carol Potaczek, Tulay Turan The 2013 U.S. Master Employee Benefits Guide is the ideal reference for HR personnel, benefits professionals, benefits attorneys, payroll managers, or anyone involved in the area of employee health and welfare benefits. This handy, authoritative book discusses pertinent federal tax and employme more... Add to cart   |  Price: $109.95  |  ISBN: 9780808034179  |  Format: Paperback  Imprint: Aspen Publishers