Health & Welfare Plans Newsletter

February 2, 2017

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Sixth Circuit Finds Failure to Provide FMLA Notice Constitutes FMLA Interference
"When the employee provided the [fitness-for-duty] certification, the employer realized that the employee had become FMLA-eligible while on leave. In response, the employer returned the employee to his original position and paid him for the time between the provision of the certification and his reinstatement.... The Sixth Circuit determined that the employer did not follow FMLA requirements when it did not provide an FMLA designation notice to the employee to explain that his reinstatement would be contingent on providing the certification." [Casagrande v. OhioHealth Corp., No. 15-3292 (6th Cir. Dec. 20, 2016, unpub.)]
The Wagner Law Group

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Is Organ Donation Covered under FMLA?
"Although the FMLA does not specifically address voluntary live organ donation, the FMLA regulations do reference voluntary cosmetic surgery and indicate that cosmetic treatments (such as most treatments for acne or plastic surgery) are not serious health conditions qualifying for FMLA leave unless inpatient hospital care is required or complications develop.... [T]he same assumption likely can be made for voluntary organ donations -- if inpatient care will be needed to recover from the donation, then it would be covered by the FMLA."
HR Daily Advisor

Assessment of One Onsite Clinic Program (PDF)
10 presentation slides. "This paper presents the results achieved by [an] onsite clinic-based primary and preventive healthcare program for a population of 790 individuals who participated [in] the program for three consecutive years."
Revere Healthcare Solutions Inc.

Small Businesses Urge Congress to Deliver Relief from Obamacare
"The House Committee on Education and the Workforce ... held a hearing [on Feb. 1] to examine the failures and consequences of the 2010 health care law and to discuss patient-centered solutions toward better, more affordable health care.... Small businesses gave first-hand accounts of how Obamacare has increased costs, limited choices, and made it harder to provide health care coverage for employees."
Committee on Education and the Workforce, U.S. House of Representatives

Another Challenge to U.S. on Risk Corridor Payments
"Molina Healthcare has joined the long line of insurers suing the government for failure to honor its obligations under the [ACA's] 'risk corridor' program. According to Molina's 84-page complaint filed Jan. 23, the U.S. owes it a whopping $52.3 million.... Molina, like 15 other insurers, is suing the government for allegedly reneging on risk corridor commitments in two basic ways: [1] promising to pay the plans annually but then saying it would wait until 2017, after the three-year program ends, and [2] promising to compensate them fully for their losses but then saying that it would pay in a 'budget-neutral' manner."
Faegre Baker Daniels LLP

[Advert.]

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Healthcare Reform: Deja Vu All Over Again (PDF)
24 presentation slides. Topics: [1] Repeal/replace activities: Executive Order(s); reconciliation activity to date; [2]  Health Care Reform Proposals: Trump campaign proposals; Empowering Patients First (Rep. Tom Price, R-Ga.), Patients' Choice Act (Rep. Paul Ryan, R-Wisc., and others), other proposals; [3] Similarities/broad brush conclusions; [4] The 'Dirty Dozen of ACA' and how they may fare.
Alston & Bird LLP

Health Insurers Warn of Wider Defections from ACA Marketplaces for 2018
"Unless the government promises to continue subsidies and other features of the law for at least another year, some states probably will not have any insurers selling health plans to individuals buying coverage on their own for 2018, the witnesses warned at a [hearing by the U.S. Senate Committee on Education and the Workforce]."
The Washington Post; subscription may be required

Rep. Issa Introduces FEHB-Based ACA Replacement Plan
"[Rep. Darryl Issa's Access to Insurance for All Americans Act] would allow anyone to enroll in Federal Employee Health Benefit Program (FEHB) health plans. FEHB plans are available everywhere, offer generous benefits and broad networks, and are sold without health, age, or gender underwriting. Issa's plan would allow employers to subsidize coverage of their employees and states to offer Medicaid coverage through the FEHB."
Timothy Jost, in Health Affairs

Benefits in General

[Official Guidance]

ERISA Form 8955-SSA 2-D Barcode Standards, Plan Years 2009-2016 (PDF)
45 pages, Jan. 13, 2017, version 1.9. "The 2D barcode is intended to represent the information on the paper form. Barcodes for this form are generated from two sources: [1] The IRS Form 8955-SSA Fillable PDF produces a barcode after printing the form in Adobe. [2] The approved software vendors for Form 8955-SSA produce a barcode when printing their forms from their software package." [Contents include: General standard; Approval procedures; Duration of approvals; Barcode specifications; Rules; Form versions and printing notes; Field types; and Form 8955-SSA barcode layout.]
Social Security Administration [SSA]

Press Releases

DCIIA Membership Elects Executive Committee Leadership
Defined Contribution Institutional Investment Association [DCIIA]

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BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2017 BenefitsLink.com, Inc. All materials contained in this newsletter are protected by United States copyright law and may not be reproduced, distributed, transmitted, displayed, published or broadcast without the prior written permission of BenefitsLink.com, Inc., or in the case of third party materials, the owner of those materials. You may not alter or remove any trademark, copyright or other notices from copies of the content.

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