Health & Welfare Plans Newsletter

October 19, 2015

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Webcasts and Conferences

457 Plans in the Public Sector: History, Evolution and Opportunities
RECORDED
(ASPPA [American Society of Pension Professionals & Actuaries])

Forfeiture Stories for a Late Night Campfire
November 14, 2015 WEBCAST
(ASPPA [American Society of Pension Professionals & Actuaries])

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[Guidance Overview]

Dancing with the Devil: Balancing FMLA and ADA Obligations
"When an employee qualifies for FMLA leave, the employer might also have obligations to the employee under the Americans with Disabilities Act ... The Wisconsin employer also might have obligations under the Wisconsin Family and Medical Leave Act, the Wisconsin Fair Employment Act, the Workers' Compensation Act, short-term and long-term disability policies, and any rights contained in a collective bargaining agreement. This is where the dance begins." (von Briesen & Roper, s.c.)  


[Advert.]

Telehealth & Remote Patient Monitoring Summit – Jan 27-28, 2016 – Atlanta

Sponsored by World Congress

Incorporating Telehealth and Remote Patient Monitoring practices has been shown to increase access to care, improve outcomes, and decrease health delivery costs. Take $200 off registration -- promo code BLINK2 (not valid on Webcast or Government Rate).



[Guidance Overview]

Pittsburgh Paid Sick Days Ordinance: Notices Published, January Effective Date Set
"[E]mployees accrue one hour of paid sick time for every 35 hours they work (including overtime hours) in Pittsburgh. Employees of employers with 15 or more employees can accrue up to 40 hours of paid sick time per year. Employees of employers with fewer than 15 employees can accrue up to 24 hours of paid sick time per year.... [E]mployees will begin accruing paid sick time on January 11, 2016, but employees are not entitled to take paid sick time until 90 days later, or April 10, 2016." (Littler)  

Medical Providers: How Not to State an ERISA Claim
"First, for a medical provider to state a claim under ERISA, it must have a valid assignment of benefits from the patient.... Second, to assert a claim for benefits under ERISA, that claim must be lodged against an ERISA plan.... Third, to file an ERISA claim for benefits in court, a provider with a valid assignment of benefits must first have exhausted its administrative remedies under the ERISA plan." [Pennsylvania Chiropractic Assoc. v. Independence Hospital Indemnity Plan, Inc., Nos. 14-2322, 14-3174 and 15-1274 (7th Cir. Oct. 1, 2015)] (Arent Fox via Lexology)  

Seventh Circuit: ERISA Claims Procedures Do Not Apply to Contractual Payment Dispute Between Network Providers and Insurer
"Reversing two trial court decisions, the Seventh Circuit has held that ERISA claims and appeals procedures do not apply to payment disputes between an insurer and its network providers, where there is no assignment of benefits." [Pennsylvania Chiropractic Assoc. v. Independence Hospital Indemnity Plan, Inc., Nos. 14-2322, 14-3174 and 15-1274 (7th Cir. Oct. 1, 2015)] (Thomson Reuters / EBIA)  

Best Practices: Managing Risk in Corporate VEBA and SERP Plans (PDF)
"OPEB plans deserve the same strategic review from an asset allocation perspective as their more traditional brethren. Thus, an evaluation of funded OPEB plans may be warranted to gauge whether the risk and return of the current portfolio is still aligned with the plan's needs and objectives. This paper discusses [a] framework for helping plan sponsors assess and enhance allocation strategy." (NEPC)  

IRS Increases PCOR Fees; HHS Issues 2015 Reinsurance Contributions Form and Announces Payment Due Dates
"For insured plans, the insurer is responsible for paying PCOR fees and reinsurance contributions. For self-insured plans, PCOR fees are imposed on the plan sponsor and generally cannot be paid from ERISA plan assets, while reinsurance contributions are imposed on the plan itself and may be paid from plan assets (if otherwise permitted)." (Thomson Reuters / EBIA)  

No Ready-Made Rx for Rising Drug Costs
"Prescription drugs account for about 10 percent of all health care spending. Two ideas for curbing that spending surface every time a price spike renews interest in drug costs: Letting consumers buy products from other countries with lower prices set by government controls, and allowing Medicare administrators to negotiate drug prices, from which they are currently barred.... [W]hat else is being tried to combat rising prices or at least bring some relief to consumers? [1] Disclose drug development costs ... [2] Cap consumer copayments ... [3] Pay up if the product delivers." (Kaiser Health News)  

Small Steps Can Create Wellness Program Success
"After giving employers pedometers, Blue Cross and Blue Shield of Tennessee found it doesn't take great strides to cut costs and improve employees' health." (PLANSPONSOR)  

Employers, Insurers Reward Consumers Who SHOP for Lower Healthcare Prices
"As healthcare costs continue to rise, both insurers and employers are turning to initiatives that reward consumers for shopping for the best prices on healthcare procedures and services." (FierceHealthPayer)  

More Health CO-OPs Face Collapse
"Health cooperatives are collapsing at such a rapid clip that some co-ops and small insurers are forming a coalition to consider legal action to try to change health-law provisions they blame for their financial distress.... The coalition wants changes to a federal formula known as risk adjustment, which takes money from plans with healthier and younger enrollees and gives it to plans with older and sicker customers to spread out financial pressures on insurers." (The Wall Street Journal; subscription may be required)  

More CO-OPs Likely to Cease Operations by Month's-End
"There are likely to be up to three more CO-OP closures before Nov. 1, says Peter Beilenson, founder and CEO of Evergreen Health, a Baltimore-based CO-OP. The closures are stacking up now because those CO-OPs that are closing will not be allowed to place product on the Affordable Care Act's exchanges, which open Nov. 1, Beilenson says." (Employee Benefit News)  

Hilton Announces GED Benefit For Employees
"The benefit provides one-on-one advising and test preparation support free of charge to Team Members, and it will also cover the cost of taking the GED tests. The GED Assistance program is available to all full-time U.S. Team Members at owned and managed hotels and corporate offices with at least six months of service." (HR Policy Association)  

Potential Impact of No Social Security COLA on Medicare Part B Premiums in 2016 (PDF)
26 pages. "[T]hose held harmless in 2016 who pay a late-enrollment penalty may still see reduced Social Security benefits as a result of the increased surcharges. The substantial majority of those not held harmless are low-income beneficiaries whose Part B premiums are paid by the federal-state Medicaid program. As a result, most of the cost of the increase in Part B premiums in 2016 would be paid by Medicaid." [Report no. R44224, dated Oct. 13, 2015.] (Congressional Research Service [CRS])  

Pressure Mounting on Congress to Stop Medicare Part B Spike
"Bills have been introduced in both the House and Senate to freeze 2016 Part B premiums at their current levels.... Freezing the premiums could cost well over $7 billion, according to a Congressional Budget Office estimate. Thus far, no pay-fors have been publicly discussed." (Bloomberg BNA)  

[Opinion]

To Reduce the Cost of Drugs, Look to Europe
"Germany, Spain, Italy and a half dozen other countries have pushed drug prices lower with a system called reference pricing. It has led to drug price decreases and significant savings in the Canadian province of British Columbia as well as in Germany, Italy, Norway, Spain and Sweden. A study published in the American Journal of Managed Care found that price reductions ranged from 7 percent to 24 percent." (Austin Frakt, in The New York Times; subscription may be required)  

Benefits in General; Executive Compensation

[Opinion]

AARP Letter to Congress Urging Medicare and Social Security COLA Fix
"If the COLA was based on a measure which more accurately reflected the living expenses of seniors, there would have been a COLA for 2016. Thus, premiums would be $120.70 and the deductible would be about $169. These are still significant increases, but much more manageable increases for seniors. AARP urges Congress to reduce and mitigate the impact of the sudden, sharp increases in the Part B premium and deductible as soon as possible." (AARP)  

Press Releases

ASPPA Welcomes Joseph Nichols as 48th President
ASPPA [American Society of Pension Professionals & Actuaries]

ASPPA Bestows 2015 Industry Awards
ASPPA [American Society of Pension Professionals & Actuaries]

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