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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.)
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[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)
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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)
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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)
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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)
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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)
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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)
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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)
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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])
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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)
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[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)
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Benefits in General; Executive Compensation
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[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)
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