Health & Welfare Plans Newsletter

January 8, 2016

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Actuarial Assistant
Actuarial/Consulting firm in Westchester County, NY
in NY

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San Diego Pension Consultants
in CA

Defined Benefit Intermediate Project Manager
Transamerica
in MA

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Webcasts and Conferences

Government Reorganizations and Priorities for 2016
January 19, 2016 in CA
(Western Pension & Benefits Council - San Diego Chapter)

Health & Welfare Plans Regulatory and Legislative Update
January 25, 2016 WEBCAST
(ABA Joint Committee on Employee Benefits [JCEB])

ASOPs Updates
February 10, 2016 WEBCAST
(Conference of Consulting Actuaries)

Employer Level SIMPLE Plans
February 11, 2016 WEBCAST
(Ascensus)

Fundamentals 03: Compensation and HCEs 2016
February 18, 2016 WEBCAST
(SunGard Relius)

457(b) Plans for 401(k) Practitioners 2016
February 23, 2016 WEBCAST
(SunGard Relius)

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Discussions


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Federal Court Allows Self-Insured Health Plan's ERISA Lawsuit Against Cigna
"Federal judge allows ILWU-PMA, a self-insured health plan, to move forward in lawsuit against Cigna and Carewise for allegedly engaging in 'prohibited transactions' and 'self-dealing' by entering into 'auto-discount agreements with providers for which it received a portion of the amount discounted'.... This lawsuit ... comes on the heels of another recent lawsuit against a different Cigna administered self-insured ERISA plan client ... for alleged ERISA plan assets embezzlement, deceptively concealed through 'fake PPO (CO) discounts' and Cigna's 'fee forgiveness protocol scam.' " (AVYM Healthcare Revenue Consultants)  


[Advert.]

You are invited to Private Exchange FORUM Dallas Feb 23-24, 2016

Sponsored by Institute for Healthcare Consumerism [IHC]

Join us in Dallas Feb. 23-24 at Private Exchange FORUM, the leading event on private exchanges! Learn next steps and best practices in health care consumerism and plan design, as well as ACA compliance and reporting issues for 2016 and beyond!



Another Judge Puts the Brakes on EEOC Wellness Plan Overreach
"Judge Barbara Crabb [of the Western District of Wisconsin] summarily rejected the EEOC's reliance on Section 12112(d)(4)(A) [which] prohibits disability-related medical examinations or inquiries that are not job related and consistent with business necessity. The judge reasoned that any EEOC reliance on [that section] is trumped by the ADA benefit plan safe harbor ... as long as the wellness provisions are terms in an employer health plan, and are used to help the employer administer and underwrite insurance risks. The judge said that the safe harbor may not apply to protect wellness programs that are not part of a plan[.]" [EEOC v. Flambeau, Inc., No. 14-cv-638 (W.D. Wis. Dec. 30, 2015)] (Seyfarth Shaw LLP)  

Does Targeting Higher Health Risk Employees, or Increasing Intervention Intensity, Yield Savings in a Workplace Wellness Program?
"The program targeting higher risk employees did not yield cost savings. Employees participating in five or more sessions aimed at encouraging more healthful living had about $20 lower per member per month costs relative to matched comparisons ... [These] results add to the growing evidence base that workplace wellness programs aimed at primary prevention do not reduce health care cost, with the exception of those employees who choose to participate more actively." (RAND Corporation)  

Telemedicine's Price Tag Depends on Vendor and Services
"When picking the right program for your organization, here are some questions to consider: What's the best way to offer telemedicine to your workforce? ... Which approach best meshes with your other health benefits? ... What services are required by your employees? ... Do you need to make telemedicine available in my workplace? ... How will you market telemedicine services to employees and family members who are on your health plan?" (The Alliance)  

Four Startups Helping Companies Successfully Implement Parental Leave
"Generous leave policies on paper don't always translate into parental leave being encouraged by the culture of a company, and the US is still far behind the rest of the world in terms of leave policies. There are several ways that employers can help ensure that their employees really do take the leave they're offered. And now, there are a few new companies that work with organizations directly to make sure the process goes well." (TechRepublic)  

A Skimpy Risk Analysis Is Risky Business for HIPAA Covered Entities and Business Associates
"A variety of tools can assist covered entities and business associates in anticipating, protecting against, and responding to privacy and security threats, and preparing for the anticipated second round of OCR HIPAA compliance audits. One of the sharpest of these tools is the Security Rule risk analysis." (Ice Miller LLP)  

UnitedHealth Says Rates for Its New York Plans Too Low in Light of CO-OP Collapse
"UnitedHealth, the largest U.S. health insurer, said its rates for plans offered under the Affordable Care Act in New York may be too low because of the failure of Health Republic ... The CO-OP's closure may lead to shortfalls in risk-adjustment payments designed to stabilize the markets created under the ACA, the report said." (FierceHealthPayer)  

Use of the Annual Appropriations Process to Block Implementation of the ACA (FY 2011-2016) (PDF)
21 pages. "This report summarizes the ACA-related language added to annual appropriations legislation by congressional appropriators since the ACA was signed into law.... [A] brief overview of the ACA's core provisions and its impact on federal spending is provided as context[.]" [Report No. R44100, dated Jan. 5, 2016.] (Congressional Research Service [CRS])  

[Opinion]

Making the Price Right (PDF)
"[M]aybe we just have to come to grips with the permanently pivotal role the provider is going to play, not only in setting prices but in effectively deciding whether, what and where treatment is delivered.... Being judicious health care consumers is not easy, and the NEBR and McKinsey studies reinforce the fact that providers are the key players in the price/cost nexus ... We aren't about to get in between the patient/doctor conversation, but we can educate the former and influence who is the latter." (Chelko Consulting Group)  

Benefits in General; Executive Compensation

[Guidance Overview]

DOL Updating Employer Disability Benefit Claims and Appeals
"The changes are intended to better align the claims and appeals processes with the requirements for internal claims and appeals for group health plans. The updated regulations will also apply to pension plans that provide disability benefits. The DOL is revising the regulations 'because of the volume and constancy of litigation in this area, and in light of advancements in claim processing technology.' " (Towers Watson)  

Press Releases

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BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2016 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 that content. You may not alter or remove any trademark, copyright or other notice from copies of the content.

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