Health & Welfare Plans Newsletter

February 5, 2016

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Webcasts and Conferences

Documenting Hardships Distributions and Participant Loans
RECORDED
(FIS Relius Education)

Service Contracts for Flexible Benefit Plans - Contracting Strategies
February 10, 2016 WEBCAST
(ECFC [Employers Council on Flexible Compensation])

New Bermuda Triangle: Navigating the Treacherous Waters of FMLA, Disability and Other Overlapping Leaves of Absence
February 10, 2016 in WV
(Littler Mendelson)

New Comparability Plans: The Potential Detrimental Impact of IRS-Proposed Regulations
February 22, 2016 WEBCAST
(ASPPA [American Society of Pension Professionals & Actuaries])

What’s in Store for FSAs, HSAs, HRAs and Flex under the Leading Health Care Proposals?
March 9, 2016 WEBCAST
(ECFC [Employers Council on Flexible Compensation])

Telemedicine - Fad or the Future of Healthcare?
March 17, 2016 WEBCAST
(ABA Joint Committee on Employee Benefits [JCEB])

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Discussions


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[Guidance Overview]

IRS Notice 2015-87 Provides Much-Needed Guidance for Account-Based Plans and ACA Employer Shared Responsibility Requirement
"The IRS says that the employer must report each individual whose medical expenses are reimbursable as having received minimum essential coverage under Section 6055 (i.e., for 1095 reporting). In some cases, an employer might not know whose expenses are reimbursable under the HRA if the employee has never received group health plan coverage through the employer and/or the employee never filed a claim for that dependent's expenses." (Alston & Bird LLP)  


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[Guidance Overview]

HHS Provides Guidance on Individuals' HIPAA Right to Access PHI
"Covered entities may require individuals to request access in writing and may offer electronic means for submitting requests, but they cannot require individuals to come to a physical office, use a web portal or mail a request. Covered entities may prescribe a particular form to be used for requests so long as it does not create a barrier or unreasonably delay access.... In general, covered entities must provide access to requested PHI within 30 calendar days following the receipt of a valid request." (The Wagner Law Group)  

Twenty Major Companies Form New Alliance to Target Healthcare Costs
"The newly formed alliance of companies, which cover about four million people among them, plan to share information about members' employee health spending and outcomes, with an eye toward using findings to change how they contract for care. Ultimately, some members say, they could even form a purchasing cooperative to negotiate for lower prices, or try to change their relationships with insurance administrators and drug-benefit managers." (The Wall Street Journal; subscription may be required)  

District Court Decision Highlights Importance of Carefully-Drafted Provider Assignment Clauses
"While the assignment conferred the Laboratories the right to collect benefits stemming from a 'collateral source,' the 'core focus' of the assignment was on the assignee's ability to recover benefits 'owed under any policy of insurance' and to pursue any rights to collect from the insurance company if for any reason the 'insurance company fails to make payments due.' Because a self-funded plan is not a form of insurance, the Court granted Cigna's motion to dismiss with respect to those claims. [This] decision is the latest in a number of cases in which a healthcare provider's ability to bring ERISA claims against insurers has turned on the language of the assignment, further underscoring the importance of careful drafting of those provisions." [BioHealth Medical Laboratory, Inc. et al. v. Conn. Gen. Life Ins. Co., No. 1:15-cv-23075 (S.D. Fla. Feb. 1, 2016)] (K&L Gates LLP)  

Employers Focus on BMI as Health Indicator, But Should They?
"Employers are pushing workers to get in shape and become more fit through workplace wellness programs. But if employers use body mass index as a yardstick for health, then that could unfairly penalize millions of Americans ... Out of a national database of more than 40,000 people, about 70 percent of people with normal weight BMIs were in the healthy range for all the other measures. So were 47 percent of people with an overweight BMI, 30 percent of those considered obese, and 16 percent of those labeled extremely obese." (MPRnews)  

Employers: Be Sure Your FMLA Policy Defines the 12-Month Period for Calculating Leave
"[An] otherwise eligible employee is entitled to 12 weeks of FMLA leave in a 12-month period. Notably, this '12-month period' is defined by the employer. What happens when an employer fails to disclose the 12-month period in its FMLA policy? ... Finding that [one employer] did not inform employees of what it was using as the 12-month FMLA period, [a federal district court] determined that the 'most beneficial' outcome should be used ... effectively earning [the employee] back two weeks of FMLA leave that he could have used in this instance." [Caggiano v. Illinois Dept. of Corrections, No. 14-C-3378 (N.D. Ill. Jan. 29, 2016)] (FMLA Insights)  

Lawmakers Introduce Medicare Telehealth Expansion Bill
"The legislation (S. 2484) would create a program that would waive for participating providers Medicare's requirement that telehealth services occur at a qualified site and other restrictions. The 'bridge program' would require these providers to submit annual reports to the Department of Health and Human Services on how their expanded use of telehealth and other technologies affected their bottom lines. These reports would be used to prove that telehealth technologies could reduce Medicare spending under the Merit-Based Incentive Payment System (MIPS)." (Bloomberg BNA)  

NCPA, IPA File Brief in Federal Appeals Court in PBMs' Case Against Iowa Drug Pricing Transparency Law
"The amicus curiae brief submitted by NCPA and IPA supports the lower court's decision and puts forth compelling legal reasons why Iowa's law is not preempted by ERISA or is unconstitutional under the so-called dormant Commerce Clause of the Constitution as PCMA has alleged. We hope the Eighth Circuit rejects PCMA's desperate attempt to invalidate the legality of the drug price transparency law." (National Community Pharmacists Association [NCPA])  

The 2016 Open Enrollment Tally: 12.7 Million Selected Plans, 1 Million More Than 2015
"The numbers from 2016 and 2015 are not truly comparable, however. The 12.7 million 2016 enrollees are net of plan cancellations; the 2015 numbers were not. In 2015, the total of 11.7 million plan selections shrank to 10.2 million effectuated enrollments. For 2016, the final 12.7 million net plan selections should be much closer to the final effectuated enrollment number." (Health Affairs)  

Benefits in General; Executive Compensation

Text of all Comment Letters on DOL Proposed Regs for Disability Benefit Claims Procedures
143 comment letters; comment period closed Jan. 19, 2016. "Many comment letters were submitted with medical or personal health information. To preserve the substance of the comment letters, the Department did not redact the medical or personal health information, but instead removed personally identifiable information (such as name, address and other contact information) from these letters to protect the privacy of commenters and other named individuals." (Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL])  

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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