Health & Welfare Plans Newsletter

March 14, 2016

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[Official Guidance]

Text of ACA Implementation FAQs, Part 30: Summary of Benefits and Coverage
"The Departments intend that health plans and issuers that maintain an annual open enrollment period will be required to use the new SBC template and associated documents beginning on the first day of the first open enrollment period that begins on or after April 1, 2017 with respect to coverage for plan years (or, in the individual market, policy years) beginning on or after that date. For plans and issuers that do not use an annual open enrollment period, the new SBC template and associated documents would be required beginning on the first day of the first plan year (or, in the individual market, policy year) that begins on or after April 1, 2017." (Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]; U.S. Department of Health and Human Services [HHS]; U.S. Department of the Treasury)  


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[Official Guidance]

Text of DOL Extension of Comment Period on Proposed Regs for Establishing Paid Sick Leave for Federal Contractors
"This document extends the period for filing written comments until April 12, 2016 on the proposed rulemaking ... [which] was published in the Federal Register on February 25, 2016. The [DOL] is taking this action in order to provide interested parties additional time to submit comments." (U.S. Department of Labor [DOL])  

[Official Guidance]

Text of FEHB Letter to Carriers: Updated Expectations for Design and Operation of Health and Wellness Programs (PDF)
"This carrier letter consolidates OPM guidance on population health and wellness. OPM expects all FEHB health plans to sponsor programs that promote healthy lifestyles and help members modify health risks.... To improve wellness performance, we ask carriers to review their programs and ensure the following: [1] ... Carriers should increase the percentage of enrollees completing HRAs each year. Most adults can benefit from completing an HRA annually ... [2] ... [T]he majority of adults must be screened at least once every three years.... [3] ... The information from HRAs and biometric screenings should be used to initiate referrals to health coaching or other plan sponsored programs. Carriers should ensure that results of any laboratory testing performed during screenings are available to appropriate clinicians ... [4] ... Programs directed at diabetes prevention, obesity management, and reduction of cardiovascular risk may satisfy both preventive services and wellness requirements. Recognized programs are listed [online]. [5] ... [T]obacco use rates are declining among FEHB members. Help us continue this trend by reinforcing communication ... [6] Effective biometric screening will identify members at risk for developing hypertension ... [A]dherence to medications will reduce heart attack and stroke rates. (U.S. Office of Personnel Management [OPM])  

[Guidance Overview]

Will Your Sick Leave or PTO Policy Satisfy DOL's Paid Sick Leave Regs for Federal Contractors?
"Contractors affected by the proposed rule will have to find a way to satisfy the new PSL requirements without impeding compliance with divergent obligations under the Family and Medical Leave Act (FMLA) and various state and local laws. Contractors can elect to comply with the proposed rule either by adopting a new paid sick leave policy that mirrors the proposed rule or by amending an existing leave or paid time-off policy. Either way, contractors will have their work cut out for them. The proposed rule is detailed and includes many uncommon provisions[.]" (Ogletree Deakins)  

[Guidance Overview]

Agencies Propose Revisions to Summary of Benefits and Coverage Template and Uniform Glossary
"Changes to the Content of the SBC: [1] Revises SBC template to 5 pages from 8. [2] Streamlines the questions on page 1.... [3] Replaces the definitions at the top with a statement about copayments and coinsurance being after the deductible, if a deductible applies.... [4] Adds a reference to the website where participants can get more information about prescription drug coverage. [5] Condenses and revises the explanation of rights to continued coverage and adds two yes/no questions regarding minimum essential coverage and minimum value standards. [6] Adds a third example of an emergency room visit for a simple fracture." (Cheiron)  


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Why Healthcare Is a Prime Target for Hackers, and How to Treat the Problem
"The US Department of Health and Human Services Office for Civil Rights publishes information about data breaches that affect the records of at least 500 individuals. For the 2015 calendar year, the wall displays over 230 healthcare breaches, and that amounts to over 110 million individuals having their records stolen due to no fault of their own.... For their effort, attackers get financial, identification, and health information all nicely bundled together.... [Also,] criminals gravitate to the easiest pickings, and right now the healthcare industry is considered the lowest hanging fruit. As to why, well, that's complicated." (TechRepublic)  

Three Tricks for Getting the Most Out of Your HSA
"If you're considering using your HSA as an investment vehicle, here are three strategies to help get the most mileage out of this valuable account type. [1] Obtain a payroll deduction while also getting away from a lousy employer-provided HSA.... [2] Take a hybrid 'spend/invest' approach.... [3] Use your HSA to cover emergency non-healthcare costs later on." (Morningstar)  

Is Your On-Site Clinic Subject to HIPAA Privacy and Security Rules?
"[D]epending on the services provided by your on-site clinic and the method used for communicating standard transactions, your clinic may be subject to the HIPAA privacy and security rules as a covered health care provider. At a minimum, this means you need a Notice of Privacy Practices, HIPAA policies and procedures and can't share information from the clinic with the company unless an exception applies." (Graydon Head & Ritchey LLP)  

Telehealth Reimbursement Remains Low Despite Interest
"[T]here is an increasing interest in the expansion of these services and states are developing methods of facilitating telehealth-related reimbursements. Yet only 7 states have passed statutes mandating parity with reimbursement for non-telehealth services and claims to private insurers for these services remain low." (American Journal of Managed Care)  

The Cadillac Tax Will Hit the Middle Class Hardest
"In absolute dollars, tax subsidies were highest for families between the 80th and 95th percentiles of family income and lowest for the poorest 20%. However, as shares of income, subsidies were largest for the middle and fourth income quintiles and smallest for the wealthiest 0.5% of Americans.... The Cadillac Tax will disproportionately harm families with (2009) incomes between $38,550 and $100,000, while sparing the wealthy." (International Journal of Health Services)  

Health Insurance Marketplaces 2016 Open Enrollment Period: Final Enrollment Report (PDF)
48 pages. "This report provides data summarizing enrollment-related activity in the individual market Marketplaces during the 2016 Open Enrollment Period for all 50 states and the District of Columbia ... The report also includes detailed state-level data on the characteristics of these individuals -- including separate breakouts on new consumers and those who are reenrolling in coverage ... [F]or the 38 states that are using the HealthCare.gov eligibility and enrollment platform, the report includes: data on the distribution of plan selections by self-reported race/ethnicity, rural location, and household income; data on the number of reenrollees who actively reenrolled and/or changed plans, including average premium savings; and statistics that measure the impact of the advance premium tax credit and plan switching on net premium costs for these states." (Assistant Secretary for Planning and Evaluation [ASPE], U.S. Department of Health and Human Services [HHS])  

Plan Selections by Zip Code and County in the Health Insurance Marketplace: March 2016
"The dataset provides the total number of Qualified Health Plan selections by ZIP Code and county for the 38 states that use the HealthCare.gov platform, including the Federally-facilitated Marketplaces, State Partnership Marketplaces, and supported State-based Marketplaces, during the Marketplace's third Open Enrollment Period ... Data for ZIP Codes with 50 or fewer plan selections and data for counties with 1 to 10 plan selections were suppressed due to privacy concerns.... ZIP Codes without data account for only 2 percent of the total 9.63 million plan selections, and Counties without data account for less than 0.01 percent of the total 9.63 million plan selections." (Assistant Secretary for Planning and Evaluation [ASPE], U.S. Department of Health and Human Services [HHS])  

[Opinion]

This Company Got a 16% Health Insurance Increase: This Is Not Sustainable
"Only 30 days in advance of my April 1st renewal date I got an email informing me that my company's medical insurance rates are increasing 16%. For a $2000 deductible plan ... it now costs $20,736 per year for family health insurance coverage. For an employee making $40,000 per year this is 50% of this employee's payroll cost. If I asked this person to pay for 100% of the increase this would be equal to a pay-cut of 7.35%. This is not sustainable." (Joe Markland)  

Press Releases

National Retirement Planning Week 2016 Announced
Insured Retirement Institute [IRI]

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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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