Health & Welfare Plans Newsletter

April 26, 2016

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Employee Benefits Jobs

Account Manager
National Retirement Services, Inc.
in NC

Senior Pension Benefits Analyst
Willis Towers Watson
in CO, MA, MI, PA, TX

Pension Consultant
Willis Towers Watson
in CO, MA, MI, PA, TX

Product Support Specialist
Newport Group
in FL

Internal Sales Consultant
Newport Group
in CA

Client Relationship Manager
Newport Group
in FL

Retirement Plan Analyst
PlanTech, LLP
in AL, Telecommute

Pension Administrator / Consultant
Boyce & Associates, Inc.
in AZ

Manager, Client Reporting
Newport Group
in NC

EM Client Executive
Transamerica
in KY, MN, OH, Telecommute

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Webcasts and Conferences

National Wellness Conference: Spotlight On Sustainability
June 27, 2016 in MN
(National Wellness Institute)

Getting It Right - Know Your Fiduciary Responsibilities
August 2, 2016 in AZ
(Employee Benefits Security Administration [EBSA], U.S. Department of Labor)

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Discussions


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[Guidance Overview]

New FAQs Cover ACA, Mental Health Parity Items
"[1] Disclosure of the calculation of out-of-network payments is now required ... [2] Clinical trial coverage clarifications ... [3] MOOPing up after reference-based pricing ... [4] Mental Health Parity and Addiction Equity analysis must be plan-by-plan ... [6] Playbook for authorized representatives requesting information about MHPAEA coverage." (Benefits Bryan Cave)  


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Not Just Vermont: Supreme Court Decision Preempts Claim Database Laws in 18 States
"Eighteen states have [all-payer claims databases (APCDs)], which collect claims information, eligibility and provider files, and other health-related data from health claim payers. Justice Kennedy's opinion clarifies that the federal government has the authority to require data from ERISA-covered self-insured group health plans. The ruling's scope makes it unlikely that any state can enforce its APCD law for ERISA-covered self-insured health plans." [Gobeille v. Liberty Mutual Ins. Co., No. 14-181 (U.S. Mar. 1, 2016)] (Willis Towers Watson)  

New York Insurers to Change Coverage of Hepatitis C Drugs
"Seven health-insurance companies in New York will change their criteria for covering costly drugs that cure chronic hepatitis C under the terms of agreements with the office of State Attorney General Eric Schneiderman. The agreements ... require the insurers to cover hepatitis C medications for nearly all patients who have commercial insurance plans in the state.... [An] investigation showed a wide discrepancy in how companies cover these drugs and found some insurers largely covered only patients with advanced stages of the disease, the attorney general's office said. Five of the insurers denied from 30% to 70% of claims[.]" (The Wall Street Journal; subscription may be required)  

One Employer Sees 129% ROI on Tuition Reimbursement Program for Employees
"[T]here is a measurable financial benefit from tuition assistance. For one company, Cigna, that benefit was at least 129% between 2012 and 2014 -- that is, for each dollar invested, the insurer got that dollar back and saved a further $1.29 on talent management costs. About 60% of employers offer such a program[.]" (CFO)  

About That Cadillac Tax
"There are two key practical issues with the tax: the indexing problem and the adaptation question. In [the authors'] opinion, these are serious enough issues to warrant continued caution before implementing the Cadillac tax." (Health Affairs)  


[Advert.]

Employer's Guide to Health Care Reform, 2016 Edition

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UnitedHealthcare's Departure from Marketplaces Could Impact Consumers' Costs, Access
"The company's departure could be felt most acutely in several counties in Florida, Oklahoma, Kansas, North Carolina, Alabama and Tennessee that could be left with only one insurer[.]" (Kaiser Health News)  

[Opinion]

Obamacare Disaster Will Be Obama's Enduring Domestic Legacy
"According to a 2014 McKinsey survey, about three-quarters of those in the exchanges were previously insured on commercial plans, either through their employers or the individual market. They were doing fine without taxpayer-subsidized insurance but were pushed into Obamacare. They now face rising premiums and smaller provider networks -- and as commercial insurers flee, they will increasingly be stuck in horrible, Medicaid-style plans. This is not what the president promised when he sold Obamacare to the American people." (The Washington Post; subscription may be required)  

[Opinion]

The Disingenuous Obama Administration's Report That Claims Obamacare's Average Premiums Rose by Only 8% in 2015
"A more truthful analysis of what really happened in 2016 would have looked at what those 43% of returning consumers gave up to keep their average rate increase at only 8%. How many of these folks ended up with much worse plans in order to keep their premiums affordable? ... When we start hearing about the big increases the administration will just roll this report out once again and make the point that the latest 10% or 20% or 30% rate increases being reported really aren't 10% or 20% or 30% rate increases -- after all those 2016 rate increases that were supposed to be so huge only averaged 8%!" (Bob Laszewski's Health Care Policy and Marketplace Review)  

Benefits in General

In the Ninth Circuit, a New Burden of Proof for Employers in Handling of Benefit Claims
"In a decision the dissent characterizes as 'off the rails,' a three-judge panel of the Ninth Circuit has ruled that where a benefits claimant makes a prima facie case of entitlement to retirement benefits but lacks access to the corporate information needed to substantiate the claim, the burden shifts to the defendant-employer to produce this information[.]" [Estate of Barton v. ADT Security Serv. Pension Plan, No. 13-56379 (9th Cir. Apr. 21, 2016)] (Practical Law Company)  

Better Pay and Benefits Loom Large in Job Satisfaction
"Sixty percent of employees rated benefits as a very important contributor to job satisfaction, keeping benefits in the No. 3 position. But just over two-thirds (68 percent) of employees indicated that they were satisfied with their benefits." (Society for Human Resource Management [SHRM])  

The Retirement Cost Variable You May Be Overlooking
"[M]ore than half (52%) of Americans turning 65 will need some form of long-term care services in their lifetime, care that typically begins in the home. Data shows the national average for a home health aide in 2015 increased 1.7% over 2014 ... [T]hat could add up to $46,000 per year based on 40 hours of care per week.... The national average fee for a registered nurse is $83 per hour, which may cost more than $172,000 annually[.]" (National Association of Plan Advisors [NAPA])  

[Opinion]

Comments to FASB on Improving the Presentation of Net Periodic Pension Cost and Net Periodic Postretirement Benefit Cost (Topic 715) and Changes to the Disclosure Requirements for DB Plans (Subtopic 715-20)
Links to the text of comment letters submitted to FASB by 27 firms, including Willis Towers Watson, AT&T, CNA Financial Corporation, BB&T Corporation and FedEx Corporation. (Financial Accounting Standards Board [FASB])  

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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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