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[Guidance Overview]
New DOL Enforcement Focus on Mental Health and Substance Use Disorder Parity (PDF)
9 pages. "While the DOL's view is not surprising, its description of the scope and level of detail required to monitor Part 7 compliance is troubling. Most plan sponsors traditionally rely heavily on health care providers and third party administrators to ensure operational compliance ... However, even plan sponsors that actively monitor ERISA Part 7 compliance are often unable to negotiate custom provisions in standard vendor agreements."
(Steptoe & Johnson LLP)
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Amicus Brief by Employer Organizations to Seventh Circuit Challenging EEOC Regulation of Wellness Program (PDF)
38 pages. "In this litigation and by regulation, EEOC is attempting to regulate -- with no authority to do so -- wellness programs that are part of employer-sponsored health benefit plans.... The plain language of the ADA contains an insurance safe harbor specifically exempting terms of health plans from the ADA's requirements. Wellness programs like the one in this case that are part of health plans clearly fall within this express safe harbor." [EEOC v. Flambeau, No. 16-1402 (on appeal to the 7th Cir.; filed June 2, 2016)]
(HR Policy Association, American Benefits Council, Chamber of Commerce of the U.S., and ERISA Industry Committee)
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Sorry, Did You Say 'Voluntary' Wellness Program?
"[U]nder the new rules, incentive maximums will be capped at 30% of the lowest cost self-only plan offered by an employer ... The incentive limit will be separately applied to employees and their spouses; so a couple could collectively be penalized 60% of the cost of self-only coverage.... This amounts to thousands of dollars for opting out of the program, yet it's still considered 'voluntary' under the rules."
(Frenkel Benefits)
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Looking Under the Hood of the Cadillac Tax
"The specific features of this tax on high-cost health plans -- notably, the inclusion of tax-favored savings vehicles such as health savings accounts (HSAs) in the formula for determining who is subject to the tax -- are designed primarily to maximize revenue and minimize coverage disruptions, not to reduce health spending. Thus, at least initially, these savings accounts, rather than enrollee cost-sharing or other plan features, are likely to be affected most by the tax as employers act to limit their HSA contributions. Because high earners are the ones benefiting most from tax-preferred accounts, the high-cost plan tax will probably be more progressive than prior analyses have suggested, while having only a modest impact on total health spending."
(The Commonwealth Fund)
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Transgender Health Benefits May Be Required Under New Rule
"As part of this ban on discrimination, blanket exclusions in group health plans for all care relating to gender dysphoria or gender transition will no longer be permitted. Rather, transgender surgery and other transgender health benefits must be provided on a nondiscriminatory basis."
(Miller Johnson)
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Nearly 80 Percent of Employees Research Medical Decisions While at Work (PDF)
"Seventy-two percent of those surveyed reported they had spent time researching a health issue and medical decision for themselves or a family member during the last year, and the average employee spent six hours of their workday on this research.... [O]ne in five people don't trust the information provided by their doctor, and 42 percent believe they've lacked the essential information they needed to make a medical decision in the past."
(Bryan, Pendleton, Swats & McAllister, LLC)
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70% of Employees Not Price Shopping for Health Care
"Despite growing industry and consumer awareness that medical procedure costs vary widely by location and provider, only 29% of health benefit plan sponsors offer a price comparison tool ... 42% of respondents said having a price comparison tool in their wellness program is 'very important,' and 48% said it would be 'nice to have.' "
(PLANSPONSOR)
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New Jersey Paid Sick Leave Bill Stalls Again
"New Jersey legislators have delayed a vote on the Paid Sick Leave Act to allow the Assembly and Senate a chance to settle their disputes over the bill's impact on small employers and its preemptive effect on municipal ordinances mandating paid sick leave.... Under the bill, private and public employers must provide their employees with one hour of paid sick time for every 30 hours worked."
(Jackson Lewis P.C.)
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UnitedHealthcare Will Stay on Just Three Exchanges
"Currently, United competes on the exchanges for 34 states, but is retreating due to large financial losses.... [A] United spokesman confirmed the insurer plans to compete again next year only on the exchanges in Nevada, New York and Virginia, meaning the company won't be back in 31 other states.... United's actions point to broader problems with the exchanges ... including financial losses for carriers, rising premiums for consumers and many potential subscribers opting out of coverage."
(StarTribune)
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BenefitsLink.com, Inc.
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Lois Baker, J.D., President
David Rhett Baker, J.D., Editor and Publisher
Holly Horton, Business Manager
BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2016 BenefitsLink.com, Inc. All materials
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