Health & Welfare Plans Newsletter

October 17, 2016

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Employee Benefits Jobs

Defined Contribution Account Manager
Qualified Plan Administrators, Inc.
in GA

Senior Employee Benefits Manager
New York University
in NY

Plan Sponsor Compliance Specialist
Lincoln Financial Group
in IL, IN, Telecommute

Consultant / Team Leader (AFS)
Nova 401(k) Associates
in AZ, TX, Telecommute

Client Relationship Manager
Nova 401(k) Associates
in AZ, TX, Telecommute

Sr. Relationship Mgr - Retirement Plan Solutions
TD Ameritrade
in CO

ERISA Manager
Ascensus
in PA

Pension Administration Group COE Leader
Willis Towers Watson
in MA

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Webcasts and Conferences

Participant Experience in the New Fiduciary World
October 27, 2016 WEBCAST
Broadridge Financial Solutions, Inc.

ACA Reporting - The Second Time Around
November 17, 2016 WEBCAST
ABA Joint Committee on Employee Benefits [JCEB]

Affordable Care Act Update: What's New That You Need to Know?
November 17, 2016 in NY
Worldwide Employee Benefits Network [WEB] - New York Chapter

5th Annual Telehealth and Remote Patient Monitoring Summit
January 25, 2017 in GA
World Congress

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[Official Guidance]

Text of CMS FAQ on Off-Marketplace Enrollment Periods for Stand-Alone Dental Plans (PDF)
Unnumbered document; dated Oct. 14, 2016. "Are Exchange-certified Stand-alone Dental Plans offered Off-Exchange permitted to accept enrollments outside the Exchange enrollment periods? Yes. Nothing in CMS regulations prohibits Exchange-certified stand-alone dental plans (SADPs) offered off-Exchange from accepting enrollments outside the Exchange enrollment periods."
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

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Refusal to Pay Claims to Gain Negotiating Leverage Is Abuse of Discretion Under ERISA, District Court Says
"[T]he court found that Cigna's interpretation of its plan language was legally incorrect, and that the evidence demonstrated that refusing to reimburse the hospital was part of Cigna's plan for bringing the hospital in-network.... While payors may incentivize out-of-network providers to come in-network, this case illustrates that certain conduct -- such as refusing to pay a provider's claims without a solid legal justification -- may cross the line and subject payors to ERISA liability." [North Cypress Med. Ctr. Operating Co. Ltd. v. Cigna Healthcare, No. 09-2556 (S.D. Tex. Sept. 28, 2016)]
Reed Smith LLP

Employers Prepare for 2017 Drug Price Hikes
"[F]or active employees and retirees under age 65, prescription drug costs are projected to rise 11.6 percent in 2017 for active employees, up from 11.3 percent in 2016. The projected rise in specialty drug/biotech medications in 2017 continues to be exceptionally high 18.7 percent. While typically less than 1 percent of all medications are specialty drugs, survey respondents indicated that those drugs now account for 35 percent of total projected prescription drug cost increases for 2017[.]"
Society for Human Resource Management [SHRM]

Election Time and the Minnesota Voter Leave Law
"For many years, Minnesota law excused employees to go to the polls in the morning before they were to report to work or to leave early if necessary to arrive at the polls before they closed, but did not require that the employee be paid for the time spent voting. The current statute allows employees to be absent from work at any time on Election Day in order to cast their ballots, without a reduction in pay."
Ogletree Deakins

House Seeks to File Amicus Brief in Risk Corridor Case; CMS Details Open Enrollment Strategy
"In its proposed amicus brief, the House of Representatives maintains that the same arguments that were made in the other cases apply to and should have been made in Health Republic. It contends that the appropriations riders cut off any sources of additional funding to cover claims under the risk corridor program, and therefore Health Republic should be dismissed. It pointedly rejects the earlier assertion of HHS that full payment under the program is owing to the insurers."
Health Affairs

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AHIP Preparing to Fight GOP Attempts to Stop Insurer Payments
"On [Oct. 14], House Republicans filed an amicus brief to one of the lawsuits saying that insurance companies are not entitled to an 'Obamacare bailout.' While spending laws have prohibited HHS from paying out the additional money, the Republicans are referring to the administration's potential plans ... that it might settle with insurers through the Justice Department using a 'Judgment Fund.' "
Morning Consult

2017 Obamacare Marketplace Slowdown Expected
"After two years of quick enrollment gains, Obamacare marketplaces in 2017 likely will see a 'significant slowdown' in growth ... [ACA] marketplace enrollment for 2017 is forecast to be between 10.2 million and 11.6 million ... As of March 31, about 11.1 million consumers had paid premiums for ACA marketplace coverage for 2016, and [HHS] projected enrollment of about 10 million people by the end of this year."
Bloomberg BNA

[Opinion]

CMS Pilot Program for Judging Breadth of Narrow Networks
"When the problem is that insurers are limiting patients' choices in their health care, CMS decides that the solution should be to merely tweak the system with more transparency while keeping it intact. The solution needed is to eliminate the restrictive provider list, allowing patient access to the entire health care delivery system."
Physicians for a National Health Program [PNHP]

Press Releases

PWL Capital Inc. is Certified for Fiduciary Excellence
Centre for Fiduciary Excellence [CEFEX]

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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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