Health & Welfare Plans Newsletter

November 3, 2016

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Employee Benefits Jobs

Associate Consultant / Retirement Plan Conversion
Spectrum Pension Consultants, Inc.
in CA, HI, WA, Telecommute

Defined Contribution Plan Administrator
EJReynolds, Inc
in FL

Retirement Plan Service Specialist 4
Wells Fargo
in NC

Strategic Account Manager
Ascensus
in PA

Manager - Administration Services
PASI, LLC
in CT

Retirement Analyst
Chevron
in TX

401(k) Administrator
Pension Plan Services, Inc.
in MI

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[Official Guidance]

CMS Guidance on CSR Reconciliation for Benefit Year 2016 (PDF)
46 pages. "CMS is releasing this draft manual to all issuers offering a qualified health plan (QHP) through a health insurance Marketplace. The manual provides information on the process for reconciling the cost-sharing reduction component of the advance payments that QHP issuers have been paid to reflect the cost-sharing reductions amounts those issuers provided to eligible Marketplace enrollees. The manual also provides QHP issuers with general instructions on using the standard, simplified, and actuarial value methodologies ... for the purpose of determining the value of cost-sharing reduction amounts provided to eligible Marketplace enrollees, and describes the data elements issuers are required to submit when the annual cost-sharing reduction reconciliation process begins in April 2017."
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

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Health Plans: Finding Parity for Mental Health Benefits and Opioid Treatment
"[Recently-issued FAQs] offer guidance to group plans unsure of how to calculate quantitative treatment limitations. MHPAEA regulations state that the quantitative treatment limitations must apply to at least two-thirds of medical and surgical benefits in order to be applied to mental health and substance use disorder benefits. The calculation should be based on the dollar amount of all plan payments for medical and surgical benefits and plans can use any 'reasonable method' to determine that dollar amount."
Bloomberg BNA

Essential Health Benefits: Why Should Employers Care?
"With the list of potential benchmark plans now condensed, employers should ... [1] Review the current list of EHB benchmark plans chosen by the states for 2017 and the three FEHBP options. [2] Choose a plan to define EHB for purposes of the annual and lifetime limit prohibition that best aligns with the employer's health program.... [3] Review the employer health plan(s) to ensure any existing annual or lifetime dollar limits do not apply to the EHBs (as defined under the chosen benchmark plan).... [4] Review the employer health plans to ensure OOP limits apply to EHBs."
Xerox HR Services

Experimental and Investigational Treatments and Procedures Under ERISA Group Health Plans (PDF)
17 pages. "While most group health plans contain an exclusion for medical and investigational procedures, the scope and the pace at which medical procedures and treatments are tested in the 21st century makes this an extremely difficult standard to apply. There is no bright-line test, experts frequently disagree as to when the line has been crossed, and in some instances the stakes are literally life and death. This article discusses some potential pitfalls for plan administrators and offers suggestions on how to address this difficult aspect of group health care administration."
The Wagner Law Group, via Benefits Law Journal

The Sandbox Bully: Health Savings Accounts, Onsite Clinics, and Telemedicine
"Employers, particularly those employers that feel they are running out of room to further pare down medical plan design(s) or shift cost-sharing to employees, are increasingly looking toward alternatives like telemedicine and onsite clinics to help lower the cost of their group health plans.... For all of their advantages, health savings accounts (HSAs) do not easily co-exist with many other benefits. This article focuses on the HSA-compatibility issues employers face when implementing telemedicine and/or an onsite clinic in conjunction with a high deductible health plan (HDHP) with an HSA and potential solutions."
Haynes and Boone, LLP

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Did You Consider the COBRA Implications of Your Severance Arrangement?
"[T]wo examples ... will help illustrate the risk: [1] Under the employer's severance program, covered employees are entitled to six months of company-paid health premiums.... [2] Employer enters into a severance agreement with an employee, which provides for three months of paid 'garden' leave, after which employment is terminated. The agreement provides that during the leave period, the company will pay the health premiums. In both cases, the terms of the arrangement do not address COBRA. This leaves open the question of whether the applicable COBRA period begins at severance/leave commencement, or after."
Thompson Coburn

Lower Paid Workers Contribute More for Medical Care Benefits Than Higher Paid Workers
"About half of private industry workers participated in employer-provided medical plans in March 2016.... 84 percent were in plans that required them to contribute toward the cost of the premiums for single coverage; 92 percent were in plans that required them to contribute toward the cost of the premiums for family coverage. The average employee contribution was $126.68 per month for single coverage and $511.47 per month for family coverage. For workers with an average wage in the lowest 10 percent, the average employee contribution for single coverage was $143.60 per month."
U.S. Bureau of Labor Statistics [BLS]

Litigation Update: New Briefs in Risk Corridor Lawsuit, House v. Burwell
"In a newly filed brief ... [Blue Cross Blue Shield of North Carolina (BCBSNC)] argues that HHS' claim that payments owed to insurers are not payable in full until sometime after 2017, rather than every year, 'is not supported by the statutory text or purpose of the ACA.' In fact, the government has already paid BCBSNC a little more than $18 million of the $147 million it owes the insurer, the brief says. Further, it says the government's motion to dismiss 'engages in revisionist history' by relying on the claim that the risk corridor program can't pay out more than it collects, saying the program was not originally intended to be budget-neutral."
FierceHealthcare

Anthem Threatens Obamacare Retreat If Results Don't Improve
"Anthem expects to post a narrow profit margin next year in exchanges created under the ACA ... Profitability will improve thanks to plan changes and premium increases averaging more than 20 percent, but Anthem said it will take more than that to stabilize markets that have so far drawn about half the membership it was planning for. The company called for eliminating a tax on health insurers, as well as changes to regulations that govern how plans are sold and administered."
Bloomberg

[Opinion]

Obamacare Coverage 10 Percent Less Expensive Than Job-Based Benefits
"[C]omparing unsubsidized Obamacare premiums to actual employer-based premiums misses the fact that 85 percent of Obamacare beneficiaries receive tax credits subsidizing coverage while 100 percent of beneficiaries of employer-based plans pay premiums with pre-tax dollars, excluded from their household taxable income. These are two very different tax treatments."
National Center for Policy Analysis Health Policy Blog

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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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