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November 14, 2016 logo logo
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[Guidance Overview]

Unpacking the 2018 Draft Letter to Federally Facilitated Marketplace Issuers
"The draft 2018 payment rule ... is shorter than the payment rules of previous years, and the 2018 draft letter resembles very closely the 2017 letter. Only a few sections of the letter -- notably those that deal with the SHOP exchange, network adequacy, and the SBM-FPs -- contain material that is significantly different from the 2017 letter. These sections closely track changes in the 2018 proposed payment rule."
Timothy Jost, in Health Affairs


Preconference Workshop Announced!

Sponsored by Health Benefits Conference & Expo [HBCE]

From new strategies in population health management to cost-containment solutions and ACA updates, HBCE will provide the in-depth information you need to keep your benefit plans compliant and your employees engaged. Want to enhance your learning? Register today!

Health Benefits: Two (Or More) Plans Are Better Than One
"Your new employee is 26 years old. He's rarely sick ... His biggest health expense is his refrigerator full of grape Mountain Dew Kickstarts. Then, there's your vice president. She's 55 and takes insulin for diabetes, just quit smoking, and has a husband and kids who rely on her insurance.... Obviously, these two have different health insurance needs. But many small and mid-sized employers would be challenged to offer more than one medical plan. In fact, about half of employers with 50 to 499 employees only offer one plan. How can they offer health benefits tailored to employees like these two, plus everyone in between?"

Incentives Tied to Wellness Data Provoke Backlash
"An increasing amount of health information has been digitized, aggregated into various demographic categories and then analyzed in an attempt to lower health care costs. In the aggregate ... that information can point to workforce issues, such as high diabetes rates, that can be addressed by offering medical compliance support to those with chronic conditions or by changing the workplace culture away from, say, pizza and pastries as the go-to refreshments at meetings.... Whether the effort of collecting biometrics such as cholesterol readings and weight measurements from employees -- as many employers do -- is worth the investment is becoming a more pointed question."
Society for Human Resource Management [SHRM]

The Cadillac Tax and Its Potential to Transform How Americans Purchase Health Care Services
"After analyzing the administrative guidance proposed since the Cadillac tax's enactment, this Article considers how that tax's effective encouragement of high-deductible health insurance plans has inadvertently made the Health Savings Accounts that President George W. Bush promoted 15 years earlier much more appealing."
Richard L. Kaplan, via SSRN

2016 Health Insurance Coverage Trends for Persons of All Ages
"From 2013 to 2016, increases were seen in both public and private coverage among adults aged 18-64.... In the first six months of 2016, adults aged 25-34 were almost twice as likely to lack health insurance as adults aged 45-64. The rates of uninsurance remained relatively stable from 2010 to 2013, however, for all age groups, the percentage of uninsured decreased significantly from 2013 through the first six months of 2016."
Wolters Kluwer

Health Care and the 2016 Elections: The GOP Sweep's Impact on ACA (PDF)
9 presentation slides. "Key Planks of GOP 'Replacement ' Plan: [1] Expand Health Savings Accounts; [2] Eliminate individual mandate; ... [3] Purchase insurance across state lines; [4] Continuous coverage replaces guaranteed issue; [5] State flexibility to shape their own insurance markets ... [6] Reduce ACA subsidies; [7] Standard tax credit with flexibility to use across commercial markets."
Mehlman Castagnetti Rosen and Thomas, for Employers Council on Flexible Compensation [ECFC]

The Affordable Care Act -- What's Next?
"Among the more concrete proposals on the President-elect's website: The complete repeal of the ACA and replacement with a solution that includes Health Savings Accounts. While the website does not get into the individual components of the ACA, a full repeal would include, among other changes, the elimination of the individual mandate, marketplace subsidies, employer 'pay or play' rules, annual reporting requirements, Medicaid expansion, the 'Cadillac' tax, design-based requirements (e.g., coverage of essential health benefits, annual and lifetime maximums, prohibition on pre-existing condition exclusions, and many other requirements), and limits on compensation paid to employees of health insurance providers."
Winston & Strawn LLP

U.S. Election Results' Impact on Health Care Reform
"This article provides a brief overview of the election's implications for the benefits-related proposals President-elect Trump put forth during his campaign, including health care reform, paid maternity leave, child care benefits and tax reform."
Willis Towers Watson


Replacing Obamacare: Seven Fundamental Questions That Should Be Addressed by President-Elect Trump
"[1] Should healthcare in the United States be approached as a fundamental right or a privilege? ... [2] How should quality, affordability, access and value be defined? ... [3] Should the healthcare system be about total health? ... [4] What role should the federal government play? ... [5] What should the role of hospitals be? ... [6] How should health insurance work? ... [7] How should individual accountability for lifestyle choices factor into the health system's performance?"
Paul Keckley

Benefits in General

Plaintiff's State Law Claims Based Upon Benefit Promises Avert Preemption
"If an employer offers a benefits arrangement to a prospective employee and later denies benefit claims based on plan eligibility requirements, could the employee assert state law claims or would ERISA preempt them? ... Rather than interpreting ERISA plans, [the plaintiff] argued, the Court need only consider the defendants' representations and promises to him before his employment and whether those representations and promises were ultimately false or breached.... The Court held that the plaintiff's state law claims were not preempted, observing that a state law claim may have an independent legal basis 'even if an ERISA plan is a factual predicate in the case.' " [Lapham v. Accenture, LLP, No. 16-1394 (D.N.J. Nov. 8, 2016)]
Harmon on Health Plan Law

Identifying ERISA-Covered Employee Benefit Plans (PDF)
11 pages. "[If] benefits are subject to ERISA, the employer or employee association sponsoring the plan or arrangement has certain obligations regarding the rights and benefits of employees (and their beneficiaries). If the employer fails to satisfy these obligations, it may face [DOL] enforcement action, civil penalty assessments, and/or participant lawsuits.... This practice note covers the following topics: [1] Significance of ERISA Coverage; [2] Determining Whether a Plan Is Covered by ERISA; [3] Identifying Plans That Are Excluded from ERISA Coverage; [4] Defining an ERISA Employee Benefit Plan; [5] Conclusions and Action Steps."
Holland & Knight, via Lexis Practice Advisor

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BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2016, 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, 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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