Health & Welfare Plans Newsletter

March 8, 2017 logo logo
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Employee Benefits Jobs

Retirement Plan Administrator
RPC CPAs + Consultants, LLP
in NM

Relationship Manager
in TX

Vice President, Operations (financial services industry)
in MA

Retirement Plan Compliance Analyst QKA
Newport Group
in AL, AZ, CA, FL, IA, IL, KS, MA, MD, MI, MN, MO, NC, OH, TX, VA, WI, Telecommute

Relationship Manager
Newport Group
in CA

Conversions Consultant
Newport Group
in AL, CA

Senior Analyst, Global Business Group on Health
National Business Group on Health
in DC

Client Relationship Manager
Professional Capital Services
in PA

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Webcasts and Conferences

DOL Fiduciary Rule: Planning for Contingencies
March 15, 2017 WEBCAST
Vorys, Sater, Seymour and Pease LLP

In Transition – What is Happening with the Affordable Care Act?
March 29, 2017 WEBCAST
Ballard Spahr Andrews & Ingersoll, LLP

Accounting and Auditing Institute for Employee Benefit Plans
June 26, 2017 in CA
International Foundation of Employee Benefit Plans [IFEBP]

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[Guidance Overview]

The Legal Status of Wellness Programs
"[R]ecent case law has revealed two potential issues regarding the new EEOC rules. First, though the EEOC specifically stated that the insurance safe harbor did not apply to wellness programs, there is disagreement between courts ... regarding whether it might be possible to structure a wellness program to which the insurance safe harbor applies. Second, while the EEOC provided guidance that wellness program incentives in certain limited amounts do not undermine a program's voluntariness, the EEOC's authority to make such a rule is now being challenged."
Trucker Huss

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Value-Based Insurance Design Can Help Drive Medication Adherence with High-Deductible Plan
"[W]hen their employers switched to a high-deductible plan, 41% were enrolled in a plan with a [value-based insurance design (VBID)] benefit that provided free preventive chronic disease medication at no out-of-pocket cost to the beneficiary.... [A]dherence among the patients without the VBID benefit dropped from 76.1% to 73.8%, while adherence remained steady among those with the VBID benefit.... However, the VBID intervention did not appear to impact adherence among certain subgroups."
American Journal of Managed Care

Corporate Alliance Unveils First Steps Toward Cutting Healthcare Costs
"The blueprint includes group contracts to purchase prescription drugs through units of CVS Health Corp. and UnitedHealth Group Inc.; the creation of specialized doctor networks; and a deal to use International Business Machines Corp.'s Watson software to analyze their health-care data. The nonprofit group, called the Health Transformation Alliance, says combining the negotiating heft of its 38 members allows it to win lower prices than any individual company could alone."
The Wall Street Journal; subscription may be required

Survey Highlights Employees' Health Plan Enrollment Drivers
"[M]ore than 40 percent of the HSA participants interviewed said they enrolled in HSAs in order to use the accounts as savings vehicles for future health care needs. This response came in ahead of 'tax savings,' which 21 percent selected, and 'lower premiums' offered by High Deductible Health Plans (HDHP), which only 9.5 percent of survey respondents selected.... When asked to rate the importance of several factors when evaluating health account vendors, 85 percent of benefits decision-makers rated 'employee customer service' as very important, while 81 percent ranked 'overall employee experience' as very important."
Connect Your Care

Unintended Consequences: Out-of-Pocket Costs Changing How Low-Wage Workers Use Healthcare
"Low-wage workers use healthcare differently than their higher-paid counterparts. with a more reactive approach to healthcare. Individuals in the low-wage category used preventive care half as often as their higher paid peers, and notably, were significantly less likely to participate in incentive-based programs to learn about their health. As a result, low-wage workers: Had nearly twice the hospital admission rate; Experienced more than four times the rate of preventable hospitalizations; Had more than three times the rate of emergency department visits."


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Health Plan & Payer Summit. Executives from health insurance organizations convene to explore new business strategies, and gain insight into unique business models, innovations, and personalized engagement strategies.

Statement by HHS Secretary Tom Price on ACA Replacement Proposals
"There are three phases of this plan. One is the bill that was introduced [March 6] in the House of Representatives.... [Second,] there were 192 specific rules that were put out as they relate to Obamacare, over 5,000 letters of guidance and the like. And we are going to go through every single one of those ... And then there's other legislation that will need to be addressed that can't be done through the reconciliation process.... [T]he goal of all of this is patient-centered healthcare, where patients and families and doctors are making medical decisions, and not the federal government."
The White House

Obamacare Repeal/Replacement Watch: First Bills Released
"[The American Health Care Act (AHCA)] has no mention of taxing employer sponsored health care and keeps the Cadillac tax in play but delays it even further until 2025.... [T]he individual mandate and the employer mandate would be repealed (or more accurately reduced to $0) for months beginning after December 31, 2015. Many other [ACA] provisions are phased out from 2018 to 2020."
Benefit Revolution

Congress Introduces the American Health Care Act (AHCA)
"The AHCA is intended only to make changes to the tax and revenue portions of the ACA. By doing so, the proposed legislation can be passed using the budget reconciliation process, which requires a majority vote in the Senate. (Senate rules otherwise would require a super-majority vote of 60 Senators.) ... [T]here is a question as to whether some of the provisions actually qualify for the budget reconciliation process."
Mazursky Constantine LLC

Is Obamacare About to Get Trumped?
"Under the proposals, the minimum essential health benefits requirement would no longer apply after December 31, 2019 and related premium tax credits would cease on the same date. The proposals would also repeal the provisions of Obamacare effective December 31, 2017 that [1] added limitations on the contributions to flexible spending accounts, [2] increased the tax on health savings accounts from 10% to 20% and [3] placed a tax on over-the-counter medications."

Beyond the ACA, the Affordability of Insurance Has Been Deteriorating Since 2015
"Since 2015, larger shares of people with health insurance say they have a difficult time affording their health care costs: from 27 percent to 37 percent for premiums, 34 percent to 43 percent for deductibles, and from 24 percent to 31 percent for copays and prescription drugs."
Henry J. Kaiser Family Foundation

Pre-ACA Market Practices Provide Lessons for ACA Replacement Approaches
"The discussion [in this article] focuses on some of the issues faced by people with health issues in the pre-ACA non-group insurance market. These pre-ACA insurance practices highlight some of the challenges in providing access and stable coverage for people and some of the issues that any ACA replacement plan will need to address."
Henry J. Kaiser Family Foundation


Health Benefits: Providing Value for Our Employees (PDF)
68 pages, including 55 different one-page position statements by CEOs. "Of the 209 million Americans who are covered by health insurance plans, 85 percent -- or 177 million Americans -- receive health coverage through an employer. This report demonstrates many different ways employers are helping to drive a health care system that delivers better health care quality and value."
Business Roundtable [BRT]


Why Living Longer Should Not Lead to Medicare Benefit Cuts
"[A] new report [analyzes] the impact of raising the Medicare eligibility age from 65 to 67 ... The findings are grim: soaring rates of uninsured people age 66 and 67, worsened health outcomes and rising use of expensive emergency medical services."


American Academy of Actuaries Comment Letter to CMS on Market Stabilization Proposed Rule (PDF)
"[An] enrollment period that ends prior to Jan. 1 could reduce the potential for adverse selection, thus improving the average risk profile.... Stricter SEP enforcement mechanisms have the potential to improve the risk profile.... A wider de minimis band would increase the variety of possible plan designs, which could in turn increase consumer choice in both the individual and small group markets but could also create consumer confusion[.]"
American Academy of Actuaries


ERIC Supports the American Health Care Act
"ERIC appreciates House leadership's decision to jettison a provision included in previous drafts to impose a tax on workers that receive health coverage from their employers.... We urge you to promptly complete full and permanent repeal of the Cadillac tax, and ensure that the bill going to the President does not subject employers and employees to taxation."
The ERISA Industry Committee [ERIC]

Benefits in General

In a Significant Change, Second Circuit Requires Strict Compliance with DOL Claim Regs
"At least in the 2nd Circuit, new pitfalls await ERISA administrators processing claims and appeals from adverse benefit determinations. If that administrator fails to comply strictly with all [DOL] regulations regarding claims administration, it is likely to lose the significant benefit of the arbitrary and capricious standard of review." [Salisbury v. Prudential Ins. Co. of America, No. 15-9799 (S.D.N.Y. Feb. 28, 2017)]
Thompson Coburn

Press Releases

PSCA Forms New Committee Focused on Health Savings Accounts
PSCA [Plan Sponsor Council of America]

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David Rhett Baker, J.D., Editor and Publisher
Holly Horton, Business Manager

BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2017, 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 those materials. You may not alter or remove any trademark, copyright or other notices from copies of the content.

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