Health & Welfare Plans Newsletter

March 10, 2017

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Senior ERISA Document Specialist
Pentegra Retirement Services
in NC, NY, OH

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PenSys, Inc.
in CA, NC

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Alerus Financial
in AZ, CA, CO, FL, GA, NC, OK, SC, TN, TX

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Universal Health Services, Inc.
in PA

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John Hancock Retirement Plan Services
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31st Annual Ohio Employee Ownership Conference
April 27, 2017 in OH
Ohio Employee Ownership Center

Certificate Program for Non-Professional ESOP Fiduciaries
September 11, 2017 in OH
Ohio Employee Ownership Center

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[Guidance Overview]

New York State Publishes Proposed Regs on New Family Leave Law
"Employers will be required to provide written policies, guidance or notifications to employees regarding leave ... Part-time employees will be eligible to receive pro-rata portions of family leave ... An employer's failure to provide paid family leave or to make applicable withholdings will expose the employer to costly penalties.... Employees may be required to submit medical documentation from a health care provider if they take leave because of the serious health condition of a family member."
Fox Rothschild LLP

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Effectively Managing FMLA Investigations by the DOL
"Neither the FMLA nor its regulations require any specific manner in which records must be maintained to comply with the recordkeeping requirements of the FMLA.... [T]he DOL has the authority to undertake unannounced employer visits. Employers need to have a procedure in place for handling such a situation, including having a designated person who is prepared to respond to investigations at a moment's notice."
HR Daily Advisor

Why the Utilization Conversation in Telemedicine Is Bigger Than Dollars and Cents
"[A recent study] found that 88 percent of visits were additive, and only 12 percent replaced in-person visits. The result: telemedicine cost the payer $45 per patient more than a plan without telemedicine would have.... [T]he study doesn't consider the long-term impact of increased utilization of preventative care. If those extra visits keep patients out of the hospital because they catch a respiratory infection early and it prevents a more serious condition like pneumonia, those savings could make up for the cost of extra visits."
MobiHealthNews

What Employers Should Know about Stop-Loss Insurance
"Including prescription drug coverage under the stop loss coverage is becoming more important as the cost and number of specialty drugs continues to grow; it makes financial sense to cap the employer's cost exposure not only for medical claims, but for prescription claims.... [E]mployers need to understand the details of the stop loss arrangement, including differences in coverages from one carrier to another carrier. It is important to understand if some claims may not be covered under the new policy."
The Alliance

Examining the House ACA-Repeal Bill's Potential Impact on Employers and Other Sponsors of Group Health Plans
"[American Health Care Act (AHCA) provisions that affect group health plans (GHPs)] and employer- and union-sponsors of GHPs ... include: [1] Repealing of the employer mandate penalty; [2] Delaying the effective date of the Cadillac Tax for five years; [3] Eliminating the health flexible spending account (FSA) employee contribution limits; [4] Expanding health savings account (HSA) availability; [5] Repealing the prohibition of tax-free reimbursements of over-the-counter ('OTC') medications by HSAs and other account-based plans; [6] Removing the limit on employer deductions relating to certain retiree prescription drug plans; and [7] Adding a new refundable, advance tax credit that could be used to pay for certain individual insurance and unsubsidized GHP COBRA coverage, which would replace the current ACA tax credits."
Trucker Huss

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To Save on Drug Costs, Insurer Wants to Steer You to 'Preferred' Pharmacies
"Blue Shield of California wants to create 'a tiered pharmacy network' in its 2018 small- and large-group plans ... If the proposal is approved ... it would affect the coverage of more than 1.8 million consumers, based on 2015 numbers from the [California Department of Managed Health Care].... [C]onsumers still would have a broad selection of pharmacies, but they would have to choose a 'preferred' pharmacy to maintain this year's copayment amount. Outside of that network, consumers could pay up to $50 more for the same prescription[.]"
Kaiser Health News

Key Findings from AHIP's Provider Directory Initiative (PDF)
10 pages. "Selected strategies that health plans should consider in future efforts to improve the accuracy and timeliness of provider directories are ... [1] Improving provider engagement.... [2] Increasing provider accountability ... [3] Improving and harmonizing technical integration and standards."
America's Health Insurance Plans [AHIP]

Medicare Premium Support Proposals Could Increase Costs for Today's Seniors, Despite Assurances
"[P]roponents would split Medicare into two parts: one for people now over age 55 who would be 'grandfathered' into the current Medicare program, and one for younger adults, now 55 or younger, who would get coverage under the new premium support system once they became eligible for Medicare.... Once the system is fully implemented, younger, healthier, and lower-cost beneficiaries, those now 55 and younger, would be cut off -- at least actuarially -- from older, sicker, and more expensive beneficiaries, those now 55 and older.... [T]he increased rate of cost growth in the current system would result in higher premiums, deductibles, and cost-sharing for those covered by it: today's seniors and near-seniors."
Health Affairs

[Opinion]

Why the House Repeal Bill Is Unlikely to Stabilize Insurance Markets
"The American Health Care Act (AHCA), introduced into the House on March 6, depends on, and assumes the existence of, a vigorous individual market for health care. And yet it removes the prime stabilizer of the ACA, the individual mandate.... [T]he 30 percent penalty is unlikely to discourage individuals who really need high-cost care and will not offset the cost of that care.... Moreover, the individual mandate penalty is repealed retroactively to 2016, but the continuous coverage requirement goes into effect in 2019, leaving a gap in market stabilizers at a critical time."
The Commonwealth Fund

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

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