Health & Welfare Plans Newsletter

March 29, 2017

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Retirement Plan Analyst
Benetrends, Inc.
in PA

Retirement Plan Analyst (Entry Level)
Benetrends, Inc.
in PA

Director, Plan Documents
Lincoln Financial Group
in IN, Telecommute

Relationship Manager
Newport Group
in TX

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Webcasts and Conferences

Rising Rx Costs: Why Costs Are Increasing and What Plan Sponsors Should Do
RECORDED
Segal Consulting

What’s Next for Health Policy?
April 4, 2017 WEBCAST
Alliance for Health Reform

Bells and Whistles: The Truth about Medical Plan Add-Ons
April 7, 2017 WEBCAST
Littler Mendelson

How to Understand and Manage Liability Exposure for 401(k) Committee Members
April 11, 2017 in IL
Drinker Biddle & Reath LLP

Selling the Business to Your Employees Using an Employee Stock Ownership Plan (ESOP)
April 12, 2017 WEBCAST
Ohio Employee Ownership Center

Developments in Executive Compensation, Fringe Benefits, and Information Reporting: Advance Planning to Reduce Audit, Class Action, and Whistleblower Challenges
April 13, 2017 in NY
Morgan Lewis & Bockius LLP

Insights from the 2016 Mercer National Survey of Employer-Sponsored Health Plans
April 19, 2017 in MO
Worldwide Employee Benefits Network [WEB] - St. Louis Chapter

403(b) Plans for 401(k) Administrators: Part 1
May 9, 2017 WEBCAST
FIS Relius Education

403(b) Plans for 401(k) Administrators: Part 2
May 10, 2017 WEBCAST
FIS Relius Education

403(b) Plans for 401(k) Administrators: Part 3
May 11, 2017 WEBCAST
FIS Relius Education

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[Guidance Overview]

Federal Acquisition Regulatory Council Issues Interim Rule Implementing Paid Sick Leave (PDF)
"The Federal Acquisition Regulatory ('FAR') Council has published an interim rule implementing Executive Order 13706, Establishing Paid Sick Leave for Federal Contractors. It applies to solicitations issued by the federal government on or after January 1, 2017, and resultant contracts. For existing contracts, the interim rule directs contracting officers to include the new FAR clause in bilateral modifications extending the contract when such modifications are individually or cumulatively longer than six months.... The companion final rule published by the [DOL] stated the applicability in different terms and with different formatting, but differences in practice are likely to be limited."
Wiley Rein LLP via Pratt's Government Contracting Law Report

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Pharmacy Benefit Managers: Market Power and Lack of Transparency (PDF)
"While a plan sponsor faces the direct financial costs of the particular prescription plan being offered to its members or employees, only a PBM has a complete understanding of the prices and costs flowing between the various players involved in prescription plans....[which creates] an environment for conflicts that drive PBMs to work for their self-interests, unbeknownst to the sponsor or beneficiary.... [This article] will evaluate the industry structure, conduct and performance, in order to determine whether there is a presence of sustained market power that poses serious anticompetitive risks for consumers and that requires a public policy remedy."
The American Consumer Institute

The Risks of Unpaid Leave and the FMLA
"Despite the FMLA's language requiring that an employee 'work' for the employer for at least 12 months, regulations implemented by the [DOL] indicate that an employee must only be 'employed' for 12 months. In other words, if an employee remains on your payroll for 12 months, he may be eligible under the FMLA, regardless of how many months he actively performed work.... Most troubling of all is the fact that unpaid leave extended before the employee becomes FMLA-eligible would not count toward his 12 weeks of FMLA leave. So after taking 8 weeks of unpaid leave, the employee could request an additional 12 weeks of leave before exhausting his protection."
HR Daily Advisor

CCIIO Gives Small Group Non-Grandfathered Policies More Time to Ease Into ACA Compliance
"[S]tates may permit issuers that have already renewed policies under the transitional policy continually since 2014 to renew that coverage for policy years starting on or before October 1, 2018, as long as they do not extend coverage beyond December 31, 2018. The CCIIO says that it will work with issuers and states on implementation of the transitional policy on options that include allowing policy years that are shorter, but not longer, than 12 months, or early renewals with a January 1, 2018 start date."
Wolters Kluwer Law & Business

ACA: Whatever Happens, Most Companies Will Stand Pat
"Employers said they were more than three times more likely to keep [unlimited lifetime benefits] in place than they were to reinstitute lifetime dollar limits: 50% versus 15%.... More than twice the number of employers would keep the eligibility age at 26 than those that would lower the age limit: 48% versus 22%.... Just 16% of employers were 'very likely' and 31% somewhat likely' to make changes if the tax exclusion is capped."
CFO

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ACA Replacement Plan: Easier Said Than Done
"Some parts of the ACA will not be enforced by these agencies. Other parts of the ACA, like the Exchanges, may die if healthy individuals leave and insurers stop offering coverage. However, it may be years before that happens."
Corporate Synergies

ACA Repeal Is Back on the Agenda, Republicans Say
"House Republican leaders and the White House ... have restarted negotiations on legislation to repeal the [ACA] ... [House Speaker Paul Ryan] declined to say what might be in the next version of the Republicans' repeal bill, nor would he sketch any schedule for action. But he said Congress needed to act because insurers were developing the premiums and benefit packages for health plans they would offer in 2018, with review by federal and state officials beginning soon."
The New York Times; subscription may be required

Insurers Struggle to Plan for Future Amid Health Care Policy Vacuum
"Insurers are most concerned about how the administration and Republicans in Congress plan to treat the ACA's cost-sharing reduction payments, which help subsidize out-of-pocket payments for lower-income enrollees, and whether the Trump administration will enforce the ACA's individual mandate ... Insurers should have until June or July to file their rate requests, an extended timeframe proposed last month by [CMS]. Those requests will offer the first insights into how much they hope to charge consumers for different plans next year."
Morning Consult

Justice Department Joins Lawsuit Alleging Massive Medicare Fraud by UnitedHealth
"The Justice Department has joined a California whistleblower's lawsuit that accuses insurance giant UnitedHealth Group of fraud in its popular Medicare Advantage health plans.... [The whistleblower] has accused the insurer of 'gaming' the Medicare Advantage payment system by 'making patients look sicker than they are' said his attorney ... [The attorney] said the combined cases could prove to be among the 'larger frauds' ever against Medicare, with damages that he speculates could top $1 billion."
Kaiser Health News

Benefits in General

Administrative Exhaustion as a Defense to Statutory ERISA Claims? Not So Much.
"[T]he Sixth Circuit joined six other circuit courts in holding that ERISA claims that seek vindication of statutory ERISA rights pertaining to the legality of a plan amendment, as opposed to an interpretation of the plan, are not subject to administrative exhaustion requirements. The Sixth Circuit joined the Third, Fourth, Fifth, Ninth, Tenth, and D.C. Circuits in so holding, while the Seventh and Eleventh Circuits require administrative exhaustion even where plaintiffs assert statutory rights." [Hitchcock v. Cumberland Univ. 403(b) DC Plan, No. 16-5942 (6th Cir. Mar. 14, 2017)]
Seyfarth Shaw LLP

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Lois Baker, J.D., President  loisbaker@benefitslink.com
David Rhett Baker, J.D., Editor and Publisher  davebaker@benefitslink.com
Holly Horton, Business Manager  hollyhorton@benefitslink.com

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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