Health & Welfare Plans Newsletter

March 30, 2017

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Employee Benefits Jobs

Assistant Plan Administrator
Retirement Planning Services, Inc.
in CO

5500 & Trust Specialist
Kravitz, Inc.
in CA

Health Insurance / Employee Benefits Account Manager
Associated Builders and Contractors Insurance Trust
in DC

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Webcasts and Conferences

Fiduciary Fee Reasonableness: Breaking Down Litigation Teachings
RECORDED
Manning & Napier, Inc.

ERISA Company Stock Fund Litigation Is Anything Left After Dudenhoeffer?
April 20, 2017 in NY
Worldwide Employee Benefits Network [WEB] - New York Chapter

How to Understand and Manage Liability Exposure for 401(k) Committee Members
April 20, 2017 in IL
Drinker Biddle & Reath LLP

The SHIFT! Navigating the Changing Retirement Plan Landscape
April 20, 2017 in GA
Worldwide Employee Benefits Network [WEB] - Atlanta Chapter

Fundamental Framework of Employee Stock Ownership Plan: Key Features Uncovered
April 27, 2017 WEBCAST
Knowledge Group

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[Guidance Overview]

New Law in D.C. Adds to Required Paid Leave Puzzle
"One of the key differences under this law is that there is no requirement that a person be employed for any significant length of time. Unless the agency administering the benefits can carefully monitor entitlement to benefits, an unintended consequence may be that employees will game the system by frequently changing employers to gain additional paid time off. This could negatively affect employers that are already plagued with high turnover positions."
Lockton

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Of RIFs and FMLA Requests
"According to the court, given the weight of the evidence (or lack thereof) and the temporal proximity of the termination, it was not an unreasonable decision by the jury to find in favor of the plaintiff.... [T]he plaintiff made an inquiry to human resources about short-term disability. [The] court found that to be sufficient notice to the employer to at least make an inquiry as to whether FMLA leave notice and adherence obligations were triggered[.]" [Crain v. Schlumberger Technology Corp., No. 15-1777 (E.D. La. Feb. 23, 2017)]
HRE Daily

House Overwhelmingly Votes to Repeal Antitrust Exemption for Health Insurers
"The bill would amend the McCarran-Ferguson Act, which has granted a limited, but important, antitrust exemption to insurers for the last 70 years. This repeal measure reflects a heightened concern by the House of Representatives about high concentration and potential anticompetitive conduct in the health insurance industry, and could be used to fill the gap in states with weak antitrust or consumer protection laws. Following the overwhelming 416-7 House vote, the bill will now go to the Senate."
Pepper Hamilton LLP

Risk Adjustment, Reinsurance Improved Financial Outcomes for Individual Market Insurers with the Highest Claims (PDF)
10 pages. "[The authors] compared revenues to claims costs for insurers in the individual market during the first two years of ACA implementation (2014 and 2015), before and after the inclusion of risk adjustment and reinsurance payments. Before these payments were included, for the 30 percent of insurers with the highest claims costs, claims (not including administrative expenses) exceeded premium revenues by $90-$397 per enrollee per month. The effect was reversed after these payments were included, with revenues exceeding claims costs by $0-$49 per month."
Health Affairs

California Bill Would Require Disclosure of PBM Rebates
"The bill would require [pharmacy benefit managers] to disclose: [1] The percentage of all oral prescriptions and self-administered drugs that were dispensed through pharmacies affiliated with the PBM and the percentage of oral and self-administered medications dispensed through retail pharmacies; [2] The total amount of discounts or price concessions the PBM received that were attributable to California residents whose drug benefits were managed by the PBM; [3] The amount and types of rebates, discounts or price concessions provided to health care plans that could be attributed to patient use under those plans; and [4] The amount of the rebates, discounts or price concessions that are passed through to enrollees and the total number of prescriptions dispensed."
AISHealth

[Advert.]

Online Learning Course: Family and Medical Leave Act (FMLA)

Sponsored by International Foundation of Employee Benefit Plans [IFEBP]

This course identifies coverage and eligibility requirements of employees and responsibilities of employers, and describes how to avoid common administration mistakes, implement best practices and be aware of interactions with other laws.


Manager's Thoughtless Comment Resurrects Poor Performer's FMLA Claims
"[T]rain your managers on how to effectively and lawfully manage leaves of absence under your personnel policies and the law. Included in this training, of course, should be a stern warning against any stray comments about an employee's medical leave. Investing a couple hundred bucks now to conduct effective FMLA training will literally save you hundreds of thousands when the real life situation presents itself." [Stewart v. Wells Fargo Bank, No. 15-988 (N.D. Ala. Mar. 14, 2017)]
FMLA Insights

[Opinion]

Proposed Legislation Would Lower U.S. Prescription Prices
"Among other reforms, the [Improving Access to Affordable Prescription Drugs Act] would curb the monopoly abuses of pharmaceutical corporations that keep prices high, penalize companies that engage in price gouging, finally allow Medicare to negotiate fair prices for seniors, cap out-of-pocket medicine costs in health insurance plans and require transparency from the pharmaceutical industry."
Public Citizen

[Opinion]

ERIC Provides Testimony on Nevada Paid Sick Leave Proposal
"While well intentioned, the proposed amendments to Chapter 608 of Nevada's Revised States will severely infringe large employers' ability to provide consistent paid sick leave to their employees in Nevada. Most large, multistate employers already offer some of the highest-quality paid leave plans to their employees, and should therefore not be subject to this bill."
The ERISA Industry Committee [ERIC]

[Opinion]

High-Risk Pools for People with Preexisting Conditions
"[H]igh rates of uninsurance and lack of affordability for all buyers in the individual market existed before the ACA, even in states with high-risk pools.... [P]olicymakers seem to substantially underestimate the number of Americans with preexisting conditions who might be forced to purchase coverage through a high-risk pool if insurers are allowed to deny coverage in the marketplace."
The Commonwealth Fund

Benefits in General

[Guidance Overview]

New Claims Procedure Requirements for Disability Claims
"[If] a plan treats a participant as being disabled, based [solely] on being granted an award of a Social Security disability benefit, the plan's claims procedures would not have to reflect or apply the prior or new rules in the regulations that apply to disability claims.... If the plan retains any other requirement for treating a participant as being disabled, such as the plan administrator retaining any authority to challenge and deny such treatment despite the grant of a Social Security disability award, then the plan would have to handle a participant's claim for a disability benefit wholly or partly in accordance with the (prior and new) rules in the regulations relating to disability claims."
Cary Kane ERISA Lawyer Blog

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David Rhett Baker, J.D., Editor and Publisher  davebaker@benefitslink.com
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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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