Health & Welfare Plans Newsletter

April 7, 2017

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401(k) Plan Administrator
BlueStar Retirement Services
in FL

Pension Administrator II
Polycomp Administrative Services, Inc.
in CA

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Continental Benefits Group, Inc.
in NJ

Group Benefits Consultant
Bouchard Insurance
in FL

401(k) Plan Administrator
Growing Third Party Administrator
in CA, GA, IL, KS, MA, NC, TX, VA, WA

Benefits Communication Consultant
Milliman
in TX

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Webcasts and Conferences

Choosing a Retirement Solution for Your Small Business
April 25, 2017 in IL
Employee Benefits Security Administration [EBSA], U.S. Department of Labor

Pharmacy Market, Trends and Understanding PBM Contracts
April 25, 2017 in TX
Worldwide Employee Benefits Network [WEB] - Dallas Chapter

ERISA Fiduciary Update 2017: Best Practices from Industry Professionals
May 18, 2017 in WI
Francis Investment Counsel

Fundamentals of 401(k) and Other Qualified Plans
June 12, 2017 in PA
FIS Relius Education

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[Official Guidance]

Text of CMS 2018 Unified Rate Review Instructions Rate Filing Justification Parts I, II, and III (PDF)
74 pages."Section 2794 of the Public Health Service Act [establishes] requirements for issuers offering non-grandfathered health insurance coverage in the small group and/or individual markets to submit rate filing information on rate increases to [CMS]. Rate Filing Justification (RFJ) submissions must provide sufficient information for State or Federal regulators to review rate filings for compliance with [federal regulations]. In addition, CMS may use data submitted on the RFJ to calculate advance payments of the premium tax credit (APTC) payments and cost-sharing reductions (CSRs) payments. The [RFJ] for single risk pool plans consists of ... three parts ... Changes [to these instructions are listed]."
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

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Coordinating FMLA with USERRA
"As a general rule, when the FMLA overlaps with other laws, the employer must follow the law that gives the employee the greatest benefits or is most favorable to the employee.... USERRA requires employers to grant up to 5 years of unpaid leave to employees for active military duty. By contrast, the FMLA entitles employees to 12 weeks of leave for a qualifying exigency and up to 26 weeks of military caregiver leave."
HRDailyAdvisor

All in the FAMILY: Small Businesses Support National Paid Leave Program
"7 in 10 owners and operators of small businesses support the recently reintroduced Family and Medical Insurance Leave (FAMILY) Act, which would establish a federal paid leave insurance program funded by modest contributions from employers and employees. Nearly half -- 47 percent -- say they strongly favor this type of program, which would ensure that employees could receive part of their salary for up to 12 weeks when they need to take time off to recover from a serious illness or to care for a new child or a sick family member."
Morning Consult

Changing Rules for Workplace Wellness Programs: Implications for Sensitive Health Conditions
"This brief reviews findings from the 2016 Kaiser Family Foundation/HRET Employer Health Benefits Survey related to wellness programs and financial incentives. It also reviews findings from the 2015 National Survey on Drug Use and Health (NSDUH) related to the incidence of certain sensitive or potentially stigmatized health conditions among adults covered under employer-sponsored health plans."
Henry J. Kaiser Family Foundation

Can HSAs Work for Everyone? (PDF)
"The average per-employee cost of HSA-eligible plans is 13% less than that of a traditional PPO.... Despite the cost savings, for the most part large employers still offer these plans as a choice, rather than as the only medical plan. Just 6% of all large employers offer an HSA-eligible plan as a 'full replacement' of their traditional medical plan.... Although full-replacement HSA plans cost more than those offered as a choice, when you compare total health plan cost per employee -- across all medical plans offered -- employers offering full replacement HSA-eligible plans spend much less."
Mercer

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2017 Health Savings Accounts Facts

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Recent HIPAA Privacy and Security Settlements, and Lessons Learned
"The settlements and penalties so far [in 2017] total over $11 million, with one of the settlements equaling the largest ever, at $5.5 million.... [L]essons and reminders [include]: [1] Don't use unsupported software (i.e., out-of-date versions) and apply patches regularly and promptly. [2] Train your workforce that idle curiosity ... is forbidden and a HIPAA violation. [3] Pay close attention to Internet scheduling tools, which can present special problems. [4] After routine maintenance, always check that firewalls are reactivated and security settings are appropriate. [5] Wipe any hard drives (which many copiers have) before reselling or returning to leasing companies."
Perkins Coie LLP

Another State Is at Risk of Having Only One Obamacare Health Insurer
"Two insurers announced this week that they would pull out of Iowa's [ACA] exchanges next year, raising worries that the decisions could be the leading edge of a trend.... The combination of the two exits will leave the vast majority of counties in the state with only one insurer ... Aetna had not made decisions yet about whether it would continue to sell insurance in Delaware, Nebraska and Virginia for 2018."
The Washington Post; subscription may be required

House GOP Amends Health Care Bill to Address Premiums
"Under the plan, the costliest people in the health care system would still obtain insurance on the individual market, unlike in a traditional high-risk pool. This proposal would likely prevent premiums from skyrocketing because insurers would get federal help to cover their most expensive patients. But the amendment lacks specifics, including which medical conditions would be eligible for remittance or when the federal funds would be used."
Morning Consult

Average ACA Marketplace Premiums for Silver Plans Would Need to Increase by 19% to Compensate for Lack of Funding for Cost-Sharing Subsidies
"[T]he estimated premium increase for silver plans would be higher (21%) in states that did not expand Medicaid under the ACA than in states that expanded Medicaid (15%).... Estimated premium changes vary for the 38 states that used healthcare.gov in 2016, ranging from 9 percent in North Dakota to 27 percent in Mississippi."
Henry J. Kaiser Family Foundation

Benefits in General

First Circuit Says ERISA Preemption of Claim Is Arbitrable Issue
"The Court held that the pending dispute did not raise a question of substantive arbitrability, because there clearly was an arbitration clause and it applied to the dispute.... The Court also rejected plaintiff's argument that an arbitrator might damage the purposes of ERISA by reaching the wrong conclusion, calling it 'exactly the kind of "outmoded" view of arbitration' rejected by the Supreme Court." [Prime Healthcare Services -- Landmark LLC v. United Nurses & Allied Professionals, Local 5067, No. 16-1161 (1st Cir. Feb. 3, 2017)]
Robinson & Cole LLP

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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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