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May 23, 2017 logo logo
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[Guidance Overview]

Georgia's New Family Care Act: Using Paid Leave for Sick Family Members
"The new law does not create an obligation for employers to provide sick leave to employees. Instead, it requires employers that already give their workers paid sick leave to permit a portion of the leave -- up to five days per calendar year -- to be used for caring for the eligible employees' immediate family members.... Importantly, the Family Care Act does not contain any enforcement or penalty provisions and it expressly states that it does not create a new cause of action against an employer."
Troutman Sanders


How to Survive an ACA Audit

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[Guidance Overview]

Telehealth Expansion Finally Comes to Texas
"For insurers, the bill clarifies that the Texas telemedicine parity law does not apply to services rendered only through audio interaction or by facsimile. In other words, insurers in Texas are prohibited from restricting coverage solely because it is provided through telemedicine, unless the services are only rendered through phone or fax. The bill also requires insurers to prominently post their telehealth coverage policies and payment practices on their websites so that consumers can easily determine whether and how coverage is available."
Morgan Lewis

Cost-Effective Healthcare Models in the Self-Insured World
"For self-insured employers, cash-based providers might be a solution to their employees' healthcare needs that result in high dollar claims. The ease of administration associated with these providers also makes them an attractive option.... Reference-based pricing follows the industry trend towards shifting healthcare costs and consumer responsibility to employees from employers. It also delivers a higher level of cost transparency from medical providers and gives the employer more control over their fixed and expected claim costs.... [C]enters of excellence have provided a seemingly win-win-win scenario for companies and their employees as well as the medical providers."

Survey Finds Healthy Trends in HSA Offerings, Enrollments
"35.1% of all plans offer a health savings account (HSA) or a health reimbursement arrangement (HRA), though that's up only slightly from the 34% who did in 2015. However, an HSA is offered in a quarter (24.6%) of plans, a 21.8% increase from five years ago ... HSA enrollment stands at 17%, up 25.9% from 2015 -- and nearly 140% from five years ago. The average employer contribution to an HSA is $474 for a single employee (down 3.5% from 2015 and 17.6% from five years ago) and $801 for a family (down 9.2% from last year and 13.7% from five years ago)."
National Association of Plan Advisors [NAPA]

Boosting Voluntary Benefits Enrollment Is a Win-Win
"Employers can get a huge return on demonstrating the value of voluntary benefit plans once their employees understand how the coverage works and the risks of not having it.... The key is to incorporate voluntary benefits into your existing communications strategy. Communication channels, like benefit websites, blogs, and other social media platforms, are your best bet when it comes to keeping employees informed."
Frenkel Benefits


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Universal Health Care Plan Hits Snag in California
"The proposal being pushed by progressive Democrats and the California Nurses Association would make California the first state with a single-payer health care system but at a striking cost: According to the Senate Appropriations Committee analysis, the plan would require the state to come up with $200 billion annually to offset the loss of employer-based expenditures and enrollee premiums and deductibles."
Courthouse News Service

Benefits Eligibility Might Be Modified If ACA Repealed
"Approximately 1 in 5 employers (20 percent) anticipate modifying eligibility requirements for health care coverage if the [ACA] is repealed ... The survey also found that if the ACA is repealed: 28 percent of respondents would not be affected, as they did not offer coverage to additional employees as a result of the law. 18 percent would allow more employees to work over 30 hours per week given that it would not trigger a requirement to offer health insurance. 17 percent would increase premiums or cost-sharing. 4 percent would drop health insurance coverage for some full-time employees."
Society for Human Resource Management [SHRM]

Insurers, Marketplaces Face Uncertainty as Parties Seek Further Delay in House v. Price
"On May 22, 2017, the House of Representatives and the Department of Justice jointly asked the District of Columbia Court of Appeals to continue to hold House v. Price in abeyance, presumably for another 90 days as contemplated by the court's earlier order. The next status report would be due on August 20, 2017. The court is expected to respond to their request in the near future."
Timothy Jost, in Health Affairs

Administration Seeks Delay of Ruling on Health Law Subsidies, Prolonging Uncertainty
"The request could further destabilize insurance markets as insurers are developing rates and deciding whether to participate in 2018. Insurers are supposed to submit their proposals to the federal government by June 21 and have already filed rate requests with several states. Loss of the cost-sharing subsidies, they say, could lead them to increase premiums by 15 percent to 20 percent or more, on top of any increases they might seek for other reasons."
The New York Times; subscription may be required

Policy Uncertainty Means Less Time for Oversight of Premium Hikes
"By some estimates, the lack of an individual mandate could result in up to a 20 percent bump in premiums; shutting off the CSRs would increase them by an additional 19 percent. At the same time, even those insurers committed to the marketplaces may need to revisit that commitment, change service areas, or adjust rates if they learn of competitors exiting the market or reducing their footprint."
The Commonwealth Fund

No SCOTUS Review: Health Benefits Opt-Out Payments Must Be Included in Overtime Calculation
"In a case of first impression, the 9th U.S. Circuit Court of Appeals ... [had] ruled that when an employer pays an employee cash for opting out of its health insurance, that payment must be considered part of the employee's 'regular rate of pay' under the FLSA. This means it must be used in calculating compensation for overtime hours. The High Court declined to take up the case May 15."


NCPA Offers House Committee Suggestions to Enhance Medicare, Increase Access to Prescription Drugs
"NCPA recommended the following: [1] Enact H.R. 1038 (the Improving Transparency and Accuracy in Medicare Part D Drug Spending Act). The legislation would ban retroactive direct and indirect remuneration (DIR) fees on community pharmacies. [2] Strengthen and finalize proposed CMS guidance on DIR and pharmacy price concessions. [3] Review and standardize how Part D plans measure pharmacy quality and performance in community pharmacies. [4] Enact H.R. 1316 (the Prescription Drug Price Transparency Act) to increase transparency into how generic drugs are priced by PBMs and paid for in Medicare."
National Community Pharmacists Association [NCPA]

Benefits in General

Form 5500 Delinquency Can Be Costly
"Article highlights: [1] [DOL] has established a new maximum penalty for failure to file; [2] Maximum monetary fine for Form 5500 filing violations is now $2,063 per day; [3] Penalties stemming from delinquent 5500 filings are to be treated on a cumulative basis."

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David Rhett Baker, J.D., Editor and Publisher
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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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