Health & Welfare Plans Newsletter

June 2, 2017

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[Official Guidance]

Text of CMS Notice: Enforcement Safe Harbor for Product Discontinuation Notices in Connection with the Open Enrollment Period for Coverage in the 2018 Benefit Year (PDF)
"[In] connection with the open enrollment period for coverage in the 2018 benefit year, CMS will not take enforcement action against an issuer for failing to send a product discontinuation notice with respect to individual market coverage at least 90 days prior to the discontinuation, as long as the issuer provides such notice consistent with the timeframes applicable to renewal notices. The renewal notice timeframe for non-grandfathered, non- transitional plans is before the first day of the next annual open enrollment period, and for grandfathered health plans and transitional plans is at least 60 days before the date of renewal." [Unnumbered document, June 1, 2017]
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

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[Guidance Overview]

Update on the Cook County and Chicago Paid Sick Leave Laws
"There are inconsistencies between the final County regulations and draft City regulations ... [including] how the frontloading of paid sick leave for FMLA-covered employers should be calculated as well as the rounding up of carried-over sick leave under the two ordinances. Employers should also be aware of the growing list of municipalities in Cook County that have affirmatively opted out of the sick leave ordinance, ostensibly due to the fact that the ordinance increases the cost of companies to do business within their boundaries."
Ogletree Deakins

Tenth Circuit Determines Employer Not Required to Repeatedly Notify Employee of FMLA Rights
"[T]he Tenth Circuit acknowledged that if an employer 'is on notice that an employee might qualify for FMLA benefits, the employer has a duty to notify the employee that FMLA coverage may apply.' ... [T]he court determined that because the employee had already requested and received FMLA leave multiple times during her tenure with the employer, she was already aware of her FMLA rights." [Branham v. Delta Airlines, No. 16-4092 (10th Cir. Feb. 3, 2017)]
The Wagner Law Group

Court Finds No Obligation to Provide COBRA Notice in Language Other Than English
"The 68-year-old employee -- who spoke Spanish as his native language -- objected that the notice was written in English ... The court dismissed [this] claim, explaining that, at 68 years old and with English as a second language, the employee was not an average plan participant within the meaning of the COBRA regulations.... In contrast, language assistance or translation services are required for certain other benefits-related documents." [Valdivieso v. Cushman & Wakefield, Inc., No. 17-118 (M.D. Fla. Mar. 16, 2017)]
Thomson Reuters / EBIA

Fourth Circuit Panel Reaffirms Finding That Retiree Benefits Were Not Vested
"Finding once again that the plain language of the applicable collective bargaining agreements and summary plan descriptions indicated there was no intent to vest retiree health benefits, a Fourth Circuit panel held on rehearing that a district court properly granted summary judgment to an employer in a suit brought by retirees and their union challenging the company's right to unilaterally alter those benefits." [Barton v. Constellium Rolled Products-Ravenswood, LLC, No. 16-1103 (4th Cir. May 11, 2017)]
Wolters Kluwer Law & Business

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Survey Says: Employees Love Voluntary Benefits
"Employee participation rates in voluntary benefits rose across the nation's four major regions in the 2017 benefit year as more employers offer high-deductible health plans (HDHP) ... Voluntary benefit participation rates rose by 567 percent in the Midwest, 208 percent in the South, 138 percent in the West and 59 percent in the Northeast, compared with the 2016 benefit year[.]"
InsuranceNewsNet.com

Access to Care Coordination Drives Members' Satisfaction with Health Plans
"[C]are coordination was the most important factor influencing member satisfaction, because it allows for easy access to doctors, but that coordination of care is lacking in most cases. A quarter of people surveyed reported that they had received coordinated care through their health plan."
FierceHealthcare

Proposed Legislation Would Expand Medicare Coverage of Telehealth Services
"The Telehealth Improvement Act would require the Center for Medicare and Medicaid Innovation (CMMI) to test the effect of including telehealth services in Medicare health care delivery reform models. More specifically, the Act would require CMMI to assess telehealth models for effectiveness, cost and quality improvement, and if the telehealth model meets these criteria, then the model will be covered through the Medicare program."
McDermott Will & Emery, via General Counsel News

The Burden of Rising Health Spending
17 slides. "Over the decade from 2006-2015, spending for personal health care services increased by more than $2,400 per person, a 40 percent rise. The higher spending was observed across all sectors of the health care system.... [P]er-capita spending for personal health care services and products had climbed from 24 to 28 percent of median personal income by 2015.... Over the past decade, the total premiums for an employer-based preferred provider organization (PPO) policy have increased persistently, and the share employees are being asked to shoulder directly has increased more rapidly than the portion advanced by the employer."
National Institute for Health Care Management

What Is Single-Payer Health Care? A Review of Definitions and Proposals in the U.S.
"[The authors] identified 25 proposals for national or state single-payer plans ... The proposals typically call for wide-ranging reform; nearly all include changes across the financing, pooling, purchasing, and delivery of health care services.... Common provisions are related to comprehensive benefits, patient choice of providers, little or no cost sharing, the role of private insurance, provider guidelines and standards, periodic reviews of the benefits package, electronic medical records and billing, prescription drug formulary, global budgets, administrative cost thresholds, payment reform and studies, and the authority to implement cost-containment strategies."
RAND Corporation

Pennsylvania Insurance Commissioner Announces 2018 Rate Increases
"[T]he five health insurers that sell on Pennsylvania's individual market will stay in the market and filed plans for 2018 with aggregate statewide rate increases of 8.8 percent for individual plans and 6.6 for small group plans.... If the individual mandate is repealed, insurers estimate that they would seek a 23.3 percent rate increase statewide. If cost-sharing reductions are not paid to insurers, the companies would request a 20.3 percent rate increase statewide. If both changes occurred, insurers estimate they would seek an increase of 36.3 percent."
Pennsylvania State Insurance Department

Benefits in General

[Official Guidance]

Text of IRS IR-2017-102: For Letter Rulings and Similar Requests, Electronic Payment of User Fees Starts June 15
"In the past, ruling requesters could only make required user fee payments by check or money order. During a two-month transition period, June 15 to Aug. 15, requesters can choose to make user fee payments either through Pay.gov or by check or money order. After Aug. 15, 2017, Pay.gov will become the only permissible payment method."
Internal Revenue Service [IRS]

Press Releases

SHRM Names Johnny C. Taylor President and CEO
SHRM [Society for Human Resource Management]

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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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