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[Guidance Overview]
Updated List of Required Preventive Services Under the ACA (PDF)
"Guidelines keep evolving for which preventive services non-grandfathered plans must provide. The most significant change is the addition of statins to the list of required preventive drugs. Sponsors of non-grandfathered plans should review plan documents and operations to ensure that the plan complies with the latest guidelines."
Segal Consulting
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[Guidance Overview]
Expensive Problems Arise for Employers Who Don't Have Clear Health Plan Eligibility Conditions
"An insurance company needs to be able to determine who is eligible for the plan so it knows who to cover with the plan's benefits. However, an insurance company has no skin in the game as it relates to the 4980H penalties. This is perhaps creating part of the problem as the insurance company does not care if the look back measurement method is accurately (or even correctly) explained and incorporated into the eligibility conditions. Consequently, there is frequently one set of eligibility standards that apply for the purposes of the look back measurement method and a separate set of standards applied to the actual health plan. Furthermore, sometimes the health plan's SPD is not providing any eligibility conditions. This lack of synchronization is a huge problem."
Accord Systems, LLC
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[Guidance Overview]
Arizona's Paid Sick Leave Law: Record-Keeping, Shifting Employment Relationships, and Tips for Drafting Policies
"Employers should be cautious not to impose unreasonable temporal requirements on notice required for PST, especially on unforeseen PST usage.... [E]mployers generally cannot restrict how an employee provides notice of an upcoming leave covered under the Act.... [O]ne key remaining unanswered question is whether an employer may use a combined PST/PTO policy without separately tracking PST hours and pay on the employee's pay stub.... [F]or businesses contemplating purchasing the assets of another business and hiring at least some of the predecessor's employees, those buyers should keep in mind that an asset purchase alone will not necessarily insulate the purchaser from the Act's successor liability[.]"
Ogletree Deakins
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Joint Employment and the FMLA: Which Employer is Responsible?
"When a staffing agency and a client both exercise control over an employee, the staffing agency is usually considered the primary employer for [FMLA] purposes... As [the city of] Alexandria found out, merely having 'secondary employer' status does not absolve an employer of its FMLA responsibilities. The DOL's regulations set out specific requirements for both the primary and secondary employer in a joint employment relationship, which it says exists when two employers exercise some control over the work or working conditions of the employee." [Quintana v. City of Alexandria, No. 16-1630 (4th Cir., June 6, 2017)]
HRDailyAdvisor
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Employees Want Flexible Schedules and Summer Fridays, But Fewer Companies Offer Them
"Sixty-two percent of human resources managers reported their organization offers flexible schedules at this time of year, down from 75 percent in a 2012 survey. About three in 10 employers (29 percent) relax their dress codes in the summer months, compared to 57 percent five years ago. Companies with shorter hours on Fridays also fell to 20 percent, a 43-point decline from 2012."
Wolters Kluwer Law & Business
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2017 Health and Well-Being Touchstone Survey Results (PDF)
114 pages. "Medical plan costs have continued to increase, but employers are expecting that the rate of increase will start to dampen. Plan design changes contributed towards slightly lower-than-expected increases in 2016.... [R]ather than considering broad, transformational changes, they continue to use traditional cost shifting approaches to control health spend.... Participants are increasing contributions in the form of surcharges for spouse, domestic partner, and dependent coverage[.]"
PricewaterhouseCoopers
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Balance Billing by Health Care Providers: Assessing Consumer Protections Across States (PDF)
10 pages. "Most states do not have laws that directly protect consumers from balance billing by an out-of-network provider for care delivered in an emergency department or in-network hospital. Of the 21 states offering protections, only six have a comprehensive approach to safeguarding consumers in both settings, and gaps remain even in these states. Because a federal policy solution might prove difficult, states may be better positioned in the short term to protect consumers."
The Commonwealth Fund
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Industry Groups to Host Series of Anti-AHCA Events
"The American Medical Association, the American Hospital Association, AARP, March of Dimes, the American Diabetes Association, the American Cancer Society, the Federation of American Hospitals and the American Heart Association will team up for the initiative ... The programs will highlight four health policy areas: insurance affordability, essential care access, protections for Medicaid patients and protections for people enrolled in employer-sponsored plans."
FierceHealthcare
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[Opinion]
Manhattan Institute Testimony to the Senate HELP Committee on the Cost of Prescription Drugs: How the Delivery System Affects What Patients Pay (PDF)
"Broadly speaking, robust generic competition, along with the advent of large and sophisticated payers, has kept the relative share of health care costs attributable to medicines broadly stable, even as new medicines have become a cornerstone of treatment for acute and chronic illness. However, there are real challenges facing the health care system today, specifically for patients with serious chronic illnesses who are facing high coinsurance or deductibles largely for what are called 'specialty' medicines, and that challenge needs to be addressed."
Manhattan Institute for Policy Research
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[Opinion]
NCPA Statement to the Senate HELP Committee on the Cost of Prescription Drugs: How the Delivery System Affects What Patients Pay (PDF)
"Since their inception, PBMs have morphed from claims adjudicators into little known and largely unregulated corporate giants that exploit their strategic position at the 'middle' of nearly all drug transactions in the U.S. to extract profits from the upstream and downstream participants in the drug supply chain while providing questionable value to the ultimate consumer. PBMs are also heavily involved in and reap enormous profits from their involvement in federally supported or subsidized health care programs, like Medicare and Medicaid."
National Community Pharmacists Association [NCPA]
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Executive Compensation and Nonqualified Plans
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Why Proper Disclosure of Executive Perks Is Important (PDF)
"Between 2009 and 2014, [MDC Parners Inc.] disclosed in its proxy statements some, but not all, of the perquisites paid to [former CEO, Miles S. Nadal] and on his behalf. The estimated $11.285 million worth of perquisites that MDC failed to disclose included private aircraft usage, club memberships, cosmetic surgery, yacht- and sports car-related expenses, jewelry, charitable donations, pet care, and personal travel expenses.... The SEC not only took action against MDC as an issuer, but also against Nadal individually since his compensation was not fully disclosed.... The SEC penalties may not be MDC's or Nadal's only legal problem."
King & Spalding
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Press Releases
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BenefitsLink.com, Inc.
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(407) 644-4146
Lois Baker, J.D., President
David Rhett Baker, J.D., Editor and Publisher
Holly Horton, Business Manager
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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