Health & Welfare Plans Newsletter

July 24, 2017 logo logo
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Webcasts and Conferences

Guidelines For Taxing Gifts, Awards, & Other Fringe Benefits
July 26, 2017 WEBCAST

Developing an Effective Financial Wellness Program
August 3, 2017 WEBCAST
Clear Law Institute

Health Savings Account Training
August 10, 2017 WEBCAST
Wolters Kluwer

Mississippi Health Care Reform Forum
August 15, 2017 in MS
Bradley Arant Boult Cummings LLP

Voluntary Fiduciary Correction Program
August 16, 2017 WEBCAST
Employee Benefits Security Administration [EBSA], U.S. Department of Labor

Prop 206 PST FAQs and NFAQs Plus Need-to-Know but Often Overlooked Employer Hot Points
September 21, 2017 in AZ
Worldwide Employee Benefits Network [WEB] - Phoenix Chapter

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[Official Guidance]

Text of HHS-Developed Risk Adjustment Model Algorithm 'Do It Yourself (DIY)' Software Instructions (PDF)
20 pages. "The HHS risk adjustment methodology calculates a plan average risk score for each covered plan based upon the relative risk of the plan's enrollees, and applies a payment transfer formula in order to determine risk adjustment payments and charges between plans within a risk pool within a market within a State.... This document provides instructions for the HHS risk adjustment models for the 2017 benefit year, with revisions from the software instructions posted on the CCIIO website on December 19, 2016." [Also available: Technical Details (XLSX) and 2017 Benefit Year Risk Adjustment: SAS Version of HHS-Developed Risk Adjustment Model Algorithm Software (ZIP). [Undated and unnumbered; posted online July 21, 2017.]
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]


Registration is Now Open -- Register early and SAVE!

Sponsored by International Foundation of Employee Benefit Plans [IFEBP]

Find the tried-and-true solutions you need to lower costs and improve employee health at the Health Benefits Conference & Expo! Participate in small group discussions, network with peers and hear from leading organizations by registering today!

Recordkeeping Evidence Leads Eleventh Circuit to Conclude That Former Employer Met COBRA Obligations
"Evidence of routine processes by BayCare and Benefits Concepts regarding the preparation and mailing of COBRA elections notices, and of how those processes were followed, along with a copy of DeBene's COBRA letter containing his premium amount and enrollment form were highlighted by the court as reasons for its decision. A report from Benefits Concepts showing when the letter was sent and successful election of coverage by other employees who received notices mailed the same day led the court to conclude that BayCare met its obligations under COBRA." [DeBene v. Baycare Health System, Inc., No. 16-12679 (11th Cir. May 31, 2017; unpub.)]
Wolters Kluwer Law & Business

Out-of-Network Billing for Emergency Care in the United States
"Because patients cannot avoid out-of-network physicians during an emergency, physicians have an incentive to remain out-of-network and receive higher payment rates. Hospitals incur costs when out-of-network billing occurs within their facilities.... [P]hysicians offer transfers to hospitals to offset the costs of out-of-network billing and allow the practice to continue.... [A] New York State law that introduced binding arbitration between physicians and insurers to settle surprise bills reduced out-of-network billing rates."
National Bureau of Economic Research [NBER]

Link Between Rising Generic Drug Prices and Market Competition Levels
"Of the 1120 generic drugs included in the study period, there was an average price increase of 30%, while the weighted price (baseline market size was used at continuous variable) decreased by 14.2%. However, drugs in the group categorized as low-competition demonstrated a 63.8% increase in average price; there was a 43.8% increase for those in medium competition, and 9.7% increase among those in high competition."
American Journal of Managed Care

Small Businesses Split Over Republican Health Plans
"With so many forces aligned in opposition to the Senate's proposed changes, the views of small-business owners have not been a decisive factor. But the enthusiasm that a growing number are voicing for the health care law weakened the argument, often cited by Republicans, that small businesses had been harmed by it and need a rollback."
The New York Times; subscription may be required


Managing the Generation Gap When Designing Benefit Programs

Sponsored by Lorman and BenefitsLink

July 27 webinar. Not all benefits are valued equally by all employees. Identify different groups within your workforce, understand benefits each group values and customize your benefits package to meet each group's needs. CE credits. Discount for BenefitsLink readers.

Senate Parliamentarian Upends GOP Hopes for Health Bill
"The official rules keeper in the Senate Friday tossed a bucket of cold water on the Senate Republican health bill by advising that major parts of the bill cannot be passed with a simple majority, but rather would require 60 votes.... Senate Parliamentarian Elizabeth MacDonough said that a super-majority is needed for the temporary defunding of Planned Parenthood, abortion coverage restrictions to health plans purchased with tax credits and the requirement that people with breaks in coverage wait six months before they can purchase new plans."
Kaiser Health News

National Commercial Insurers Are a Dying Breed on ACA Exchanges
"Insurers like Aetna, Cigna and UnitedHealth comprise less than 2% of ACA exchange offerings in U.S. counties.... That's a marked difference from back in 2013, when national commercial insurers and limited coverage specialists together accounted for 70% of individual market insurers.... [T]his may be simply because locally based plans tend to have a greater commitment to their exchange populations."

Demand for Health Insurance Marketplace Plans Was Highly Elastic in 2014-2015
"Although enrollment initially grew in these markets, enrollment has fallen recently amid insurer exits and rising premiums.... [The authors] estimate premium elasticity of demand for Marketplace plans, using within-plan premium changes from 2014 to 2015... [Their] preferred estimate implies that a one percent premium increase reduces plan-specific enrollment by 1.7 percent.... [T]his high elasticity reflects the rapid growth and high churn in this market, as well as the high degree of standardization and the availability of many close substitutes."
National Bureau of Economic Research [NBER]

Effects of the ACA on Health Insurance Coverage and Labor Market Outcomes
"[T]he majority of the increase in health insurance coverage since 2013 is due to the ACA [and] areas in which the potential Medicaid and exchange enrollments were higher saw substantially larger increases in coverage. While labor market outcomes in the aggregate were not significantly affected, ... labor force participation reductions in areas with higher potential exchange enrollment were offset by increases in labor force participation in areas with higher potential Medicaid enrollment."
National Bureau of Economic Research [NBER]


Waiving Federal Insurance Rules: How the Senate Bill Would Allow States to Improve Their Health Insurance Markets
"The Senate health reform bill allows states to take advantage of a broad waiver authority that would enable them to regulate their own health insurance markets. It would give states ample opportunity to pursue more aggressive reforms of the insurance markets. The Senate bill holds open the possibility of securing an even broader range of coverage options and more robust cost control."
Robert E. Moffit, for The Heritage Foundation


The Truth Behind the CBO
"CBO economists are trained to apply Keynesian economic formulas to predict future consumer behavior, but their projections don't often account for common-sense realities, such as the wet blanket effect that Obamacare had on job creation and economic growth. Time and time again, their projections miss the mark because they don't consider economic reality.... [T]he updated CBO baseline for Obamacare showed that the exact same number of people would buy insurance in 2018 under the BCRA as would under Obamacare -- a figure which would be one million more than the 18 million currently on the individual market. More importantly, their projections miss the basic point that people are more likely to purchase an affordable product that meets their needs."
Reps. Mark Meadows and Jim Jordan, in Washington Examiner

Benefits in General

Supreme Court Indirectly Stiffens a Fiduciary Breach Time Limit and Helps ERISA Fiduciaries in the Process
"The Supreme Court appears to have barred equitable tolling under ERISA Section 413's six-year statute of repose for fiduciary breach claims, subject only to well-pled allegations and proof of fraud or concealment.... [T]he Court dismissed as untimely a securities case filed by CALPERS after the statute of repose expired. CALPERS argued that the lawsuit was timely because the same claim was timely asserted in another securities class action that CALPERS opted out of after filing its own case. The Court rejected the CALPERS argument that the timely filing of the class action equitably tolled statute of repose for its individual case." [CalPERS v. ANZ Securities, Inc., No. 16-373 (U.S. June 26, 2017)]
Seyfarth Shaw LLP

Press Releases

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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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