Health & Welfare Plans Newsletter

August 1, 2017

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Retirement Plan Consultant
QRPS, Incorporated
in NC, Telecommute

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Aldrich Retirement Solutions (formerly AKT Retirement)
in AK, CA, OR

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Webcasts and Conferences

How Financial Advisors Can Ensure Compliance with the DOLís Fiduciary Rule
August 1, 2017 WEBCAST
Bloomberg BNA

Intermediate IRA Training Part 1
August 15, 2017 WEBCAST
Wolters Kluwer

Fundamentals Series 02: Vesting [2017]
September 19, 2017 WEBCAST
FIS Relius Education

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[Guidance Overview]

The Emerging Contours of the Rules Governing Wellness Programs
22 pages. "Whatever the form, these programs share a common need to navigate a shockingly complex legal and regulatory environment.... [A] basic structure for the regulation of wellness programs is still emerging. And the final EEOC rules, once they emerge, will almost certainly include some limitations with which employers disagree ... This article traces the development of the regulation of workplace wellness program design."
Alden J. Bianchi of Mintz Levin, via The Practical Lawyer

[Advert.]

SALGBA National Conference for public sector benefit professionals

Sponsored by SALGBA [State and Local Government Benefits Association]

The SALGBA National Conference will be held April 29 Ė May 2, 2018 in Jacksonville, FL. More information please visit http://www.salgba.org.


[Guidance Overview]

Properly Distributing ERISA Health and Welfare Plan Materials (PDF)
"Most health plan notices must be distributed to employees before or at the time of enrollment.... However, it's important to understand the notice distribution rules to identify a compliant strategy that coordinates with a company's enrollment process. [This] enrollment checklist provides guidance for conveying enrollment information in a compelling and compliant manner."
EPIC

FMLA Limitations Period Is Statutory Right That Cannot Be Waived by Contract
"Refusing to dismiss a fired employee's FMLA interference and retaliation claims, a federal district court in Indiana first found that it was not barred by a six-month contractual limitations period because the longer two-year statutory period was an FMLA right that could not be waived. The court also found that the employee sufficiently pleaded her claims by alleging that she had a serious health condition, about which the employer knew, and she was fired because she had to miss too much work to receive treatment."[McKinley v. Rapid Global Business Solutions, Inc., No. 17-621 (S.D. Ind. July 26, 2017)]
Wolters Kluwer

Will Point-of-Sale Rebates Disrupt the PBM Business?
"Since 2011, the difference between pre-rebate costs (known as gross costs) and post-rebate costs (known as net costs) has grown so that the 'gross-to-net bubble' is worth approximately 10% of all Pharmacy spend -- or about $37 billion.... PBM financial improvements are overwhelmingly -- usually 70% or more -- due to higher rebates instead of better discounts or lower fees.... [S]ince rebates are paid to the plan sponsor, members on High Deductible plans still see higher costs ... [S]ome PBMs are offering 'Point of Sale' rebates, where the member on a High Deductible plan sees their cost immediately reduced by the rebate. This approach benefits the member, yet the plan sponsor needs to approve this approach as it affects net plan costs."
Mercer

PBMs Are Targets in Nevada's Diabetes Drug-Pricing Transparency Bill
"Nevada's Senate Bill 539 places new reporting requirements on pharmaceutical manufacturers and PBMs for drugs that are determined to be essential for treating diabetes. Pharmaceutical sales representatives and some non-profit organizations are also faced with new reporting requirements under the law.... The new law also creates a fiduciary relationship between PBMs and third parties that contract with the PBM for pharmacy benefit management services."
FisherBroyles, via Lexology

[Advert.]

Online Learning Course: Family and Medical Leave Act (FMLA)

Sponsored by International Foundation of Employee Benefit Plans [IFEBP]

Learn how to avoid common administration mistakes, implement best practices and be aware of interactions with other laws.


What Are the Current Costs and Outcomes Related to Mental Health and Substance Abuse Disorders?
"This collection of charts (updated July 31, 2017) explores trends in the prevalence, outcomes, costs, and access to care associated with mental health and substance abuse disorders in the United States and comparably wealthy countries."
The Peterson Center on Healthcare and the Kaiser Family Foundation

[Opinion]

American Benefits Council Statement on Strategies for Improving Parity for Mental Health and Substance Use Disorder Coverage (PDF)
"The 'parity' requirements are not intuitive. 'Parity' compliance requires a complex analysis. It is not a simple 'cross walk' of the same co-pays or the same medical management standards. Because of this, parity is confusing to consumers and challenging for even the most sophisticated plan sponsors and insurers."
American Benefits Council

[Opinion]

Trump Move Would Boost Premiums, Raise Federal Costs, Destabilize Insurance Market
"In threatening to stop making federal cost-sharing reduction payments (CSRs) to health insurers providing marketplace coverage, President Trump falsely claimed that they constitute an insurer 'bailout.' Actually, the federal government must make these payments to compensate insurers for reducing deductibles and copayments for low- and moderate-income marketplace consumers, as the [ACA] requires. Ending the CSR payments would boost premiums for many consumers, raise overall federal marketplace subsidy costs, and likely cause some insurers to withdraw from the marketplaces."
Center on Budget and Policy Priorities

Discussions on
the BenefitsLink Message Boards

Reporting a Drug Plan on a Form 5500 That's Used to Report Various Medical Plans
"Company offers three insurance choices for medical care but an employee can choose only one. Three Schedule A's are filed on one Form 5500. Employees may elect drug coverage also, which is offered as a separate self-insured plan. Can the drug plan be filed with the same 5500 or does the drug plan need to be treated as a separate plan? Moving forward, a megawrap will be in place."
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Lois Baker, J.D., President  loisbaker@benefitslink.com
David Rhett Baker, J.D., Editor and Publisher  davebaker@benefitslink.com
Holly Horton, Business Manager  hollyhorton@benefitslink.com

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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