Health & Welfare Plans Newsletter

August 2, 2017

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Employee Benefits Jobs


Webcasts and Conferences

Intermediate IRA Training Part 2
August 17, 2017 WEBCAST
Wolters Kluwer

SALGBA Regional Conference
August 28, 2017 in TN
State and Local Government Benefits Association [SALGBA]

CB and DB Plans: Who, When, and Why Plus a Bit of What and How
August 29, 2017 WEBCAST
ASPPA [American Society of Pension Professionals & Actuaries]

Getting to Know Auto Features and How They Enhance Plan Performance
August 31, 2017 WEBCAST
Pension Consultants, Inc.

2017 HERO Forum
September 12, 2017 in AZ
Health Enhancement Research Organization

Determination Letters, Pre-Approved, and Individually-Designed Plans: New Guidance, Tips, and Concerns
September 14, 2017 WEBCAST
American Law Institute Continuing Legal Education Group [ALI CLE]

Unauthorized Practice of Law Issues for Employee Benefits Lawyers
September 19, 2017 WEBCAST
American Bar Association Joint Committee on Employee Benefits [JCEB]

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Minimizing Risk of Out-of-Network Provider Litigation for Sponsors of Self-Insured Medical Plans
"There are several actions that you should take immediately to minimize your risk: [1] Include a legally enforceable non-assignment of benefits clause in your plan document and summary plan description. [2] Provide for a time limit under which a participant may bring a suit for a claim in your plan document and summary plan description. [3] Delegate final claims adjudication responsibility to your third-party administrator in the services agreement and in practice. [4] Ensure that your ERISA plan documents and summary plan descriptions are up-to-date and well-organized."
Stevens & Lee

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Employer Faces Class-Action Lawsuit Because of Vague Language in COBRA Notice
"Roberto argued that [1] Cushman & Wakefield failed to include in the notice the specific date coverage will end, and [2] Roberto cannot determine whether this monthly coverage would end at the beginning or the end of the 18th month and whether it would end on the day that was exactly 18 months in the future. The notice stated that coverage may generally last for up to 18 months, and Cushman & Wakefield contended that the notice need not specify the day on which coverage ends. The court noted that Roberto stated a plausible claim because the regulation's inclusion of the phrase 'termination date' suggests that the employer must identify the day on which coverage ends." [Valdivieso v. Cushman & Wakefield, Inc., No. 17-118 (M.D. Fla. May 18, 2017)]
HR Daily Advisor

Heightened Transparency in Breach Notification Tool Nudges HIPAA Compliance
"The new [HIPAA Breach Reporting Tool (HBRT)] features enhanced search and navigation functions, but its main purpose is much the same as its predecessor -- namely, public access to information about HIPAA breaches affecting 500 or more individuals. Its enhanced functions allow HBRT users to filter through the most recent types of breaches, where the breaches occurred, and the number of impacted individuals. The HBRT ... provides enough information about the type, source and scope of the breach to potentially impact the breaching party's reputation as a provider or vendor."
Drinker Biddle

Benefits Communication: Budgeting, Timing and Evaluating Your Program
"[W]hen it comes to your benefits communication strategy, you want to be able to gather insights on how well it performed. How well did it drive employees to take the action you wanted them to take? ... [M]ake sure you can clearly link your objectives to your evaluation metrics and milestones ... [B]uild out your timeline.... Clarify your budget."
Benefitfocus

After Changing Insurance Carriers, Do Patients Change Physicians and Use Emergency Departments More?
"For patients initially covered by private insurance, changing carriers was associated with a nearly 50 percent increase in new [primary care physician] visits while visits to new specialists fell slightly. The overall decline in new specialist visits was caused by lower use among patients who faced higher deductibles after changing plans. These average utilization changes reflected larger changes in use shortly after the insurance switch that diminished over the subsequent year."
National Institute for Health Care Management [NIHCM]

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Latest Motion in House v. Price Has Significant Impact on Future of CSR Payments
"The decision does not mean that the Trump administration is barred from ending the cost-sharing reduction payments. It does mean, however, that the administration cannot unilaterally stop the CSR payments, dismiss the appeal, and claim judicial imprimatur for its doing so. If the administration does stop making the payments, the states -- or insurers, or possibly consumers -- would be able to sue to require the payments to be made and the injunction entered by the lower court would not be as much of a 'roadblock' to their prevailing." [House v. Price, No. 16-5202 (D.C. Cir. Aug. 1, 2017)]
Health Affairs

Lawmakers to Hold Hearings to Stabilize Insurance Markets
"[T]he Senate Health, Education, Labor and Pensions committee will hold bipartisan hearings on ways to stabilize the [ACA] marketplaces for 2018. The hearings will start the week of Sept. [4] Their aim is to act by Sept. 27, when insurers must sign contracts to sell individual insurance plans on HealthCare.gov for 2018."
National Public Radio

U.S. Employers Expect Health Care Costs to Rise by 5.5% in 2018
"Employers expect health care costs to increase by 5.5% in 2018, up from a 4.6% increase in 2017 ... In the face of these continued cost pressures, including employee affordability, employers plan to step up cost management strategies over the next three years, including evaluation of emerging health care delivery solutions and improved patient navigation and health engagement."
Willis Towers Watson

Covered California Expects 12.5% Average Rate Rise in 2018
"The expected 2018 rate increase is down from 2017's average rise of 13.2 percent, and it includes a one-time increase averaging 2.8 percentage points because of the end of a 'holiday' that has given health plans a break from the tax they are required to pay under the [ACA]."
Kaiser Health News

Benefits in General

[Guidance Overview]

Disability Claims Procedures Must Comply with New Regs Starting in 2018
"These regulations apply to ERISA-covered short-term and long-term disability plans, as well as retirement plans that provide disability benefits that require disability determinations by the plan administrator ... The new disability claims procedures are largely meant to track, with some differences, the enhanced disclosure and claims procedures established for medical claims by the [ACA]. [Here] are the key components that employers and plan administrators should consider."
Proskauer's ERISA Practice Center

ERISA Advisory Council to Meet August 22-24
"[T]he 187th open meeting of the Advisory Council on Employee Welfare and Pension Benefit Plans (also known as the ERISA Advisory Council) will be held on August 22-24, 2017.... The Advisory Council will study the following topics: [1] Reducing the burden and increasing the effectiveness of mandated disclosures with respect to employment-based health benefit plans in the private sector, and [2] Mandated disclosure for retirement plans -- enhancing effectiveness for participants and sponsors."
Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]

Executive Compensation
and Nonqualified Plans

Where Is SEC Headed on CEO Pay Ratio and Other Compensation-Related Issues?
"[T]he SEC recently updated its list of regulatory initiatives that it plans to complete during the second half of 2017, and moved the following [Dodd-Frank] provisions from this agenda to the long-term agenda: [1] Pay versus performance disclosures (Sec. 953(a)); mandatory clawbacks for financial restatements (Sec. 954); [3] hedging policy disclosures (Sec. 955); and [3] compensation prohibitions for covered financial institutions (Sec. 956). This likely means we will not see a short-term move to finalize any of these proposals[.]"
Willis Towers Watson

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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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