Health & Welfare Plans Newsletter

August 10, 2017

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Plan Document QA Software Tester
ftwilliam.com part of Wolters Kluwer Legal & Regulatory
in WI, Telecommute

Compliance Coordinator / Senior Plan Administrator
Scholz & Friends Enlightened Retirement Group, Inc.
in TX

Jr. Plan Document Associate
Professional Capital Services
in PA

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Webcasts and Conferences

Health Plan Due Diligence for Mergers & Acquisitions
August 29, 2017 in TX
Worldwide Employee Benefits Network [WEB] - Dallas Chapter

Structuring and Negotiating Executive Compensation Packages: Addressing Pay, Severance, Restrictive Covenants
September 19, 2017 WEBCAST
Strafford

Regional Employee Benefits Forum
September 27, 2017 in GA
Southeast Benefits Education Network [SBEN]

New Trustees Institute—Level II: Concepts in Practice
October 21, 2017 in NV
International Foundation of Employee Benefit Plans [IFEBP]

28th Annual Benefits Compliance Conference
November 2, 2017 in TX
SouthWest Benefits Association

Ultimate Cash Balance Seminar
November 2, 2017 in IL
DATAIR Employee Benefit Systems, Inc.

Certificate Program for Non-Professional Fiduciaries
February 11, 2018 in CA
Beyster Institute

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[Guidance Overview]

New York Issues Final Paid Family Leave Law Regs
"[T]he final regulations [1] define 'full-time' employees as those working 20 or more hours per week, and 'part-time' employees as those working fewer than 20 hours per week.... [2] address whether use of paid time off counts towards 'consecutive weeks worked' or 'days worked' for eligibility purposes.... [3] clarify the procedure for computing the rate for weekly leave and the average daily rate for daily leave.... [4] clarify when time off taken by an employee under the [FMLA], an employer's vacation or paid time off policies, or an employer's private paid leave policies, can be counted against PFLBL paid family leave."
Littler

[Advert.]

Online Learning Course: HSA and HRA Basics

Sponsored by International Foundation of Employee Benefit Plans [IFEBP]

This e-learning course will provide an in-depth look at HSA and HRA programs as well as how these programs interact with an HCFSA.


Eighth Circuit Permits Declaratory Judgment Action to Determine Primary Liability for Overlapping Claims as Equitable Relief Under ERISA (PDF)
"[The court] found that an ERISA health plan may file a declaratory judgment action against a private insurer to determine primary liability for unpaid medical expenses incurred by a common insured.... In finding that the ERISA plan was seeking an equitable remedy, the Eighth Circuit noted that because the claims had not been paid, the ERISA plan was not seeking to recover any payments, past or future. Rather, the plan was seeking to enforce its plan terms, which the statute expressly authorizes." [Dakotas and Western Minn. Elec. Ind. Health and Welfare Fund v. First Agency, Inc., Nos. 16-1846, 16-3319, 16-3375 (8th Cir. Aug. 3, 2017)]
Anderson, Helgen, Davis & Cefalu, P.A.

Tips to Create a Culture of Health (PDF)
"Employees are three times more likely to take action to improve their health when their employer promotes a workplace environment that supports health and well-being, or a 'culture of health.' [1] Lead by example ... [2] Offer program choices ... [3] Focus on strategic communications ... [4] Use digital tools ... [5] Reward healthier behaviors ... [6] Measure success."
ActiveHealth Management

How Narrow Networks Can Reduce Plan Costs
"Some health plans create multiple narrow networks to choose from that get progressively narrower.... Another approach is for the insurer to create two tiers of in-network providers -- often called 'designated' and 'non-designated' -- with no out-of-network coverage.... This final kind of narrow network structure, which grew in popularity after the ACA was enacted, is the accountable care organization (ACO)."
Fidelity Health Marketplace

Gaps in Planning Impact Ability to Manage Benefits Costs
"65% of respondents say they spend less than a year developing their annual benefit plan changes.... 81% of respondents selected managing costs as one of their three primary benefits priorities; 50% list helping workers make better benefits decisions.... While four out of five companies say one of their goals is to manage health benefits costs better, 40% do not plan to implement any new cost management programs in the next 12 to 18 months and 50% believe that they've done all they can reasonably do to manage costs.... 54% cite employee morale as their most improved metric from implementing wellness programs."
HR Daily Advisor

[Advert.]

Save $50 – use promo code BLINK2 (not valid for webcast)

Sponsored by World Congress

Executive Forum on On-Site and Near-Site Employee Health Clinics. Employers and health system executives involved in on-site/near-site clinic operation/management, worksite health services, and employee wellness meet to discuss developments and innovations.


The ACA Stability 'Crisis' in Perspective
"84% of the enrollees in the marketplaces -- about 8.7 million people -- receive premium subsidies under the ACA and are insulated from these premium hikes. However, roughly 6.7 million people -- the ones who buy ACA-compliant plans inside or outside the marketplace and aren't subsidized -- will feel the full brunt of premium increases. They'll be hit if the uncertainty is not resolved and the rates do not come down before they are finalized. In many cases, there is as much as a 20 percentage point swing or more in rates depending on whether the CSRs are paid."
Drew Altman, Kaiser Family Foundation, via Axios

Soaring Health Insurance Profits Add Intrigue to Obamacare Debate
"Aetna and Cigna are each up five-fold from March 2010, the month the [ACA] took effect. UnitedHealth is up more than six-fold. In the spring quarter, Aetna earned $1.2 billion in operating profit after taxes, more than double its quarterly average since Obamacare started. Cigna shares are up 31 percent in 2017.... The profits and the market gains are drawing attention, but not all of it welcome. Consumers don't like paying rising premiums and big bucks for medical services that were once fully covered at a time of exploding profits by the companies."
InsuranceNewsNet.com

2018 Projected Health Insurance Exchange Coverage Map, Updated Aug. 9, 2017 (PDF)
[CMS] has posted an update to the Health Insurance Exchanges Issuer County Map. This map is of projected issuer participation on the Health Insurance Exchanges in 2018 based on the known issuer public announcements through August 9, 2017. Participation is expected to fluctuate and does not represent actual Exchange application submissions.
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

[Opinion]

Making the Exchanges More Competitive by Bringing Medicare Into the Fold
"Introducing Medicare wouldn't require significant new spending. It would provide competition in counties with only one or two insurers. And it would ensure that all counties would always have at least one insurance option available. What's more, Medicare could be used to provide new private plan options by allowing Medicare Advantage private plans to offer coverage to nonelderly Americans through the exchanges."
Gerard Anderson, Jacob S. Hacker, and Paul Starr, in Health Affairs

[Opinion]

Suggestions for a Bipartisan Approach on Health Care
"[B]ipartisan discussion should focus [on:] [1] Stabilize the market In the short run.... [2] Improve support for the middle class.... [3] Strike a compromise on medicaid expansion and reform.... [4] Explore alternatives to the individual mandate.... [5] Make consumer-directed health plans available to all individual insurance market enrollees.... [6] Establish automatic enrollment.... [7] Replace the Cadillac Tax with a 'tax cap'.... [8] Improve the ACA's delivery system reform agenda.... [9] Repeal the IPAB."
Joseph Antos and James Capretta, in Health Affairs

Executive Compensation
and Nonqualified Plans

Preference for Annual Say-on-Pay Votes Grows -- For Now
"2017 data indicate a growing preference for annual say-on-pay frequency recommendations and adoptions, although possible future legislation could alter the course of this trend.... [In] 2011, companies that recommended annual and triennial frequencies each represented sizeable portions of all public companies queried. In 2017 ... far more companies are recommending an annual frequency compared with 2011."
Willis Towers Watson

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David Rhett Baker, J.D., Editor and Publisher  davebaker@benefitslink.com
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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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