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[Official Guidance]
Text CMS Q&A on Risk Adjustment Methodology and Rate Filing Deadlines (PDF)
"What changes will be made to the risk adjustment methodology to account for recent rating practices that assume issuers of silver -level QHPs facing increased liability for enrollees in cost -sharing reduction plan variations? ... Given these requests from the States, will CMS provide further flexibility on filing deadlines to permit issuers to account for these rating changes?" [Unnumbered document, Aug. 10, 2017]
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]
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[Advert.]
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Generous Parental Leave Policies Spreading in Law Firms
"Lawyers typically work long hours that don't leave much time for personal pursuits. When they have a baby, however, they may need to slow the pace for a while, and many firms are helping them do that with generous parental leave policies. Large law firms generally offer 16 to 18 weeks of paid leave for mothers and approximately six weeks for fathers ... Many firms also allow lawyers to add paid sick or vacation leave or unpaid leave to extend their time off."
Bloomberg BNA
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Comparing Discounts in a Self-Insured Arrangement
"In a self-insured plan, where 85% or more of cost is the actual payments made for medical claims, one of the most important factors to consider is the network; which one will provide the best access and which will yield the best provider discounts.... It's more critical to look closely at the in-network statistics for noise such as inclusion of repricing networks or the exclusion of certain ancillary providers."
Frenkel Benefits
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With ACA Repeal on Hold, Return of Health Insurance Tax Worries Business Groups
"[T]he 'annual fee,' which insurers call the Health Insurance Tax or HIT, remains on the books. The HIT took a holiday in 2017 thanks to the Consolidated Appropriations Act of 2015, but is scheduled to return next year.... [A] new report by Oliver Wyman estimates that the tax will increase premiums by 2.6% in 2018, and between 2.5% and 2.7% in later years when amounts collected are tied by law to premium trends."
American Journal of Managed Care
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After ACA 'Repeal and Replace' Effort Fails, What's Next for Employers on Healthcare?
"The apparent end of the congressional effort to repeal and replace the ACA through the budget reconciliation process, which would have required only a simple majority vote to pass the Senate, has given rise to discussions about potential bipartisan legislation to stabilize the individual insurance market.... Pressure for bipartisan legislation to fund the cost-sharing reductions, currently the subject of a House lawsuit challenging their validity, will likely continue to rise. This could be the vehicle for additional ACA-related changes."
Littler
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[Opinion]
The Case for Abolishing Obamacare's Individual Mandate
"[T]he individual mandate is not the only way to prevent people from waiting to get sick before purchasing health insurance coverage. Policymakers could allow individuals to opt out of regulatory guarantees for pre-existing conditions or impose waiting periods for those who fail to maintain continuous coverage."
U.S. News & World Report
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Benefits in General
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Employers Are Revamping Benefits Strategies to Outmaneuver Competitors and Become Destination Employers
"[R]educing healthcare costs remains the main driver for offering a wellness program (60 percent) ... The need to appeal to younger workers with parental leave policies has prompted a discussion about supporting the total wellbeing of employees as they try to solve the work-life equation.... [N]early half (48 percent) of employers use auto-enrollment in retirement plans to help employees improve savings, [but] only 37 percent are measuring retirement readiness."
Wolters Kluwer Law & Business
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Seventh Circuit: Plan's Forum-Selection Clause Is Not Precluded by ERISA (PDF)
"With support from the Secretary of Labor, Mathias argues that forum-selection clauses in plan documents are categorically invalid because they deprive plan participants and beneficiaries of the right to select from the menu of venue options offered by Section 1132(e)(2).... [F]orum-selection clauses promote uniformity in plan administration and reduce administrative costs and in that sense are consistent with the broader statutory goals of ERISA.... The forum-selection clause in the Caterpillar plan chooses from among the venue options listed in Section 1132(e)(2), and nothing in the statute makes that choice invalid. Accordingly, we hold that the plan's forum-selection clause is enforceable." [In re Mathias, No. 16-3808 (7th Cir. Aug. 10, 2017)]
U.S. Court of Appeals for the Seventh Circuit
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Discussions on the BenefitsLink Message Boards
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Reservist Becomes Part-time Employee; USERRA Affects Premium Sharing Rate?
"A reservist has been repeatedly called up for 3- and 4-day/week assignments. He has ceased to satisfy the 'regularly works 30 hours/week' requirement for maintaining health plan coverage, i.e., has become a part-time employee. Must we treat each weekly notice as a new period of service and restart the 30-day clock for retaining the eligible employee premium sharing rate? Can we unilaterally classify this pattern of military service as a continuous period of part-time military service and then convert from the active employee rate to the 102% COBRA rate after the employee has lost the active employee coverage and received 30 days of coverage at the active employee rate?"
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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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