Health & Welfare Plans Newsletter

September 6, 2017

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Managing Leave of Absence
September 12, 2017 WEBCAST
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October 30, 2017 WEBCAST
American Bar Association Joint Committee on Employee Benefits [JCEB]

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IRS Releases Draft of 2017 Instructions for ACA Reporting Forms
"A Form 1095-C is filed for each employee, who was full-time for one or more months during the calendar year and includes details of any health care coverage offered to the employee, reported on a monthly basis. For self-insured plans, Form 1095-C must also be provided to any individuals who enrolled in qualified coverage, which may include non-full-time employees and any covered spouses and dependents."
ADP

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Employee's FMLA Claims Survive Because Employer Miscounted Leave Days Used
"Holidays, spring breaks and office closures may or may not be counted against an employee's 12-week FMLA entitlement, depending on the length of the leave, the length of the holiday/break/closure, and whether the employee would otherwise be required to work on those days or weeks." [Jones v. Maywood Melrose Park Broadview School District, No. 16-9652 (N.D. Ill. July 11, 2017)]
Society for Human Resource Management [SHRM]

Innovation in Health Benefits
"[E]ntrepreneurs have created nearly 100 companies focused on consumer-driven innovations in the fields of telemedicine, education, model innovation, process improvement, and wellness.... These offerings, and many others, are leading the way in improving many outdated health care systems and processes, while also uncovering long-term solutions to the failures of legacy benefit approaches for consumers."
Willis Towers Watson

More Employers Are Requiring Same-Sex Couples to Marry to Receive Health Benefits
"In 2016 ... the number of employers offering health care benefits to unmarried same-sex couples has dropped. Employers report that: 31 percent are providing benefits to same-sex partners in civil unions (down 20 percent from 2014) 48 percent are providing benefits to same-sex domestic partners (down 11 percent from 2014)."
Wolters Kluwer Law & Business

Telehealth Experts See Quality Measurement as Vehicle for Payment Reform, Consumer Choice
"New quality measurements ... could lay the groundwork for telehealth payment reform by giving payers a better grasp on how to define an effective program and expanding access to quality care. More broadly, the framework to measure telehealth quality will help vendors and providers adapt to a larger volume of users and allow the technology to become fully integrated with traditional care models."
FierceHealthcare

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Studies Shed New Light on Provider Networks under ACA Exchange Plans
"60% of provider networks in plans offered in the federally facilitated marketplaces in 2016 included at least a quarter of local physicians.... [C]onsumers' access to broad-network plans remained stable between 2015 and 2016. And consistent with past research, ... large-network silver plans had 6% to 7% higher premiums than extra-small network silver plans, suggesting an upside to smaller networks among price-conscious exchange shoppers."
FierceHealthcare

How Below-the-Radar Mergers Fuel Health Care Monopolies
"Hospitals have gone on a doctor-buying spree in recent years, in many areas acquiring so many independent practices they've created near-monopolies on physicians.... How could this happen? Where are the regulators charged with blocking mergers that have been repeatedly shown to drive up the price of health care? The answer, in many cases, is that they're out of the game."
Kaiser Health News

[Opinion]

The Anthem-Cigna Merger: A Post-Mortem
"In the future, insurers might successfully argue that when they negotiate deep discounts, they are merely 'robbing Peter to pay Paul,' in which Peter is a powerful and profitable provider, and Paul is an employer or employee. This has the flavor of a 'countervailing market power' argument, in which the best way to counterbalance a monopoly seller is through a monopsony buyer.... Economic theory fails to tell us how to strike this balance and even suggests that the two monopolies may act in their combined best interests, at the expense of consumers."
Health Affairs

[Opinion]

Getting Risk Adjustment Right Is Key Under Any Individual Market Scenario
"Risk adjustment is a vital tool in preventing community rating in the individual market from causing harmful risk selection against plans and insurers' consequent risk avoidance. Effective risk adjustment lets insurers compete based on efficiency, networks, medical management, and consumer value, instead of by avoiding uncompensated risks. It also ensures that carriers can offer different levels of coverage, even though plans with the most comprehensive coverage are likely to disproportionately attract unhealthy members."
Health Affairs

Benefits in General

ERISA Advisory Council to Meet September 25
"[An] open meeting of the Advisory Council on Employee Welfare and Pension Benefit Plans (also known as the ERISA Advisory Council) will be held as a teleconference on September 25, 2017.... The purpose of the open meeting is to discuss reports/recommendations for the Secretary of Labor on the issues of [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]

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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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