Health & Welfare Plans Newsletter

September 18, 2017

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Affordable Care Act
September 27, 2017 WEBCAST
Employee Benefits Security Administration [EBSA], U.S. Department of Labor

Lowering Specialty Drug Costs Through Copay Assistance and Manufacturer Coupon Programs
October 19, 2017 WEBCAST
University Conference Services

Benefits Briefing 2017
November 2, 2017 in CA
Trucker Huss

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[Guidance Overview]

IRS Permits Employees to Donate Paid Leave to Harvey and Irma Victims, Without the Tax Consequences (PDF)
"To avoid tax consequences to the donating employees, the employer's donations must ... [1] Go to one or more charitable organizations described in Tax Code section 170(c). [2] Go specifically toward the relief of the victims of Hurricanes Harvey and/or Irma. [3] Be made before January 1, 2019."
Lockton

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Court Finds Pregnancy is Not a Pre-existing Condition for Subsequent Disability Claim
"The court concluded that the policy would essentially require a claimant to be in perfect health at the time of obtaining the policy before the policy would benefit the claimant during the succeeding 12-month period, which would be next to impossible for anyone.... [T]he Eleventh Circuit rejected the insurer's 'but for' argument (i.e., that but for the insured's pregnancy, she would not have developed high blood pressure; but for her high blood pressure, she would not have developed preeclampsia; but for her preeclampsia, she would not have suffered a stroke; and, finally, but for her stroke, she would not have become totally disabled) on the basis that it required too many links." [Bradshaw v. Reliance Standard Life Ins. Co., No. 16-11125 (11th Cir. Aug. 31, 2017; unpub.)]
The Wagner Law Group

States Protect Consumers Against Balance Bills
"Beginning July 1st, California is the latest state to enact consumer protection against balance billing.... California is now one of 21 states with some form of consumer protection against balance billing. Unfortunately, many of these 21 states have protections for consumers only in limited situations such as emergency care or on certain types of health plans."
Hill, Chesson & Woody

Sanders Bill Would Outlaw Traditional Employer Health Benefits
"[The single-payer health care bill introduced by] Sen. Bernie Sanders (I-VT) ... would create a national health insurance program (NHIP) and make it 'unlawful' for employers to provide benefits that 'duplicate' the program's benefits. However, the bill appears to allow employers to provide supplemental benefits that cover private contracts employees may enter into with providers, but these benefits may be subject to corporate and individual income taxes as well as payroll taxes."
HR Policy Association

UNC Health Care Set to Merge with Carolinas Healthcare, But Is This Good for Consumers?
"Both systems emphasized that a merger will improve patient access, create efficiencies, provide better outcomes, and lower costs.... Leading healthcare policy experts from Duke, Carnegie Mellon, and Johns Hopkins have expressed doubts that a merger of this magnitude will result in any patient savings."
Hill, Chesson & Woody

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2017 Health Savings Accounts Facts

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Employers Face 4.3% Increase in U.S. Health Benefit Cost in 2018, Highest Since 2011
"Average per-employee health benefit cost is predicted to rise by 4.3% in 2018, the highest since 2011, but the long-term trend remains stable. Employers are struggling to control cost for pharmaceuticals, which will rise more than 7% next year as spending on new specialty medications skyrockets. Following the failure of repeal and replace, the excise tax on high-cost plans will go into effect in 2020 -- and with the tax threshold rising at only about half the current rate of health benefit cost, many employers will be affected."
Mercer

[Opinion]

States See Opportunities for Flexibility in the ACA's Innovation Waiver Program
"The waiver program unquestionably provides an opportunity for coverage and affordability improvements, but one that must be monitored. Efforts to streamline the waiver application process ... may be appropriate. But these steps can't override legal protections designed to ensure waivers result from a deliberative process at the state and federal levels, with sufficient opportunity for public review and input. Just as importantly, state waivers must remain within the current guardrails to guarantee that residents, particularly the most vulnerable, aren't hurt by policy changes."
The Commonwealth Fund

[Opinion]

Why Bernie Sanders' Single Payer Health Care Plan Is a Total Disaster
"[I]mposition of a government health-care monopoly -- be it in the form of the Medicare fee-for-service system, the British National Health Service or the Canadian health system -- has certain economic features in common. First, such a system will rely on broad-based taxation, usually in the form of some sort of payroll tax.... Second, the program costs will surely outrun the official projections.... Third, the program will not be a model of simplicity."
The Heritage Foundation

[Opinion]

Medicare for All: The Two Issues It Must Confront
"The U.S. debate will center on two issues: the relatively high prices we pay for the drugs, devices, technologies, services and facilities we use, and the medical necessity for many services provided for which evidence shows no benefit. What happens to innovation if the federal government uses its muscle to ratchet down what it pays for services and who decides what's necessary or not? And what's the administrative expense necessary to managing our $3.4 trillion expenditure? ... The issue will be whether and how primary and preventive health will be elevated in a U.S. single payer model and how specialty and long-term care are impacted long-term."
Paul Keckley

Benefits in General

Appeals Office to Resume In-Person Conferences
" 'Step one is going to be for field cases to turn the decision back over to taxpayers,' Andy Keyso, acting deputy chief at the [IRS] Office of Appeals, said ... 'Do you want an in-person conference? If so, you'll get it.' Step two is to include campus cases. Currently, Appeals is unable to offer in-person conferences for smaller cases that are worked out of the IRS campuses, Keyso said. Field cases include audits by a field revenue agent or office examiner, while campus cases include correspondence exam cases[.]"
Bloomberg BNA

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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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