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Loan and Distribution Specialist
Gorrelick, Tievy & Abacus
in MD

Benefits Analyst / Consultant - Group Benefits Advisory
Plante Moran
in MI

Account Services Representative
Ingham Retirement Group
in FL

Pension Plan Administrator
American Pension Advisors, Ltd.
in IN

Retirement Plan Consultant
United Benefit Pensions Inc.
in NY

Retirement Plan Consultant
Independent Retirement
in OR, Telecommute

Retirement Plan Administrator
Independent Retirement
in OR, Telecommute

Client Relations Specialist
BlueStar Retirement Services, Inc.
in FL

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HSA's - What's the Recipe for Success
April 26, 2018 in IL
Worldwide Employee Benefits Network [WEB] - Chicago West Chapter

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[Official Guidance]

Text of HHS Notice of Benefit and Payment Parameters for 2019
523 pages. "This final rule sets forth payment parameters and provisions related to the risk adjustment and risk adjustment data validation programs; cost-sharing parameters; and user fees for Federally-facilitated Exchanges and State Exchanges on the Federal platform. It finalizes changes that provide additional flexibility to States to apply the definition of essential health benefits (EHB) to their markets, enhance the role of States regarding the certification of qualified health plans (QHPs); and provide States with additional flexibility in the operation and establishment of Exchanges, including the Small Business Health Options Program (SHOP) Exchanges. It includes changes to standards related to Exchanges; the required functions of the SHOPs; actuarial value for stand-alone dental plans; the rate review program; the medical loss ratio program; eligibility and enrollment; exemptions; and other related topics."
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]


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[Official Guidance]

CMS Issues Final 2019 Payment Notice Rule to Increase Access to Affordable Health Plans
Press release. "The final rule builds on the significant steps already taken by the Administration to promote health care choice and competition and decrease costs." Includes links to related documents:

  • Fact Sheet provides highlights of the final rule.
  • Final Annual Issuer Letter provides operational and technical guidance for issuers seeking to offer in 2019 qualified health plans in the Federally-facilitated Exchanges (FFEs) or the Federally-facilitated Small Business Health Options Programs (FF-SHOPs).
  • Hardship Exemption guidance for individuals who live in counties with no issuers or only one issuer, who will now qualify for a hardship exemption from paying the ACA's penalty for not having coverage. Also allows CMS to consider a broad range of circumstances that result in hardship exemptions.
  • Extended Transitional Policy guidance extends the CMS transitional policy for one additional year.

Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

[Official Guidance]

Text of CMS Key Dates for Calendar Year 2018 (PDF)
April 2018. "This document summarizes key dates for calendar year 2018 regarding some activities and policies that are outlined in other documents[.]"
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

[Official Guidance]

Text of CCIIO Technical Guidance: New Q&A on the Medical Loss Ratio (MLR) Reporting and Rebate Requirements (PDF)
"[B]eginning with MLR reports filed in the 2018 calendar year ... health insurance issuers may elect to use either the same employee counting method as that used for the HHS-operated risk adjustment program or the employee counting method specified in Q&A #18 [in the July 18, 2011 CCIIO Technical Guidance].... [T]he MLR report and calculation must account for risk adjustment program payments and receipts; therefore, we believe it is appropriate to allow issuers the option to elect to use the same counting method for both the MLR and risk adjustment programs."
Center for Consumer Information and Insurance Oversight [CCIIO], Centers for Medicare and Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

[Official Guidance]

Text of CCIIO Technical Guidance: Process for a State to Submit a Request for Adjustment to the Individual Market Medical Loss Ratio Standard (PDF)
"[T]he request must be made by the State's insurance commissioner, superintendent, or comparable official of the State. The request must include the proposed adjusted MLR standard and an explanation of how the adjustment will help stabilize the State's individual market (Section 158.322), as well as the proposed effective date and duration of the adjustment ... In proposing the effective date for the adjustment, States are expected to take in to consideration issuers' ability to factor the adjustment, if and when one is granted, into their respective pricing and market participation decisions.
Center for Consumer Information and Insurance Oversight [CCIIO], Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

[Guidance Overview]

New Guidance on Exemptions from Individual Health Insurance Mandate
"The guidance expands the availability of hardship exemptions for consumers who: [1] live in bare counties (with no marketplace plans available); [2] live in counties with one insurer, [3] object to abortion coverage, and [4] meet other hardship circumstances (such as needing specialty care that would be out-of-network)."
Katie Keith, in Health Affairs

Blue Cross Blue Shield Antitrust Suit Moves Forward
"[The judge ruled that] decades-old agreements made by the insurer to divide its service areas could potentially limit competition and would be reviewed as inherent violations of the Sherman Antitrust Act of 1890 ... The plaintiffs include a number of small employers insured by BCBS along with several healthcare providers which claim the insurer's actions led to higher premiums and lower reimbursement rates." [In re Blue Cross Blue Shield Antitrust Litigation, No. 13-20000 (N.D. Ala. Apr. 5, 2018)]

Development and Testing of Behavioral Health Quality Measures for Health Plans (PDF)
98 pages. "Measures that assessed diabetes care, high blood pressure control, BMI screening, and tobacco screening among the [population having a serious mental illness (SMI)], as well as tobacco screening among the [alcohol and other drug (AOD) use disorder] population, demonstrated strong reliability and meaningful variation across health plans, suggesting they are suitable to differentiate the quality of care.... [C]hallenges for developing and using measures focused on behavioral health populations [include] a lack of evidence to support some measure concepts and difficulty accessing data to calculate measures."
Assistant Secretary for Planning and Evaluation [ASPE], U.S. Department of Health and Human Services [HHS]

Summary of Federal Requirements That Affect Private Health Insurance Plans (PDF)
20 pages. "The first part of this report provides background information about health plans sold in the [private health insurance] market and briefly describes state and federal regulation of private plans. The second part summarizes selected federal requirements and indicates each requirement's applicability to one or more of the following types of private health plans: individual, small group, large group, and self-insured." [Report R45146, Mar. 29, 2018]
Congressional Research Service [CRS]

Voluntary Benefits Now Viewed as Essential Offerings by Employers
"[V]oluntary benefits expected to attract more employer attention over the next few years include: [1] Identity theft protection: 36% of employers currently offer -- could increase to 63% by 2021; [2] Pet insurance: 34% of employers currently offer -- could increase to 57% by 2021; [3] Long-term care insurance: 16% of employers currently offer -- could double to 33% by 2021; [4] Critical-illness insurance: 43% of employers currently offer -- could increase to 71% by 2021; [5] Hospital indemnity: 24% of employers currently offer -- could more than double to 50% by 2021."
Willis Towers Watson


Pharmacy Associations Urge Senate Judiciary Committee to Hold Hearing on PBMs
"The specific areas of concern the committee was asked to investigate [include]: [1] The lack of oversight of PBMs at the federal and state level. [2] One-sided business arrangements that disadvantage pharmacies in their contracts with PBMs. [3] Spread pricing models ... . [4] Self-dealing ... [5] The inherent conflicts of interests of PBMs owning mail-order pharmacies that directly compete with community pharmacies."
National Community Pharmacists Association [NCPA]

Benefits in General

[Official Guidance]

List of IRS-Approved Nonbank Trustees as of April 1, 2018 (PDF)
An entity that is not a bank (or an insurance company in the case of Archer Medical Savings Accounts and health savings accounts) can request to be a nonbank trustee/custodian by applying in writing and demonstrating that certain requirements will be met in order to handle any of the following fiduciary accounts: [1] Archer Medical Savings Account (MSA); [2] Health Savings Account; [3] Qualified Retirement Plan Custodial Account; [4] 403(b)(7) Custodial Account; [5] Individual Retirement Arrangement (IRA); [6] Roth IRA; [7] Deferred Compensation Plan of State & Local Government and Tax Exempt Organizations; [8] Custodial Accounts Coverdell Education Savings Account. [More information is on an IRS web page.]
Internal Revenue Service [IRS]

Two Ways the New DOL Disability Claims Regs Will Change Litigation
"The new regulations allow for the court to substitute de novo review in cases where an insurer failed to strictly adhere to the regulations.... There are several strategic advantages to agreeing to de novo review, depending on your administrative file."
Lane Powell PC

Executive Compensation
and Nonqualified Plans

Should Compensation Committees Seek CEO Input When Deciding CEO Pay?
"[T]he CEO's perspective can be useful ... The CEO should not be present when the compensation committee is making decisions about his or her compensation.... Prior to receiving any input from the CEO, the compensation committee chair, board chair, or lead independent director should set clear expectations about the process and that the committee or board will make the final pay decisions.... Directors should get the CEO's view of his or her individual and company performance."
Meridian Compensation Partners, LLC


Navigating the Pay-Ratio Quagmire
"While pay-ratio information is supposed to be useful to investors, attention needs to be paid to the anticipated reactions to these disclosures by the media, current and potential employees and unions. Anyone who is a shareholder will have access to this information, including employees, who may own stock either directly or through a 401(k) plan. Religious and other groups who own just a single share will also have access to it. And for larger companies, it would be surprising if the media did not focus on 'outliers.' "
Human Resource Executive

Selected Discussions
on the BenefitsLink Message Boards

Cafeteria Plan's Plan Year Not Same as Insurance Policy's Fiscal Year
Cafeteria plan is on a calendar year basis. The client's insurance policies are on a fiscal year basis (5/1 -- 4/30). I know how to file Form 5500 with these policies. A question has come up regarding the "lock in" period. The employees should be able to enroll and make changes for 5/1 open enrollment. The cafeteria plan has a January to December term on their forms and would normally be "locked in" for this period unless they had a Change in Status. What are your thoughts on this, considering the two different periods? I suggested changing the cafeteria plan year to match the insurance policy years to make it less confusing.
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BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2018, 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, 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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