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Health & Welfare Plans Newsletter May 14, 2018 |
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Jobs
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Webcasts, Conferences New ERISA Disability and Claims Appeal Regulations in Effect after April 1: What to Do Right Now to Comply
Is Your Nonqualified Plan Up to Par?
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Discussions |
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This Newsletter:
BenefitsLink Retirement Plans Newsletter:
Message Boards Digest:
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Experienced Defined Benefit Plan Administrator|
[Official Guidance]
45 pages. "The blueprint covers multiple areas including, but not limited to: [1] improving competition and ending the gaming of the regulatory process, [2] supporting better negotiation of drug discounts in government-funded insurance programs, [3] creating incentives for pharmaceutical companies to lower list prices, and [4] reducing out-of-pocket spending for patients at the pharmacy and other sites of care.... HHS seeks to identify when developed nations are paying less for drugs than the prices paid by Federal health programs, and correct these inequities through better negotiation.... Through this request for information, HHS seeks comment from interested parties to help shape future policy development and agency action."
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[Advert.]
Health Savings Accounts (HSAs): Compliance Obligations Under the Internal Revenue Code and ERISA
May 30 webinar. Complex employer health care offerings can make it difficult to determine HSA eligibility. This webinar will help health plan administrators navigate this sometimes treacherous terrain. Discount for BenefitsLink readers. |
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[Guidance Overview]
44 pages. "HHS has proposed a comprehensive blueprint ... identifying four key strategies for reform: [1] Improved competition; [2] Better negotiation; [3] Incentives for lower list prices; [4] Lowering out-of-pocket costs. HHS's blueprint encompasses two phases: [1] actions the President may direct HHS to take immediately and [2] actions HHS is actively considering, on which feedback is being solicited."
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[Guidance Overview]
CMS Pushes for Hospital Price Transparency in Proposed Rule "The Proposed Rule ... provides that beginning January 1, 2019, CMS will ... require hospitals to make available a list of their current standard charges via the Internet in a machine readable format, which requirement a hospital may satisfy by publishing its chargemaster (i.e., a hospital's comprehensive list of services and charges billable to a hospital patient).... [T]he Proposed Rule further requires hospitals to update the standard charges they publicize at least annually."
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[Guidance Overview]
Departments Ramp Up Mental Health Parity Compliance and Enforcement Efforts "Plans with carve-out prescription drug benefits should ensure that vendors are aware of, and are administering benefits in compliance with, parity requirements.... Plan sponsors might want to review plan language for clarity on whether particular conditions are described as MH/SUD conditions.... Plans must respond to disclosure requests within 30 days of the plan's receipt of the request. Failure to comply with a disclosure request within this timeframe may result in a penalty of $110 per day."
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[Guidance Overview]
New Jersey Governor Signs Mandatory Sick Leave Bill Into Law "[T]he Act defines the term 'employer' broadly to encompass any entity that employs workers within the state ... There is no minimum number of employees an employer must employ before being covered by the Act. Employees of temporary help service firms will accrue sick leave based upon their total time worked on assignment with the firm, rather than separately for each client to which they are assigned by the firm."
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[Advert.]
Employee Health, Benefits, & Well-Being Congress | July 30-31
Who is moving the needle on employee health care? This event convenes HR, benefits, and wellness executives, TPAs, Brokers, Payers, and Providers to learn and discuss strategies to enhance employee health and improve outcomes while reducing costs. |
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Takeaways from Trump's Plans to Lower Drug Prices "[K]ey proposals unveiled on [May 10:] [1] Lower drug prices for older people ... [2] Persuade other countries to pay more ... [3] Require drug ads to include the price ... [4] Ban 'gag clauses' for pharmacists ... [5] End the patent games."
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'Eliminating the Middlemen': Trump Takes Aim at PBMs in Drug Pricing Speech "The administration is questioning the current rebate system for PBMs, aiming to restrict its use in the future, and seeking formal input on how to restructure it ... [HHS Secretary Alex Azar] said the administration has 50 relevant policy proposals in the works, though some are being implemented as immediate actions while others are under consideration and headed for a public comment period."
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"The Ninth Circuit recently dealt another major blow to healthcare providers that attempt to bring suits as assignees of their individual patients, holding that an ERISA plan's anti-assignment provision bars a provider's suit even where the plan mistakenly told the provider that no such anti-assignment provision exists." [Eden Surgical Center v. Cognizant Technology Solutions Corp., No. 16‑56422 (9th Cir. Apr. 26, 2018; unpub.)]
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Consumers Brace for Premium Hikes While Lawmakers Grasp at Remedies "The heightened political rhetoric comes after the first two states unveiled insurance company premium requests for policies on the individual market for 2019. These are not final rates, but they give an idea of what premiums for next year might be for people who don't get insurance through their job or the government and buy their own coverage on the individual market."
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Wisconsin's Reinsurance Waiver Deemed Complete "Wisconsin proposes to develop and implement a state-based reinsurance program -- the Wisconsin Healthcare Stability Plan (WIHSP) -- for its individual insurance market. WIHSP, if approved, would begin in the 2019 plan year and reduce premiums by 10.6 percent (relative to what premiums would have been in the absence of the waiver). It would also stabilize enrollment in the individual ACA market at about 203,000 enrollees in 2019, representing an increase of about 0.8 percent relative to 2018."
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[Opinion]
Fixing Health Insurance: Interview with Mark Pauly "Most successful ... has been covering about half of the formerly uninsured. That, presumably, was a primary reason [the ACA] got passed in the first place. The Achilles' heel ... has been its treatment of risk variation in the individual insurance market.... [T]he end state of the exchange will probably be a pool of mostly low-income, high-risk people.... [T]he inclusion of community rating ... has caused all sorts of unnecessary mischief, which has resulted in both political blowback and difficulty of market functioning in the exchange."
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Benefits in General |
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[Guidance Overview]
Independent Contractor or Employee? Precautions for California Employers "[1] The burden to establish that a worker is an independent contractor, and not an employee, is on the employer. [2] Avoid engaging a person as an independent contractor to carry out a core business function or to perform services that are the same as those performed by employees. [3] If engaging a person as an independent contractor ... [m]ake certain that the worker actually controls the means and method of achieving the employer's objective."
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"The crucial ambiguity in the Plan is whether the 'early retirement reducers' apply to the Plaintiff-Retirees. The district court applied contra proferentum to find in favor of the Retirees.... The [Sixth Circuit] explained that, as a practical matter, Firestone deference and contra proferentum cannot be applied to the same case without contradiction. First, Firestone deference must include the ability to choose between two reasonable interpretations of the Plan, but this is the precise situation in which traditional contra proferentum operates against the drafter. " [Clemons v. Norton Healthcare Inc. Ret. Plan, Nos. 16-5063 and 16-5124 (6th Cir. May 10, 2018)]
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The Evolving Definition of Work-Life Balance "Work-life balance means something a little different to everyone.... [T]he knowledge and approach of work-life balance has been constantly evolving, and it might be helpful for employers to identify the difference in opinions among the Baby Boomers, Generation X and Millennials."
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The Lifetime Medical Spending of Retirees "[At] age 70, households will on average incur $122,000 in medical spending, including Medicaid payments, over their remaining lives. At the top tail, 5 percent of households will incur more than $300,000, and 1 percent of households will incur over $600,000 in medical spending inclusive of Medicaid. The level and the dispersion of this spending diminish only slowly with age."
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Executive Compensation |
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[Guidance Overview]
SEC Issues FAQs on Compensation Plan Proposals Included in Proxy Statements "The SEC has issued a series of frequently asked questions, ... referred to as Compliance and Disclosures Interpretations ... on proxy statements and proxy solicitations. In general the C&DIs replace previously issued telephone interpretations ... [S]ome of the more interesting C&DIs address Item 10 of Schedule 14A which sets forth disclosure requirements when compensation plans are submitted for shareholder approval."
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Selected Discussions |
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Mandatory Elections Through a 125 Plan and Collective Bargaining? Can an employer require employees to take a certain election through a 125 plan? If it's a requirement, then isn't it no longer an "election"? The employer with the union and the CBA can create the cafeteria menu, but can they force an employee through the cafeteria line?
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Press Releases |
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Former Owner of North Carolina's House of Lights Ordered To Pay $1,639,983 in Restitution to Profit-Sharing Plan
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Connect
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BenefitsLink.com, Inc.
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Lois Baker, J.D., President
David Rhett Baker, J.D., Editor and Publisher
Holly Horton, Business Manager
BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2018 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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