Health & Welfare Plans Newsletter

May 16, 2018

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ESOP Administrator
Blue Ridge ESOP Associates
in VA, Telecommute

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JCCS, P.C.
in MT

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Benefit Plans Plus, LLC [BPP]
in IL, MO

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University of Maryland Medical System
in MD

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Webcasts, Conferences

Mid Year Legislative Update
May 24, 2018 in IL
Worldwide Employee Benefits Network [WEB] - Chicago West Chapter

Fringe Benefits for Tax Exempt Organizations
May 30, 2018 WEBCAST
GRC Educators

Employee Health, Benefits, & Well-Being Congress + Expo East
July 30, 2018 in MA
World Congress

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►See 1381 Recorded Webcasts


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[Guidance Overview]

Proposed FAQs on Nonquantitative Treatment Limits under the MHPAEA

"These FAQs cover experimental treatment exclusions, evidentiary standards, prescription drug limits, exclusions for conditions, step therapy, reimbursement rates, network adequacy standards and more. A general exclusion for a particular condition or disorder is not an NQTL. Comments on the FAQs are due by June 22, 2018, and the guidance will take effect when the final FAQs are published."
Willis Towers Watson

[Advert.]

ftwilliam.com -- Enhanced Welfare Documents Module!

Sponsored by Wolters Kluwer

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[Guidance Overview]

San Francisco Revises Rules for Paid Sick Leave Ordinance

"The [ordinance] applies to employees who perform work in San Francisco. The 2007 rules established a 56-hours-working-in-San Francisco coverage requirement for employees working in the city on an occasional basis. However, the new rules remove 'on an occasional basis' and appear to apply the 56-hour threshold generally."
Littler

CMS Unveils Enhanced 'Drug Dashboards' to Increase Transparency on Drug Prices

"The dashboards are interactive online tools that allow patients, clinicians, researchers, and the public to understand trends in drug spending.... In 2012, Medicare spent 17 percent of its total budget, or $109 billion, on prescription drugs. Four years later in 2016, spending had increased to 23 percent, or $174 billion. In 2016, the drugs listed [in this news release] accounted for $39 billion in total spending by Medicare and Medicaid."
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

Fact Sheet: CMS Drug Spending Dashboards

"CMS is highlighting year-over-year changes in per unit spending for individual drugs at both the drug and the manufacturer-level. CMS is also expanding the dashboards to include the majority of drugs prescribed under these programs.... The tools focus on average spending per dosage unit and change in average spending per dosage unit over time. They also display consumer-friendly information on drug uses and clinical indications as well as spending information on manufacturer(s) of the drugs[.]"
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

2019 Health Plan Design Considerations

"So now we wait and watch, and if there are no new developments, the EEOC's GINA and ADA regulations limiting all wellness program incentives will be vacated and will not apply as of January 1, 2019, and only the HIPAA limits as amended by the ACA for the health contingent wellness programs will apply as of January 1, 2019."
Winstead PC

[Advert.]

Employee Health, Benefits, & Well-Being Congress | July 30-31

Sponsored by World Congress

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.


How CBO Defines and Estimates Health Insurance Coverage for People Under Age 65

"[This] report: [1] Describes how CBO defines health insurance coverage ... [2] Explains how the agency estimates the number of insured and uninsured people in that population ... and [3] Describes where CBO obtains the data to estimate coverage, the limitations of those sources, and how the agency adjusts its estimates because of those limitations."
Congressional Budget Office [CBO]

Designing a Wellness Program for Multigenerational Workplaces

"[E]very generation has their own general set of workforce behaviors and motivations, making implementing an employee wellness program a challenge. As employers account for multigenerational diversity in their wellness program, they must consider these five factors. [1] Physical health ... [2] Financial health ... [3] Occupational health ... [4] Nutritional health ... [5] Emotional health."
WellRight

Benefits in General

Dynamex Case Sets Forth New California Standard for Answering the Question: Employee or Independent Contractor?

"[T]he opinion will likely make it considerably harder for some businesses and organizations to justify independent contractor classifications. The opinion's focus on industrial wage orders (and not employment laws arising from other sources) is unlikely to lessen the impact. The decision certainly makes it easier for some contractors to demonstrate misclassification." [Dynamex Operations West, Inc. v. Superior Court of Los Angeles County, No. S222732 (Cal. Apr. 30, 2018)]
Duane Morris LLP

Sixth Circuit Clarifies Importance of Firestone Language for ERISA Plan Interpretation

"[P]lan sponsors should take the following steps as a result of this litigation. [1] Inventory all plans, including qualified, nonqualified, health and welfare, and severance plans, that are subject to ERISA. [2] Review these plans to make sure that they have language that provides the plan administrator with authority to interpret the plans and resolve ambiguities, consistent with Firestone. [3] Ensure that these plans have appropriate claims procedures. If the plans provide benefits upon a determination of disability, make sure that the plans comply with the most recent claims procedure regulations from the DOL. [4] Document compliance with the claims procedures and take steps to avoid conflicts of interest in order to help ensure a favorable arbitrary and capricious standard of review rather than a de novo standard of review." [Clemons v. Norton Healthcare Inc. Ret. Plan, Nos. 16-5063 and 16-5124 (6th Cir. May 10, 2018)]
Porter Wright Morris & Arthur LLP

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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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