Health & Welfare Plans Newsletter

June 6, 2018

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Newport Group
in FL

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RPG Consultants
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[Official Guidance]

Text of CMS MLR Annual Reporting Form Instructions (PDF)

55 pages. "These are the filing instructions for the report to the Secretary required by section 2718 of the Public Health Service Act (PHSA), which includes elements that make up the medical loss ratio (MLR) and the calculation and provision of rebates to enrollees.... These MLR Form Filing Instructions only apply to the 2017 MLR reporting year and its reporting requirements." [Also available: MLR 2017 Annual Reporting Form (XLSX); MLR 2017 Calculator and Formula Tool (XLSM); MLR 2017 System Validations (PDF)]
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

[Advert.]

31st ECFC Annual Symposium

Sponsored by ECFC [Employers Council on Flexible Compensation]

The 31st Annual ECFC Symposium combines networking and professional development to provide those involved in healthcare consumerism with practical advice, education and updates on the regulatory front.


[Official Guidance]

Text of HHS Request for Information: Facilitation of Public-Private Dialogue to Increase Innovation and Investment in Healthcare Sector

"This request for information solicits public comment ... on how to structure a workgroup, or other form of interaction between the Department and such participants in the healthcare industry, in order to best support communication and understanding between these parties that will spur investment, increase competition, accelerate innovation, and allow capital investment in the health care sector to have a more significant impact on the health and wellbeing of Americans. HHS also seeks comment more broadly on opportunities for increased engagement and dialogue between HHS and those focused on innovating and investing in the health care industry."
U.S. Department of Health and Human Services [HHS]

[Guidance Overview]

State of Washington's Paid Family Leave Is Coming in 2019

"[E]ligible employees will be entitled to paid leave up to 12 weeks for their own serious health condition (medical leave) or for family care (family leave), up to 16 weeks combined family and medical leave, and up to 2 additional weeks for certain pregnancy complications. Starting on January 1, 2019, employers must begin remitting premiums and submitting quarterly reports for PFML. Starting January 1, 2020, employees may begin taking PFML leave."
Davis Wright Tremaine LLP

Medicare Trustees Report Shows Lower Spending Projections for Medicare Part D

"[In the 2018 Annual Report to Congress, the Medicare Trustees said] Part D drug spending projections are lower than in last year's report because of higher manufacturer rebates, a decline in spending for Hepatitis C drugs, and a slowdown in spending growth for diabetes drugs.... [T]he Trust Fund will be able to pay full benefits until 2026, which is three years earlier than last year's projections ... [T]otal Medicare costs ... will grow from approximately 3.7 percent of GDP in 2017 to 5.8 percent of GDP by 2038, and then increase gradually thereafter to about 6.2 percent of GDP by 2092." [Also available: 2018 Expanded and Supplementary Tables and Figures (ZIP)]
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

Medicare Financial Outlook Worsens

"[T]he trustees projected lower wages for several years, which will mean lower payroll taxes, which help fund the program. The recent tax cut passed by Congress would also result in fewer Social Security taxes paid into the hospital trust fund, as some higher-income seniors pay taxes on their Social Security benefits. The aging population is also putting pressure on the program's finances."
Kaiser Health News

[Advert.]

Health Savings Accounts (HSAs): Essential Compliance Updates

Sponsored by Lorman and BenefitsLink

June 13 webinar. Avoid legal missteps under ERISA when administering your company's health savings accounts. Discount for BenefitsLink readers.


Some Employers Are Giving More Health Care Help to Low-Wage Workers

"[S]ome employers have moved to 'progressive,' or wage-related, health benefits ... where their lower wage employees pay a smaller share of insurance premiums, deductibles or health account contributions than higher-wage employees do.... More large non-profits seem interested in progressive benefits than corporations do.... There are other complexities: What wage level is fair? Will employees just above the level feel aggrieved or seek a salary cut to reduce their health costs? How complicated is the policy to administer? How will this play out in unionized work forces?"
Drew Altman, via Axios

Reference-Based Pricing: Another Self-Insured Option for Employers

"This method typically does not involve a traditional insurance carrier or provider network negotiating covered services for the plan. Instead, employers will set a fixed limit on the amount a plan will pay for certain health care services.... The fixed limit is often based on a percentage or multiplier of what Medicare would pay the provider. The question then becomes whether the health care provider will be willing to accept these fixed limits, which can be much less than what a traditional insurance carrier or provider network would pay."
Society for Human Resource Management [SHRM]

Chairman's Statement at Hearing: Lowering Costs and Expanding Access to Health Care Through Consumer-Directed Health Plans

"Engaging consumers in their health care spending is critical to reining in our system's ever-increasing costs. [Health Savings Accounts (HSAs)] continue to increase in popularity, now covering more than 21.8 million Americans.... [W]itnesses will tell us about the barriers employers and individuals face when trying to offer or enroll in an HSA-qualified plan. Finally, we will examine the various reform ideas, including many authored by members of this subcommittee, that are aimed at expanding access to HSAs."
Committee on Ways and Means, U.S. House of Representatives

Price Check on Drug Ads: Would Revealing Costs Help Patients Control Spending?

"[W]hat is the right number to use? There is a dizzying array of ways to look at drug prices, including average wholesale and average sales prices.... Would the price be pegged to a monthly cost? A per-dose cost? Or, even more inscrutable, a 'unit cost,' which may not equal a single dose? ... The prices likely would not be what most consumers actually pay. Most patients with insurance typically shell out either a flat-dollar copayment or a percentage of the drug's cost. Some patients get coupons that can reduce their cost to zero."
Kaiser Health News

How to Hack Your Employer's Health Plan

"Take full advantage of your employee health benefits, including claiming money from your flexible spending account before you contribute to it.... Drain your FSA early ... Let your HSA grow, but keep your receipts ... Use COBRA to retire (a little) early."
U.S. News & World Report

Impact on Enrollment and Premiums of Short-Term Health Plans

"Extending the duration of short-term plans has little effect on premiums and enrollment alone. Repealing the individual mandate in addition to extending the duration of short-term plans leads to fewer young people enrolled in ACA-compliant plans ... [W]hen behavioral factors ... are removed, [the authors] estimate that 5 million people will enroll in short-term plans, and ACA-compliant premiums will increase by 3.6 percent."
The Commonwealth Fund

Benefits in General

Big Data and the Role of the Actuary (PDF)

64 pages. "[S]ignificant advances have been made in recent years in the use of Big Data in health and life insurance. Similar advances in the pension area have not been as noticeable. However, it can be expected that over the next decade, all areas of actuarial practice will be significantly impacted by the use of Big Data."
American Academy of Actuaries

Press Releases

NTSA announces update to 'The Source: 403(b) and 457(b) Plan'
National Tax-Deferred Savings Association [NTSA]

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David Rhett Baker, J.D., Editor and Publisher
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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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