Health & Welfare Plans Newsletter

June 13, 2018

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[Guidance Overview]

Rhode Island Releases Final Sick Leave Regs; Effective Date Is Near

"As the state paid sick leave law's July 1, 2018 effective date approaches, the regulations impose additional obligations on various topics -- employer coverage, written policy requirements, sick leave accrual, calculating payment for used sick leave, etc. -- that employers must satisfy for full compliance."
Seyfarth Shaw LLP

[Advert.]

ftwilliam.com -- Enhanced Welfare Documents Module!

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[Guidance Overview]

Association Health Plans, Part 4

"If the proposed rule were issued in its current form, AHPs would be forced to quote basically the same rates for all member employers, and commercial carriers would quote unhealthy large employer groups at higher rates than healthy groups ... Large employer groups with higher-than-average claims would have a financial incentive to join AHPs, and healthier-than-average-groups with lower costs would inevitably choose to purchase health insurance from commercial carriers.... AHPs would then be required to increase premiums across the board, diminishing the ability to attract even moderately healthy groups, resulting in further market segmentation and destabilizing the AHP marketplace."
Benefits Bryan Cave

[Guidance Overview]

Chart of California State and City Paid Sick Leave Laws (PDF)

The state has its own rules and so do seven municipalities, with Berkeley and Santa Monica joining the list in 2017. This 12-page chart describes their requirements.
Fox Rothschild LLP

Ninth Circuit Rejects Challenge to Enforceability of ERISA Plan Anti-Assignment Provision

"The defendant health plan's claim administrator, Aetna, determined that benefits were not payable under the plan because the patient had not satisfied the plan's deductible. Plaintiff brought this action on behalf of its patient challenging that benefit determination. The Ninth Circuit found that the plaintiff's Complaint was properly dismissed by the district court because the patient's health benefit plan did not permit assignments." [Eden Surgical Center v. Cognizant Technology Solutions Corp., No. 16‑56422 (9th Cir. Apr. 26, 2018; unpub.)]
Robinson & Cole LLP

Nevada Supreme Court Rejects Interpretation of 'Health Insurance' That Would Nullify State Wage System

"The Court found employers comply with the [minimum wage amendment's] requirement to offer health insurance to employees and dependents so long as the employer spends 'at least one additional dollar per hour' on the cost of health insurance for each employee and the insurance offered costs the employee no more than 10 percent of the employee's gross taxable income from the employer." [MDC Restaurants, LLC v. The Eighth Judicial Dist. Court, No. 71289 (Nev. May 31, 2018)]
Jackson Lewis P.C.

[Advert.]

Develop a Strong Parental Leave Policy

Sponsored by Lorman and BenefitsLink

July 25 webinar will address the changes taking place in parental leave policies and how to develop a policy which is legally compliant, and which is best suited to help employers recruit and retain employees. Discount for BenefitsLink readers.


Arkansas PBM Law Preempted by ERISA and Medicare Part D

"Act 900 attempted to set a floor to offset an industry trend in which pharmacies accepted reduced reimbursement rates for dispensed prescriptions ... as a result of participating in a PBM's preferred pharmacy network.... Act 900 also included a "decline-to-dispense" option if a pharmacy would lose money on a particular transaction.... The court relied on a recent Eighth Circuit decision in which the court held that an Iowa statute similar in purpose to Act 900 was ERISA-preempted ... The court observed that the law implicitly referenced ERISA by regulating PBMs in administering benefits for "covered entities," which necessarily included health plans." [Pharmaceutical Care Mgmt. Ass'n v. Rutledge, Nos. 17-1609, 17-1629 (8th Cir. June 8, 2018)]
Thomson Reuters Practical Law

Behind the Numbers 2019: Healthcare and Medical Cost Trends (PDF)

38 pages. "[T]hree factors inflating medical cost trend in 2019: [1] Care anywhere and everywhere.... [2] Provider megamergers.... [3] Physician consolidation and employment.... Three factors are tempering the spending increases. [1] Flu impact.... [2] Care advocacy.... [3] High-performance networks.... HRI projects medical cost trend to be 6 percent in 2019 ... The net growth rate in 2019, after accounting for benefit design changes such as higher co-pays and narrow provider networks, is expected to be 5.5 percent."
PwC

Drivers of 2019 Health Insurance Premium Changes (PDF)

9 pages. "Key drivers include the underlying growth in health spending, which will increase premiums relative to 2018. The termination of funding of the CSRs has led to different strategies for building the cost into premiums, and insurers may need to make adjustments for 2019 rates."
American Academy of Actuaries

Employers Hope to Shield Employees from Increased Health Coverage Costs

"Employers continue to be focused on bringing overall costs down by designing medical plans with tighter provider networks, and drug plans with restrictive brand name formularies. But most large employers are trying to avoid raising deductibles and shifting more costs to employees, and planning to absorb the higher costs."
CNBC

Common Drugs May Be Contributing to Depression

"Over one-third of Americans take at least one prescription drug that lists depression as a potential side effect ... About 200 prescription drugs can cause depression, and the list includes common medications like proton pump inhibitors (PPIs) used to treat acid reflux, beta-blockers used to treat high blood pressure, birth control pills and emergency contraceptives, anticonvulsants like gabapentin, corticosteroids like prednisone and even prescription-strength ibuprofen. Some of these drugs are also sold over-the-counter in pharmacies."
The New York Times; subscription may be required

Migraine Impacts Employers in Both Health Care Spend and Lost Productivity

"[F]rom 2011 to 2015, employees treated for migraine had higher health care costs on average than employees without migraine treatments -- a difference of about $2,000 per year. Employees treated for migraine also had an average of 2.2 more sick days per year, at a cost of almost $600 in wages and benefits.... Employees who take short-term disability leave for migraine miss an average of 38 work days per episode--an economic loss to their employer of about $10,400."
Integrated Benefits Institute

Benefits in General

BenefitsLink Message Boards Digest Now Has 1,000 Subscribers

The Message Boards Digest has just passed 1,000 subscribers! Begun six months ago, the free daily email publication has the text of each new topic on the popular BenefitsLink Message Boards. Take a look at a recent, sample issue. To subscribe, just enter your email address on our online form, then click the Subscribe button.
BenefitsLink

Executive Compensation
and Nonqualified Plans

Moving the Bonus Plan Goalposts: Be Smart or Be Sued

"Well-drafted plans and programs include significant employer protections. But some defects can really come back to haunt employers, such as the failure to allow for the impact of a future merger or acquisition, or the omission of a maximum limit. Panera Bread tried to recover from the latter, but lost in the 8th Circuit Court of Appeals because its bonus plan did not clearly reserve a right for Panera to unilaterally modify or terminate the plan." [Boswell v. Panera Bread Co., No. 16-3230 (8th Cir. Jan. 5, 2018)]
The Wagner Law Group

Press Releases

DOL Works With Insurers to Distribute Up to $116 Million to Retirement Plan Participants
Employee Benefits Security Administration [EBSA], U.S. Department of Labor

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Lois Baker, J.D., President  loisbaker@benefitslink.com
David Rhett Baker, J.D., Editor and Publisher  davebaker@benefitslink.com
Holly Horton, Business Manager  hollyhorton@benefitslink.com

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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