Health & Welfare Plans Newsletter

July 19, 2018

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[Guidance Overview]

DOL's Final Rule on Association Health Plans

"[A chart] notes which important [ACA] protections AHPs must meet and compares those requirements to requirements for large groups and small groups. AHPs will also be subject to other federal laws affecting large group plans such as ERISA, the Mental Health Parity and Addiction Equity Act (MHPAEA) and the Consolidated Omnibus Budget Reconciliation Act (COBRA)."
Segal Consulting

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Michigan Repeals Health Insurance Claims Assessment Tax, Introduce More Limited Tax

"The [Insurance Provider Assessment (IPA tax)] will generally be lower than the [Health Insurance Claims Assessment (HICA tax)], and self-insured group health plans will not be subject to the new tax at all.... Managed care organizations (MCOs) would pay a variable- and fixed-rate tax.... Health insurers (which include HMOs) would be subject to a fixed-rate tax of $2.40 per member month for all member months not supported by Medicaid funds.... Prepaid inpatient health plans would be subject to a fixed-rate tax of $1.20 per member month for all member months not supported by Medicaid funds."
Willis Towers Watson

Why It's Time to Put Social Media in Your Open Enrollment Strategy

"[S]even-in-ten Americans use social media to connect with one another, consume news content, share information and entertain themselves.... Drive awareness and/or persuasion with your posts.... Host an 'Ask Me Anything' with your HR team on internal or external social media.... Hashtag important keywords in social media posts."
Benefitfocus

Coverage Denied: Anthem Blue Cross Blue Shield's Emergency Room Initiative (PDF)

32 pages. "Anthem denied 12,200 ER claims in Missouri, Kentucky, and Georgia from July 2017 through December 2017. These denials represent approximately 5.8% of total ER claims submitted from these states during this period.... Anthem overturned the majority of ER claims denials appealed by Missouri beneficiaries each month between July 2017 and November 2017, and the rate of overturned denials increased every month to a high of 73% at the end of this period.... ER claims denial information for January 2018 through March 2018 shows that denials dropped sharply after Anthem implemented several 'enhancements' to its claims review process."
Sen. Claire McCaskill (D-Mo.)

Progress Toward Value-Based Care Slipping

"[O]nly 27 percent of the respondents said the nation has a [value-based care (VBC)]-based healthcare system, down from 29 percent in 2017.... The percentage of respondents who said they believe physicians have the tools needed to succeed with VBC dropped to 42 percent this year from 46 percent last year. The percentage of respondents who said they think doctors lack enough information about their patients to make VBC work jumped to 72 percent this year from 60 percent last year."
HFMA

Employee Must Renew Request for Intermittent FMLA Leave Annually

"The court ruled that, when intermittent leave is taken, an employee is entitled to take leave at different times during the year without continually having to re-qualify for such leave and the leave may be taken over such periods in an amount equal to the FMLA's twelve-week yearly limit. However, ... an employee seeking additional FMLA leave after the expiration of the twelve-month period following the initial exercise of leave must request and re-qualify for FMLA leave." [Feistl v. Luzerne Intermediate Unit, No. 14-491 (M.D. Penn. Apr. 6, 2018)]
The Wagner Law Group

Novartis Joins Pfizer in Freezing Drug Prices

"Novartis, the Swiss drugmaker, said [July 18] that it would not raise prices on its products in the United States for the rest of 2018, joining Pfizer, which delayed its increases last week after President Trump singled out the company for criticism."
The New York Times; subscription may be required

[Opinion]

Mercer Comment Letter to HHS on Blueprint to Lower Drug Prices and Reduce Out-of-Pocket Costs

16 pages. "Rebate reform should be coupled with increased transparency for private payers and flexibility for public payers.... Reforms in the rebate system are needed to get to a value-based model, but any changes must occur across both the public and private sector.... Incentives should be created to increase transparency and flexibility ... Any approach taken must ensure it does not result in cost shifting and that it includes mechanisms to increase competition across the pharmacy landscape."
Mercer

Benefits in General

Supreme Court Lets Stand Holding That Parties Under DOL Investigation Can Expressly Waive Time Limits on ERISA Claims

"The Court declined to review a holding of the US Court of Appeals for the Eleventh Circuit dealing with how much time the DOL has to initiate a civil action under ERISA. In denying a petition for certiorari, the Court left intact a holding that the statutory limit on DOL's window of time to initiate ERISA claims can be waived by the party under investigation." [Secretary, U.S. Dept. of Labor v. Preston, No. 17-10833 (11th Cir. Oct. 12, 2017; cert. denied June 25, 2018)]
Eversheds Sutherland

Employee Benefits Apps Enhance the Employee Experience and Boost ROI

"How can HR be certain employees fully understand, appreciate and utilize their benefits? One way is to introduce an employee benefits app to provide fingertip access 24/7. Mobile access to benefits ... [1] Makes benefits accessible for employees ... [2] Increases employee engagement ... [3] Boosts employee retention ... [4] Consolidates data to contain costs."
Hodges-Mace, via HR Dive

IRS Proposed Regs Modify Electronic Filing Requirement for Information Returns

"Under the proposed regulations, all information returns, regardless of type, must be taken into account to determine whether a person meets the 250-return threshold for the electronic filing requirement. Further, a person required to file information returns electronically would be required to file corrected information returns electronically. The new rules ... will not apply to information returns required to be filed before January 1, 2019."
Wolters Kluwer Law & Business

Executive Compensation
and Nonqualified Plans

SEC Provides Disclosure Relief, Considers Employee Stock Purchase Rules

"The SEC voted ... to provide disclosure relief for certain securities offerings related to employee compensation, and to seek public comment on ways to modernize its rules for employee stock compensation. Rules adopted [July 18] raised the threshold for the aggregate sales price or amount of securities sold in compensatory arrangements that require an issuer to deliver additional disclosures to investors ... from $5 million to $10 million for any 12-month period."
Journal of Accountancy

SEC Eyes Equity Compensation Changes for 'Gig Workers'

"The SEC solicited public comment on potential changes to the regulator's treatment of equity compensation, tied to the emergence of the 'gig economy.'... Explaining the thinking behind its call for commentary, SEC highlights that equity compensation can be an important component of the employment relationship."
planadviser

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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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