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Health & Welfare Plans Newsletter August 31, 2018 |
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Jobs
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Webcasts, Conferences Annual Enrollment Boot Camp: Quick-Hit Strategies to Get You in Benefits Shape
What's Driving Claim Costs and Employer Solutions
New Jersey's Looming Paid Sick Leave Law: Are You Ready?
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Discussions |
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This Newsletter:
BenefitsLink Retirement Plans Newsletter:
Message Boards Digest:
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Retirement Services Analyst|
[Guidance Overview]
DOL Opinion Letter Addresses Whether Wellness Activities Constitute Compensable Time "[Opinion Letter FLSA2018‑20] reiterated that its analysis was only of activities in which participation was strictly voluntary: it was up to the employee to decide whether to participate or in which activity they may want to participate; none of these activities were related to an employee's orientation or job duties; and the employer did not derive a financial benefit if an employee participated in any activity."
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[Advert.]
Check Out the Preconference Sessions for the 28th Annual HBCE!
Don't miss out -- attend the preconference sessions HBCE! We are excited to offer three preconference options for the 2019 program. Start your journey to earning a certificate, and gain important knowledge for your organization. Register today! |
![Sponsored by Health Benefits Conference & Expo [HBCE]](https://benefitslink.com/bnrs/2017/HBCE_earlybird_top.jpg "Sponsored by Health Benefits Conference & Expo [HBCE]")
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[Guidance Overview]
"[A recent IRS information letter] restates the special transition rule from Notice 2015‑87 allowing employers subject to the SCA to include employer cash-out payments as part of the employee's required contribution for purposes of determining the affordability of such coverage under Code Section 4980H(b)."
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"[E]ven if an insurer incorrectly denied an insured's claim, it does not necessarily follow that the insured has continued to be disabled through the date of trial. Thus, a jury must determine not only if an insured was disabled when an insurer denied his or her claim, but also whether the insured remained continuously disabled from the date of that denial through the date of trial.... Insurance counsel, however, frequently allow these two time periods to conflate so that when deciding whether an insurer erroneously denied a claim, jurors are allowed to consider evidence that did not even exist at the time of the claim denial. This is a mistake."
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Three Easy Steps to Avoid Unnecessary Claims Litigation "[1] Understand your plan document regarding descriptions of each benefit plan. Carefully consider language used to draft such a keystone document.... [2] Ensure your claims procedure for each plan is followed and regularly reviewed ... [3] If you receive a claim appeal, be meticulous in its review -- follow it to its end, making sure to compare plan document language with the nature and circumstances surrounding the claim."
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"[House] Energy and Commerce Committee leaders ... sent letters to various Pharmacy Benefit Managers (PBMs) to better understand the role of PBMs in the drug supply chain.... The leaders [wrote] 'Based on the testimony we received in our hearings and an ongoing examination across the drug supply chain, we request your assistance in order to better understand the relationship of a drug's list price with the price negotiated and the different incentives that are offered to encourage reductions in list price.' "
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[Advert.]
What Employers Need to Know About ACA 'Pay or Play' Mandates
Sept. 18 webinar will clear up any confusion about the ACA 'Pay or Play' mandates and help employers to avoid penalties. Discount for BenefitsLink readers. |
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A Formula for Choosing the Right PBM for Your Benefits "A PBM should actively manage the drug formulary by excluding unnecessary medications and putting hard edits on others. The right PBM reviews how certain drug classes, such as opioids, are prescribed. They manage high-cost drugs and create strategies to prescribe them only when necessary, and they manage prescribers."
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You'll Never Guess Which Company Is Reinventing Health Benefits "Comcast, which spends roughly $1.3 billion a year on health care for its 225,000 employees and families, has steered away from some of the traditional methods other companies impose to contain medical expenses. It rejected the popular corporate tack of getting employees to shoulder more of the rising costs -- high-deductible plans, a mechanism that is notorious for discouraging people to seek medical help."
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How Can Accreditation Programs Promote Health Plan Value? "Health plan accreditation programs can help payers highlight offerings that deliver on key quality, efficiency, and beneficiary satisfaction measures.... [P]ayers can supplement their current performance efforts with specialized accreditation programs that display a health plan's unique features and expertise for addressing specific healthcare concerns."
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Breaking Down the Breakdown of Private Exchanges (PDF) "For some companies, private exchanges have performed as promised, and for others they have failed to meet expectations. Over the last three years, many companies in the latter category have decided to move away from private exchanges, instead opting for a combination of a broker and software partner.... By breaking down the parts of an exchange, companies can create solutions that deliver the advantages of a private exchange, in addition to offering the flexibility and control a best-in-class broker relationship and software platform can provide. This white paper discusses issues and missed expectations by private exchanges."
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Microsoft Requiring Suppliers to Offer Paid Parental Leave "Over the next 12 months we will work with our U.S. suppliers to implement this new paid parental leave policy. It will require that suppliers offer their employees a minimum of 12 weeks paid parental leave, up to $1,000 per week. This change applies to all parents employed by our suppliers who take time off for the birth or adoption of a child. The new policy applies to suppliers with more than 50 employees and covers supplier employees who perform substantial work for Microsoft."
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[Opinion]
What's Next After the Affordable Care Act? "As the current marketplace for health insurance benefits continues to evolve, both consumers shopping for individual coverage and businesses looking at group plans need to understand what they are purchasing regarding deductibles, co-pays, scope of benefits, and provider networks,among many issues. Should the ACA ultimately crumble, the collateral effects will impact not only those who first obtained insurance coverage because of ACA but those who receive health insurance from their employers."
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Selected Discussions |
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Trouble Handling Demutualization Proceeds of Terminated Plan; Employees Already Gone Employer had Trigon/Anthem health insurance for many years. It never received shares in the demutualization process; they found their way to the state unclaimed property fund, which eventually sold them for cash, and just recently distributed the cash to the employer. Problem is, the employer terminated all its employees several years ago. Some now work for a related entity over which the employer has no control. The employer getting the demutualization proceeds has no employees, no group health plan, etc. At least some, but not many, of the demutualization proceeds were from employee premium payments. Many were from the 1990s and payroll records have been lost/destroyed. The DOL guidance doesn't seem to squarely address the situation. There are cases where funds from a terminating welfare benefit plan are transferred to another welfare benefit plan covering the same employees, but I
can't find anything where the plan was out-and-out terminated and no employees remain. Regs say upon termination of a welfare benefit plan, the remaining assets will be distributed in accordance with the plan. Here it was just a group health and dental policy. Is it a reversion if the employer takes the money back? Subject to excise tax? A PT? Is the only option track down former employees and give them a check for an arbitrary amount? Can we give the money to the other related employer to use toward these employees' current premiums/benefits?
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Most Popular Items in the Previous Issue |
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A Six-Step Solution to the PBM Problem
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Another Court Scrutinizes Plan Exclusion for Wilderness Programs
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Connect
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BenefitsLink.com, Inc.
1298 Minnesota Avenue, Suite H
Winter Park, Florida 32789
(407) 644-4146
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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