Health & Welfare Plans Newsletter

September 6, 2018

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All About Leave: From FMLA Requests to Benefit Plans, with ADA Obstacles in Between
September 14, 2018 in MS
Ogletree Deakins

Understanding the Opioid Crisis
September 20, 2018 in GA
Worldwide Employee Benefits Network [WEB] - Atlanta Chapter

Understanding Medicare and Medicare Supplements as Group Retiree Benefit
September 20, 2018 in IL
Worldwide Employee Benefits Network [WEB] - Chicagoland Chapter

Go All the Way with HSA: Everything HDHP / HSA You Need to Know
September 27, 2018 WEBCAST
ABD Insurance & Financial Services

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Deadline for Medicare Part D Creditable/Non-Creditable Coverage Notices Nears

"Plan sponsors that offer prescription drug coverage must provide notices of creditable or non-creditable coverage to Medicare-eligible individuals before each year's Medicare Part D annual enrollment period -- this year, by October 14. The notice obligation is not limited to retirees and their dependents but also includes Medicare-eligible active employees and their dependents and Medicare-eligible COBRA participants and their dependents."
Buck

Association Health Plans: Opportunity Lost, or Ill-Conceived Initiative?

"The new DOL rules open a second path by which associations and other employer groups can, in theory, provide health insurance to small-group members under a large-group insurance contract. Older DOL rules established a still-available path by which insurers could cover small-group employers under a large-group contract issued to an association.... States retain the right to regulate and limit, or even extinguish, association health plans whether formed under the old or the new rules."
Lockton

Las Vegas Metro Chamber to Offer New Association Health Plan

"The chamber ... has entered into an exclusive agreement for a two-year rate with Anthem to offer health insurance plans, some of which will be available as early as Oct. 1, to its members. The chamber will also offer dental, vision and life insurance benefits as part of its insurance package. According to the chamber, the plan will be the only one of its kind in Nevada to offer insurance to sole proprietors, small and medium-sized businesses and larger companies."
The Nevada Independent

Hospital Charges and Reimbursement for Medicines: Analysis of Cost-to-Charge Ratios (PDF)

"[On] average, hospitals charge 479% of their cost for drugs nationwide.... Most hospitals (83%) charge patients and insurers more than double their acquisition cost for medicine, marking-up the medicines 200% or more. The majority of hospitals (53%) markup medicines between 200‑400%, on average. A small share of hospitals -- one in six (17%) -- charge seven times the price of the medicine."
The Moran Company, for the Pharmaceutical Research and Manufacturers of America [PhRMA]

Your CFO May Have a Few Questions about High-Cost Claims

"[1] What are you doing to proactively review and manage drug spending not just in your pharmacy plans, but also in your medical plans? [2] How effective are your clinical management programs? (Which specialty drugs present the biggest opportunity with better management? What is being done to promote the most effective site of care?) [3] When did the company last review the terms of its stop loss coverage? (The use of stop-loss is growing among employers of all sizes -- even the largest. Options to explore include stop-loss collectives and captive programs.)"
Mercer

Timing of Court Ruling on ACA Could Help Democrats in Midterms

"Perhaps with political ramifications in mind, Brett Shumate, the lawyer arguing for the Justice Department in Fort Worth on Wednesday made a point of urging Judge Reed O'Connor not to issue a preliminary injunction putting the law on hold until the case is decided, as the Republican state plaintiffs have asked. He said such a move could cause 'extraordinary disruption' in the [ACA]'s open enrollment period. That begins Nov. 1, just before Election Day."
The New York Times; subscription may be required

Federal Judge Hears Republican-Led States' Challenge to Constitutionality of ACA

"U.S. District Judge Reed O'Connor, a George W. Bush appointee, did not immediately rule on Texas' motion for a preliminary injunction against the [ACA] at the end of the four-hour hearing, telling the packed courtroom he will render his decision 'as soon as I can.' "
Courthouse News Service

[Opinion]

American Academy of Actuaries Letter to CMS on Adoption of Methodology for HHS-Operated Permanent Risk Adjustment Program for 2018 Benefit Year (PDF)

"The proposed rule reissues the previously published 2018 benefit year risk adjustment methodology with additional explanation supporting the use of statewide average premium and the rationale for operating risk adjustment in a budget-neutral manner.... Using statewide average premium makes the risk-adjustment methodology self-balancing. If a plan's own premiums were used under a budget-neutral program, the payments and/or charges would have to be prorated."
American Academy of Actuaries

Benefits in General

Agreements to Individually Arbitrate ERISA Claims After EPIC Systems Corp. v. Lewis (PDF)

"The U.S. Supreme Court's blessing of class and collective action waivers in mandatory arbitration agreements related to employment claims brings some long-awaited clarity to this topic and opens the door to waiver of class actions arising under [ERISA].... Before employers rush to implement mandatory arbitration programs, a variety of factors touching on the legal, social, and practical implications of such a decision merit careful consideration." [Epic Systems Corp. v. Lewis, No. 16-285 (U.S. May 21, 2018)]
Greensfelder

Press Releases

DATAIR Approved for 2018 EFAST2 Filings
DATAIR Employee Benefit Systems, Inc.

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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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