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[Official Guidance]

Text of CMS Technical Guidance 01-2018: Standards for Self-Insured Non-Federal Governmental Health Plans and Health Insurance Issuers Offering Group and Individual Health Coverage Using the HHS-Administered Federal External Review Process (PDF)

"This Technical Release replaces the technical guidance issued January 11, 2017 with updated notice requirements for self-insured non-Federal governmental health plans and health insurance issuers offering group and individual health coverage using the [HHS]-administered Federal external review process.... CMS is requiring that all plans and issuers participating in the HHS-administered Federal external review process update notices accordingly in order to properly inform policyholders and beneficiaries of their three options for requesting an external review."
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]


Earn Your Certificate in Benefits and Compensation This Fall

Sponsored by International Foundation of Employee Benefit Plans [IFEBP]

The Certificate in Benefits and Compensation program provides a survey of these primary areas, including terminology, the historical and legal environment, plan design, and trends and strategies needed to effectively manage plans and the bottom line.

[Official Guidance]

Draft 2018 Instructions for IRS Forms 1094-C and 1095-C (PDF)

18 pages, Sept. 11, 2018. "Employers with 50 or more full-time employees (including full-time equivalent employees) in the previous year use Forms 1094-C and 1095-C to report the information required under sections 6055 and 6056 about offers of health coverage and enrollment in health coverage for their employees."
Internal Revenue Service [IRS]

[Guidance Overview]

Michigan Adopts Paid Sick and Safe Time Law

"Different standards will apply depending on whether an employer has 10 or more, or fewer than 10, individuals on its payroll during any 20 or more calendar workweeks in either the current or preceding calendar year.... Employees can use leave for themselves or to care for or assist a ... child, grandchild, grandparent, parent, sibling, spouse, and any other individual related by blood or affinity whose close association with the employee is the equivalent of a family relationship."

Avoiding Unexpected Liability for Former Employees' Medical Expenses

"Assuming the allegations as true, one might be inclined to side with Hager, in which case the lesson of the case would be a pedestrian common sense one: don't send notices of plan termination to former employees who have elected COBRA to the wrong address. What makes this case interesting is the tortuous route the Court had to take to get to this result. In so doing, the Court meticulously parsed the statute, thereby, in our view, making it noteworthy." [Hager v. DBG Partners, Inc., No. 17-11147 (5th Cir. Sept. 6, 2018)]
Mintz Levin

Second Circuit: Plan Limitation on Mental Health Benefits Applies Even If Bi-Polar Disorder Is Biological Illness (PDF)

"[R]egardless of whether bipolar disorder has a physical cause, Hartford's classification of Kim's disability as a 'Mental Illness' and its subsequent denial of her claim for continued benefits -- in reliance on the DSM and in accordance with the explicit terms of the Policy -- was 'plainly reasonable.' " [Kim v. The Hartford Life Ins. Co., No. 17-2122 (2d Cir. Sept. 7, 2018, unpub.)]
U.S. Court of Appeals for the Second Circuit

Average Health Care Deductible Nearly $1,500 for Individual Coverage Through an Employer Plan

"[F]or employees with deductibles, the average they can expect to pay is $1,491 with single coverage and $2,788 with family coverage.... [Of] those who have single coverage health insurance: 7% have no deductible; 16% have a deductible under $500; 19% have a deductible between $500 and $999; 46% have a deductible between $1,000 and $2,999[.]"
International Foundation of Employee Benefit Plans [IFEBP]

More Than Half of Americans Misuse Prescription Drugs

"While the rate remains unchanged from 2016, there was an observed shift from prescription opioids to other drugs and drug mixing.... Of those who misused drugs, 45% tested positive for nonprescribed or illicit drugs in addition to their prescribed drugs, compared with 43% in 2016."
American Journal of Managed Care

House to Consider Changes to ACA Employer Provisions

"The Save American Workers Act of 2018 proposes to: Suspend the ACA's employer mandate for 2015 through 2018.... Establish a 40-hour workweek for determining full-time status under the ACA's employer mandate.... Establish a 40-hour workweek for determining full-time status under the ACA's employer mandate."

Hospital Groups Sue HHS Over Long-Delayed 340B Drug Discount Program Final Rule

"Four national healthcare organizations have filed suit against HHS over the long delay of its final rule that would implement price ceilings in the 340B drug discount program. The rule, should it be finalized, would set the price ceilings and impose civil penalties on pharmaceutical companies that knowingly overcharge hospitals in the program. The Department of Health and Human Services delayed the rule for a fifth time in June, after it was initially issued in January 2017."

Editor's Pick The Secret Drug Pricing System Middlemen Use to Rake in Millions

"In an analysis of pharmacy and middleman markups in Medicaid plans around the country, Bloomberg found big spreads on dozens of drugs, and evidence that the spreads are growing. For many widely used generic drugs, state insurance plans are collectively paying millions of dollars in fees to private companies."


Half a Century of the Health Care Crisis -- and Still Going Strong

"Health care costs had been an on-and-off concern for decades when, on July 10, 1969, President Richard Nixon proclaimed, 'We face a massive crisis in this area.' Without prompt administrative and legislative action, he added at a special press briefing, 'we will have a breakdown in our medical care system.' ... Leaders of what was then the Department of Health, Education, and Welfare (HEW) added ... that what the administration planned was nothing less than 'drastic measures' to cut costs and improve quality via 'revolutionary change in the medical care system.' That is what every single administration since then has promised, in one form or another, as national health expenditures have grown from 6.9 percent of GDP in 1970 to 17.9 percent in 2016[.]"
Michael L. Millenson, in Health Affairs

Benefits in General

AICPA Working Draft of Chapter on Multiemployer Benefit Plans (PDF)

149 pages. "[This working draft has] been developed by the AICPA Multiemployer Plans Task Force to assist preparers of multiemployer plan financial statements in preparing [those] financial statements in conformity with accounting principles generally accepted in the United States of America (GAAP) and to assist auditors in auditing and reporting on such financial statements in accordance with generally accepted auditing standards."
American Institute of Certified Public Accountants [AICPA]

Press Releases

Grants Awarded for the Federally-Facilitated Exchange Navigator Program
Centers for Medicare & Medicaid Services [CMS]

Most Popular Items in the Previous Issue

Does Your Health & Welfare Plan Need a Trust? (PDF)
Kathleen Salas Bass and Sherrie Boutwell, via Journal of Pension Benefits

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BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2018, 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, 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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