Health & Welfare Plans Newsletter

October 5, 2018

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Counsel - Retirement Plans
Nationwide
in OH

Senior Pension Consultant
The Ryding Company
in CA, Telecommute

Retirement Plans Specialist
Benefit Plans Plus, LLC [BPP]
in IL, IN, KS, MO, Telecommute

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You Know Health Benefits Matter. But Did You Know How Much?

"73% of workers report that health insurance is one of the top three most important benefits influencing their employment decisions. That's significantly higher than the 57% reporting that a retirement savings plan is in the top three.... [W]hen asked to name the most critical issues facing our nation, healthcare was picked by more workers -- 26% -- than any other issue. And one-half of workers describe the health care system as poor (22 percent) or fair (28 percent)."
Mercer

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Neutralizing the Effects of 'Conflict of Interest' in Disability Determinations

"[A] structural 'conflict of interest' can occur where the plan administrator has the 'dual role' of administering and funding the plan benefit. Courts typically look for evidence that the structural conflict actually affected the claim handling, which can affect the scrutiny of review. One well-known and easy way to inoculate the effect of structural conflicts of interest is to use 'independent peer reviewers.' " [Green v. Life Ins. Co. of North America (LINA), No. 17-1383 (10th Cir. Sept. 26, 2018)]
Lane Powell PC

California Law Will Put Limits on PBMs, Add Notice Requirements

"The law bars 'gag clauses' that have prevented pharmacies from telling consumers when they would save money by paying cash for a prescription instead of obtaining it through insurance with a higher co-payment. Under the California law, if the customer pays the retail price, the pharmacy can still put the claim through the insurer and credit the amount paid toward the customer's deductible and out-of-pocket maximum."
American Journal of Managed Care

Unauthorized Disclosure of PHI During Filming of TV Series Leads to Nearly $1 Million in HIPAA Settlements

"[T]hese settlements provide important reminders. First, information that identifies, or can be used to identify, individuals may be PHI, even if the individuals are not specifically named.... Second, HIPAA generally does not recognize implied authorizations to use or disclose PHI."
Thomson Reuters / EBIA

Editor's Pick Health Plan Trends (PDF)

11 pages. "[This report] compares the results of MMA-MI's 2018 Southeast Michigan Mid-Market Group Benefits Survey to our national benchmark, Mercer's 2017 National Survey of Employer-Sponsored Health Plans. Mercer reflects large employer data (500 or more employees). Both sources provide specific data on what employers are currently doing to keep health plan costs in check."
Marsh & McLennan Agency LLC

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How Smartphone Apps Could Help Keep Health Records Accurate

"[W]hile patient harm is the primary risk posed by inaccurate records, cost is no small consideration. The Office of the National Coordinator for Health Information Technology reported that each instance of a misidentified record cost the Mayo Clinic roughly $1,200 -- and that's just within the Mayo system. These administrative costs are magnified when data are exchanged on a nationwide scale."
RAND Corporation

Benefits in General

The Fiduciary Duty of Loyalty (PDF)

"While there is consensus chat the duty of loyalty is derived from the common law of trusts, and the restatement of trusts states that the duty of loyalty is an objective standard, case law has generally taken a different approach based upon the language of ERISA Section 404(a)(l) (which is framed in terms of acting for an exclusive purpose). Note, however, there was a recent difference of opinion on this issue between District Courts."
The Wagner Law Group

Selected Discussions
on the BenefitsLink Message Boards

ACA/PHS Act Section 2706: Provider Non-Discrimination Rule Ever Enforced?

Has anyone ever heard of any enforcement of this provision by any agency? It's well established that no private cause of action exists to enforce it. I can't find that HHS has ever taken enforcement action to enforce it. In theory, being out of compliance triggers the excise tax under IRC 4980D, but I can't find that IRS has ever sought it, or any guidance from IRS. Has there been any consequence for failing to remove exclusions of certain types of provider from a self-insured health plans?
BenefitsLink Message Boards

What Kind of In-Office Wellness Program Do You Provide?

I'm curious to hear from everyone what kind of wellness programming/workshops you offer at your workplace. Chair massage, yoga, something else?
BenefitsLink Message Boards

Press Releases

DOL Seeks to Amend Complaint to Protect Participants And Beneficiaries of Failing Multiple Employer Welfare Plan
Employee Benefits Security Administration [EBSA], U.S. Department of Labor

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David Rhett Baker, J.D., Editor and Publisher  davebaker@benefitslink.com
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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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