Health & Welfare Plans Newsletter

November 6, 2018

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[Guidance Overview]

Massachusetts Unveils New Employer Health Insurance Reporting Requirement

"The new HIRD form collects employer-level information about employer-sponsored health plans, in order to assist MassHealth in identifying members who can participate in such plans and who may be eligible for premium assistance from MassHealth. In most instances, the HIRD form will eliminate the need for employers to complete a separate premium assistance application for the employee. Unlike the old HIRD forms, there is no individualized information and employees need not complete a form."
The Wagner Law Group

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Dependent Verification: Why You Need a Third-Party Partner

"[M]any employers shy away from a dependent verification process for fear of workload increases, employee scrutiny, and a never-ending project. In reality, a dependent verification is a phenomenal opportunity for the employer to change the narrative and truly convey how much they care about not only keeping the cost down but ensuring their valuable employees aren't stuck with a big claim due to lack of education around their benefits."
Hodges-Mace, via HR Technologist

Checklist for Evaluating Business Associate Compliance with HIPAA

"[1] Verify that a Business Associate Agreement is in-place with all service providers that handle PHI. [2] Designate a security officer. [3] Perform a Security Risk Assessment. [4] Implement administrative, physical, and technical safeguards to protect PHI. [5] Identify and report breaches of security. [6] Develop policies for HIPAA / HITECH compliance. [7] Impose disciplinary actions where employees or vendors violate HIPAA / HITECH obligations. [8] Maintain HIPAA and HITECH relevant documentation for such periods as required by law."
Bryan Cave Leighton Paisner

PCORI Fee Increases to $2.45 per Covered Life

"The PCORI fee will no longer apply for policy and plan years ending on or after Oct. 1, 2019. The final filing for a calendar year plan will be July 31, 2019, with respect to the 2018 plan year."
Lockton

Presenteeism in the Workplace

"How to change the culture: [1] Provide a good healthcare benefits package.... [2] Educate employees about the dangers of coming to work sick.... [3] Develop a workplace policy on presenteeism.... [4] Strive to boost employee morale.... [5] Take disciplinary action (when necessary).... [6] Set a good example."
DataPath

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Defining Pre-Existing Conditions in an Era of Genetic Testing

"The combination of electronic health records, wearable devices tracking health data, and improved genetic testing will lead to a massive influx in biometric information accessible by your health care providers and insurers. Vast quantities of available data blur the distinction between asymptomatic and not, and non-discrimination laws will need to account for this ambiguity.... The lack of clarity will become an issue for pre-existing conditions coverage as well."
The Brookings Institution

2019 Global Medical Trends Survey Report

"For 2019, the projected global, weighted medical trend is 7.6%, which continues to outstrip general inflation by a factor of more than 2:1 on a global basis. However, this value is just 0.5% higher than the reported value for 2018, with no increase at all expected in Europe.... The largest increases are expected to be seen in the Middle East and Africa where the regional trend increased from 8.5% to 9.9% in 2018 and is projected to rise to 12.4% in 2019."
Willis Towers Watson

CVS Expects to Close Aetna Deal by Thanksgiving, Floats 'Simpler' PBM Models

"CEO Larry Merlo said the company has already 'reached an agreement on all material terms' with California regulators, and ... that CVS was 'pretty far down the road' with New York regulators ... As part of the integration, CVS is planning to launch concept stores early next year that will target Aetna's membership and focus on managing chronic illnesses, extending primary care and reducing avoidable hospital admissions."
FierceHealthcare

Benefits in General

How to Defend an ERISA Lawsuit

"One of the earliest actions taken may be the filing of a motion to dismiss.... Class actions can be more difficult and expensive to defend. Fortunately, it is possible to resist class certification using Rule 23(b)(3).... It is crucial to make sure your plan documents include language about forum selection, fiduciary duties, and Firestone deference."
Hall Benefits Law

Selected Discussions
on the BenefitsLink Message Boards

2019 FSA Limits: MIA?

Any idea when they coming out? Have been holding up the open enrollment process waiting for the new 'official' rates.
BenefitsLink Message Boards

Press Releases

ACEBC Announces Winners of the Inaugural Simplification Award
American College of Employee Benefits Counsel

Most Popular Items in the Previous Issue

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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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