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Reforming America's Healthcare System Through Choice and Competition (PDF)

119 pages. "This report identifies barriers on the federal and state levels to market competition that stifle innovation, lead to higher prices, and do not incentivize improvements in quality. It recommends policies that will foster a health care system that delivers high-quality care at affordable prices through greater choice, competition, and consumer-directed health care spending."
U.S. Department of Health and Human Services [HHS], U.S. Department of the Treasury, and U.S. Department of Labor [DOL]



Sponsored by DATAIR Employee Benefit Systems, Inc.

DATAIR's FlexPlus Software for Proposals, Testing & Administration of Cafeteria/Sec. 125 Plans: FSA, DCAP, HRA, HSA and Sec. 123(f). Benefits Debit Card for automated claims processing and Internet inquiry. For more information: or 888-328-2474

Experiences Under the ACA Suggest Association Health Plans Could Harm the Small-Group Insurance Market

"[In] each of the past three years ... each regulation permitting non-ACA-compliant plans -- self-insurance and transitional plans -- was associated with a risk profile for the ACA-compliant market that was 10 percent to 14 percent higher than in states without such policies. Also, states that adopted both policies had risk profiles that were 15 percent to 20 percent higher than states with neither regulation.... Association health plans ... could have a much more pervasive effect on market segmentation. Unlike transitional plans, they can enroll new subscribers, and, unlike self-funding, they are feasible for groups of any size, or self-employed individuals."
The Commonwealth Fund

Judge Questions CVS-Aetna Merger, Says He May Halt Asset Integration

"A federal judge on Monday sharply questioned the Justice Department's decision to green-light CVS Health Corp.'s nearly $70 billion acquisition of Aetna Inc., and said he may order CVS to halt its integration of Aetna's assets while he considers the merger's implications. It is highly unusual for a judge to make such an announcement, since Justice Department antitrust enforcers had approved the deal in October under the condition the companies sell Aetna's Medicare drug business to preserve competition."

What's Trending in Wellness?

"Very few in-house programs are utilizing a wellness committee ... Employee engagement and participation was ranked as the number one indicator of program success ... Many companies do not have a wellness brand, but it was listed high on considerations."
Frenkel Benefits

Successful Challenges to Parity Act Claims Regarding Wilderness Treatment

"[W]hen evaluating a pleading alleging that a wilderness program limitation/exclusion violates the Parity Act, defense counsel may wish to consider a pleading stage challenge where the pleading fails to compare the limitation/exclusion to a relevant medical/surgical analogue, or where the limitation/exclusion applies equally to mental health and medical treatments[.]"
Robinson & Cole LLP

Is the Time Now Right for Consumer Telehealth?

"Ochsner Anywhere Care debuted in November.... [T]his consumer-facing virtual platform offers live, on-demand urgent care video visits with board-certified primary care providers for $54 a session through a smartphone app or an online portal.... A look at Ochsner's strategy provides insights into why organizations should consider incorporating these programs among their offerings, and what guard rails should be put in place to ensure a successful launch."
HealthLeaders Media

Minnesota Employers' Group Seeks to Improve Mental Health for Workers

"This year was the 10-year anniversary of the Paul Wellstone and Pete Domenici Mental Health and Parity and Addiction Equity Act, designed to provide comparable coverage for mental and behavioral treatment as for physical health treatment. The legislation was a hallmark of Sen. Wellstone's career, but compliance in his home state has been abysmal ... [A] report this year from the Kennedy-Satcher Center for Mental Health Equity at the Morehouse School of Medicine ... gave Minnesota an F.... 43 states got a D or an F, and only Illinois got an A."
Duluth News Tribune

Former HHS Official Says Health Data Must be Portable, But Don't Forget the Consumer

"HIPAA does not address the handling of PHI by other entities, typically referred to as 'non-covered entities,' including many new consumer health technology companies (and even some healthcare providers who don't accept insurance). Limited protections exist for data held by these entities under current state and federal law."
Bloomberg BNA


The Tortuous History of HRAs: What Does the Future Hold?

"Which employers would go in this direction, under what circumstances, and for which employees? Would it vary by firm size? Do the strength of the economy and labor market conditions factor in? ... Employers may decide that they no longer need to offer health benefits to be competitive in the labor market during the next recession, and the combination of the insurance market reforms and the ability to give workers tax-free money to purchase health insurance on their own may finally put the future of employment-based health coverage to the test."
Paul Fronstin, EBRI [Employee Benefits Research Institute]

Benefits in General

Limitations Periods in Benefit Plans: Guidance from the Courts (PDF)

"ERISA contains specific limitations periods for fiduciary claims ... But ERISA is silent for nonfiduciary suits such as health benefit claims, claims of interference with ERISA rights or document request claims.... To avoid the need to consult state law, a plan may specify that a claimant must bring suit within a certain period after a triggering event ... or within a certain period after completing the internal appeals process. Courts have long upheld such provisions, though courts in different jurisdictions have varied in their approach."
benefits magazine, a publication of the International Foundation of Employee Benefit Plans [IFEBP]

Editor's Pick Can ERISA Plans Require That Fiduciary Claims Be Arbitrated? Should They? (PDF)

"Despite ERISA's endorsement of arbitration for certain issues, breach of fiduciary duty claims, which tend to involve greater damages and tend to attract the most media attention, are not arbitrated. One possible reason is that ... arbitration is not all it is chalked up to be -- for sophisticated fiduciary disputes, arbitration may in fact be just as time consuming, just as expensive, and less likely to lead to a just outcome."
Steptoe & Johnson LLP

Press Releases

Most Popular Items in the Previous Issue

Text of 2018 DOL Form M-1 for Use by Association Health Plans and Other MEWAs (PDF)
Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]

DOL Releases 2018 Form M-1 for Use by Association Health Plans and Other MEWAs
Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]

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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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