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January 9, 2019 logo logo
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ERISA Attorney
Kraw Law Group APC
in CA

Enrolled Actuary
EJReynolds, Inc.
in FL

Pension Administrator
Flynn, Shojinaga & Associates, Inc.
in CA

Pension Benefits Senior Analyst
Willis Towers Watson
in CO

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[Guidance Overview]

HIPAA Breach Notification: When and How to Self-Report

"Under the breach notification rule, covered entities are only required to self-report if there is a 'breach' of 'unsecured' PHI.... [T]he covered entity or business associate must determine the following: Was there a violation of the privacy rule? ... Does the violation fit within breach exception? ... Is there a 'low probability that the data has been compromised?' ... When in doubt, it is likely safer to report."
Holland & Hart LLP

[Guidance Overview]

New Year, New Changes to New York Paid Family Leave

"Any requests for leave which are submitted on or after January 1, 2019 will be entitled to 10 weeks if the employee qualifies for NYPFL, even if the qualifying event (such as the birth of a child) occurred in 2018.... The Statewide AWW has increased from $1,305.92 (in 2018) to $1,357.11 in 2019, which means that the maximum weekly benefit for 2019 is $746.41.... Beginning January 1, 2019, the employee contribution rate also increased from 0.126% to 0.153% of an employee's gross wages each pay period, ... The definition of 'serious health condition' has expanded."

Employees May Use FMLA Leave in Nonconsecutive Weeks

"The Alaska Marine Highway System (AMHS) cannot count as part of a rotational employee's [FMLA] leave those weeks that the employee is not scheduled to work, a federal district court held.... The court [found] that rotational employees not scheduled to work were not missing but were not eligible to work like employees during a business closing." [Acosta v. State of Alaska, No. 17-009 (D. Alaska Nov. 6, 2018)]
Society for Human Resource Management [SHRM]

Insurer's Acceptance of LTD Insurance Premiums Does Not Guarantee Coverage

"[T]he court ruled that the insurer did not waive its right to deny coverage by accepting premiums and failing to notify him that coverage was not in effect.... [T]he employer had paid premiums to the insurer on an aggregate basis that did not provide data at the individual employee level. As a result, the insurer did not know what amount in premiums was being paid for which employees." [Ward v. Aetna Life Ins. Co., No. 17-331 (S.D. Miss. Dec. 20, 2018)]
The Wagner Law Group

A Brief Comparison of MEWA and AHP Requirements

"Both MEWAs and AHPs may be considered ERISA plans but it is not a given.... Though the primary purpose of an AHP can be providing health care coverage, the AHP must also have a viable business purpose. MEWAs are not held to the same group/association standard.... A MEWA is also not held to any commonality of interest standards. While AHP members do need to have someone in common, the new DOL regulations offer more flexibility."
Hall Benefits Law

Millennials Prefer On-demand Healthcare to Primary Care

"45% of 18- to 29-year-olds say they don't have a primary care physician. Instead, they're opting for on-demand healthcare.... For employers, it's important to understand the reasons behind the shift to on-demand healthcare and educate employees to ensure they can get appropriate medical attention when they need it."
Corporate Synergies

Will More Services Under One Roof Boost Telehealth Utilization?

"As major players like Teladoc Health continue to scoop up smaller telehealth fish, the ultimate beneficiaries may be employer-sponsored health plan members. Integrated telehealth platforms will, in theory, provide easier access to a wider range of telehealth services and, as a result, lead to increased usage of such benefits."

New York City Launches $100 Million Universal Health Insurance Program

"New York City has launched a $100 million health insurance program to cover 600,000 uninsured residents, including those unable to afford coverage and those living in the United States illegally ... The NYC Care plan, which de Blasio said would be funded without tax increases, is an expansion of the city's existing MetroPlus plan that covers hospital bills for low-income residents. The new plan provides insurance for visits to doctors outside of hospitals."

The Benefits Beyond Salary You Can -- and Should -- Negotiate for When You Get a New Job

"These eight options ... are not only common to ask for, but also commonly granted... [1] A higher salary ... [2] More vacation time ... [3] The ability to work remotely ... [4] Commuter subsidies ... [5] A flexible schedule ... [6] Health and wellness benefits ... [7] Work devices and related services ... [8] Professional development."

Outlook 'Stable' for Health Insurers in 2019 Despite ACA Uncertainty

"A robust job market bolstering employer-sponsored plans, Baby Boomers transitioning to Medicare Advantage, and ACA exchanges attracting new payers are good signs for health plans in the coming year."
HealthLeaders Media


Can The Market Deliver Affordable Health Insurance Options In Rural Areas?

"Policies that would encourage or require states to consolidate rating areas would expand the size of risk pools (including statewide risk pools), helping insurers spread risks across a greater number of people and perhaps discouraging insurers from exiting rating areas with small populations.... State insurance commissioners could consider requiring plans to offer insurance across an entire rating area if the plan is offered anywhere in a rating area, essentially requiring that rating areas and service areas align."
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BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2019, 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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