Health & Welfare Plans Newsletter

January 23, 2019

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Senior Pension Administrator - Combo DB/DC Plans
Primark Benefits
Telecommute

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Growing Consulting Firm
in TX

Assistant Corporation Counsel
Milwaukee County Corporation Counsel
in WI

Enrolled Actuary
Florida consulting company
in FL, NY, Telecommute

Client Service Manager
Willis Towers Watson
in TX, UT

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New Year, New Data: 2019 Employee Healthcare Views

"68% of respondents say the cost of healthcare has gone up in the past three years. 62% of respondents feel their employer does not serve as a resource for their healthcare-related questions.... Only 33% of respondents say they completely understand the health coverage offered through their employer ... 60% of respondents say that financial incentives would make them more willing to improve their health regime.... 54% of respondents don't know what the term 'self-funded healthcare' means."
Maestro Health

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HHS Proposals Could Increase Health Costs for Consumers

"Health plans have annual limits on consumers' out-of-pocket costs. Under the proposal, insurers would not have to count the full amount of a consumer's co-payment for a brand-name drug toward the annual limit on cost-sharing. Insurers would have to count only the smaller amount that would be charged for a generic version of the drug."
The New York Times; subscription may be required

The Future of Global eHealth

"Digitizing personal health information ... [can] empower patients with their own electronic records and can also be used to implement various telehealth and home health options to improve chronic disease management.... [C]ore challenges ... include insufficient communication of eHealth goals, concerns regarding system standardization, and a current lack of governance and funding."
University of Illinois at Chicago

FMLA Reg Allows Weekend Pay Bump to Be Premised on Attendance

"A hospital employer did not violate the FMLA when it no longer paid a weekend nurse a 30% shift differential due to absences that exceeded the allotted contractual amount, some of which were FMLA leave ... The court explained that an FMLA 'regulation explicitly allows employers to withhold a bonus or 'other payment' that is based on the achievement of a goal related to hours or attendance. Even if the employee does not meet the goal due to FMLA leave, the employer may withhold the payment -- so long as the employer would withhold it for non-FMLA leave as well.' " [Flowers v. McCartney, No. 17-604 (E.D. Ark. Jan. 8, 2019)]
Wolters Kluwer; free registration required

Paid Time Off Plans: IRS Guidelines and Why They Matter

"The IRS appears to generally require that the earned time being paid out be substantially less than the accrued earned time owed to the employee. This is to ensure that the earned time program remains a bona fide sick or vacation pay plan and not a plan of deferred compensation. This particular requirement can get tricky and may be different in each employer's case."
Berry Dunn

Medicare Expands Value Pay in MA and Part D Plans

"The voluntary expansion will be open to MA plans, Regional Preferred Provider Organizations, and all special-needs plans.... The new VBID models will focus on one or more of the following: [1] Condition- or socioeconomic-based designs; [2] Rewards and incentives programs; [3] Telehealth networks; [4] Wellness and healthcare planning."
HFMA

GAO Report: Medicare -- Voluntary and Mandatory Episode-Based Payment Models and Their Participants

"GAO was asked to review the episode-based payment models developed by CMS. This report [1] describes the characteristics of the providers that participated in these models and [2] compares the relative advantages of voluntary versus mandatory episode-based payment models, as identified by stakeholders." [GAO-19-156, published Dec. 21, 2018, publicly released Jan. 22, 2019]
U.S. Government Accountability Office [GAO]

[Opinion]

The Potential of Incremental Health Reform

"Plans to fundamentally transform the US health care system -- through, for example, replacing the current fragmented system with Medicare for all -- have received a great deal of attention from the press and pundits. But budgetary and political realities will make it very challenging to achieve these ambitious goals.... Advocates who seek to improve health insurance coverage for Americans should also consider proposals for incremental improvements to the ACA that are more likely to be achieved."
Sherry Glied, in Health Affairs

Benefits in General

[Guidance Overview]

Editor's Pick DOL Increases Civil Monetary Penalties for 2019

"The DOL provided a table illustrating which penalty level applies, keyed to when the underlying violation occurred and when the resulting penalty was assessed.... [A table in this article] reflects the DOL's 2019 annual inflation adjustments to the civil money penalties for violations of certain requirements under ERISA, effective January 23, 2019."
Thomson Reuters Practical Law

Selected Discussions
on the BenefitsLink Message Boards

Confused About Proposed Excepted Benefit HRA

I'm confused by the recently proposed excepted benefit HRA that would allow an HRA to reimburse dental/vision premiums and other ACA exempt benefits if eligible employees are also offered group health plan coverage. I thought current rules already allow for a limited scope HRA that reimburses dental/vision expenses only (including premiums) as long as they are not an "integral part of a group health plan" or they are provided "under a separate policy, certificate, or contract of insurance" (such as an individual dental/vision policy). What am I missing?
BenefitsLink Message Boards

Press Releases

Plan Enhancements Drive Record Retirement Savings Rates
PSCA [Plan Sponsor Council of America]

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BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2019 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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