Health & Welfare Plans Newsletter

January 29, 2019

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[Official Guidance]

FAQs on Participation Requirements for EDE Entities Serving Consumers in States with Federally-facilitated Exchanges (PDF)

"When can prospective [Enhanced Direct Enrollment (EDE)] Entities pursue EDE for calendar year 2019? ... What constitutes a complete Business Requirements Audit? ... What constitutes a complete Privacy and Security Audit? ... How can prospective EDE Entities implement EDE for calendar year 2019?"
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

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[Guidance Overview]

Massachusetts Releases Draft Regulations, Contribution Rates for State Paid Family and Medical Leave

"[S]tarting on July 1, 2019, Massachusetts will collect contributions from employers, employees, and the self-employed at an initial rate of 0.63% of wages... [E]mployers may deduct up to 100% of the contributions for family leave from employees' wages, but may deduct only 40% of the contributions for medical leave from employees' wages.... For employers with 25 or more employees, ... 0.52% of the Initial Contribution Rate is designated for medical leave, while the remaining 0.11% of the Initial Contribution Rate is designated as family leave."
Jackson Lewis P.C.

[Guidance Overview]

Editor's Pick The ACA's Employer Shared Responsibility Provisions (PDF)

26 pages. "This report begins with an overview of how employers determine whether they are considered an ALE before outlining the [employer shared responsibility provisions (ESRP)]. It then discusses the two types of ESRP penalties and introduces administrative aspects of the ESRP. This report also includes two appendixes that contain definitions of terms as used in the report and a summary of how various worker classifications are considered for ALE determinations and under the ESRP." [Report R45455, Jan. 9, 2019]
Congressional Research Service [CRS]

EEOC Vacates the Incentive Sections of its Final Wellness Regulations

"The EEOC has withdrawn the incentive provisions in its ADA and GINA wellness program regulations. The remaining provisions have less bite as a consequence, especially in the ADA context. But HIPAA wellness regulations remain unaffected by this agency action."
Seyfarth Shaw LLP

2019 Outlook for Healthcare Issues in Congress

"[A]ny measures that might be signed by the president will likely focus on further delaying the controversial Cadillac tax and other ACA taxes, and on affordability issues such as drug pricing and 'surprise' medical bills from out-of-network providers."
Mercer

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Senate Finance Committee Hearing: Drug Pricing in America -- A Prescription for Change, Part I

Testimony from: [1] Kathy Sego, Mother of a child with insulin-dependent diabetes; [2] Douglas Holtz-Eakin, Ph.D., American Action Forum; [3] Mark E. Miller, Ph.D., Laura and John Arnold Foundation; [4] Peter B. Bach, MD, MAPP, Memorial Sloan Kettering Center for Health Policy and Outcomes.
Committee on Finance, U.S. Senate

House Ways and Means Committee Hearing: Protecting Americans with Pre-Existing Conditions

Provided are Chairman's Opening Statement and testimony from: [1] Karen Pollitz, Kaiser Family Foundation; [2] Andrew Stolfi, Oregon Division of Financial Regulation; [3] Keysha Brooks-Coley, American Cancer Society Cancer Action Network; [4] Andrew Blackshear, one of the 133 million Americans with a pre-existing condition; and [5] Rob Robertson, Nebraska Farm Bureau.
Committee on Ways and Means, U.S. House of Representatives

2018 Benefits Strategy and Benchmarking Survey: Healthcare Industry Addendum (PDF)

"Ninety-one percent (91%) of healthcare employers believe their employees have access to the quality medical services they need, and in terms of their health benefits ... But only a slim majority think employees are satisfied with their health benefits (56%). And not even half (49%) of sector employers say premiums are affordable for family coverage, while only 56% say additional costs like deductibles are affordable."
Gallagher

2018 Benefits Strategy and Benchmarking Survey: Public Entity Industry Addendum (PDF)

"In 2018, 56% of public sector employers did not increase cost sharing; of those that did, higher premiums was the most common (35%) means of doing so. Notably, employees do not contribute to individual coverage premiums at 39% of public entities, although the number drops to 11% for family coverage."
Gallagher

2018 Benefits Strategy and Benchmarking Survey: Entertainment, Hospitality, and Restaurant Industry Addendum (PDF)

"Two-thirds (66%) of hospitality employers offer two or more medical plans.... Just 49% of hospitality employers say they have an effective strategy to manage healthcare costs.... 53% of employers offer telemedicine, compared with 21% in 2016."
Gallagher

GAO Report on Health Insurance Exchanges: Claims Costs and Federal and State Policies Drove Issuer Participation, Premiums, and Plan Design

41 pages. "[GAO] looked at factors driving insurer participation in exchanges, interviewing representatives of 9 insurers and reviewing data on profits and losses. Insurers told us they generally raised their premiums from 2014-2018 and projected more increases in 2019. Reasons for this included: Higher costs to them to provide services than first estimated [and] the ending of several federal risk mitigation and cost-sharing programs." [GAO-19-215, Jan. 28, 2019]
U.S. Government Accountability Office [GAO]

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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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