Health & Welfare Plans Newsletter

February 12, 2019

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Jobs

Non-Qualified Client Service Manager (Vanguard)
Newport Group
in Lake Mary FL / Dallas TX

Product Support Consultant
ftwilliam.com part of Wolters Kluwer Legal & Regulatory
in Madison WI / Telecommute

Marketing Analyst
Milliman
in Dallas TX

Employee Benefit Assistant (P/T)
Tycor Benefit Administrators, Inc.
in Berwyn PA

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Webcasts, Conferences

Annual Legal & Regulatory Update
March 7, 2019 in OH
Worldwide Employee Benefits Network [WEB] - Northeast Ohio Chapter

►See 169 Upcoming Webcasts and Conferences

►See 1478 Recorded Webcasts


Discussions

New Topics on the BenefitsLink Message Boards

New Comments and Topics

All Topics, Grouped by Forum


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[Guidance Overview]

Editor's Pick Toolkit for Sections 6055 and 6056 Reporting Requirements

"[This] toolkit for IRS Sections 6055 and 6056 reporting requirements will help reporting employers comply with the requirements and avoid penalties.... Although the penalty for the individual mandate was reduced to $0 on January 1, 2019, employers are still required to report to the IRS and provide statements to employees."
Gallagher

[Advert.]

Evaluating Your Employee Health Benefits

Sponsored by Lorman and BenefitsLink

Feb. 27 webinar. Arm yourself with the knowledge to evaluate your plan's funding methods, as well as what ancillary insurance products fit for your company and how best to communicate all of this to the employee population. BenefitsLink discount.


[Guidance Overview]

HHS Proposes Rule to Eliminate Safe Harbor for PBM Drug Rebates

"If the Proposed Rule goes into effect, PBMs may be more vulnerable to [Anti-Kickback Statute (AKS)] enforcement actions for discounts that they negotiate with drug manufacturers.... [T]he Pharmaceutical Care Management Association has expressed concern that eliminating rebates could increase drug prices and force Medicare beneficiaries to pay higher premiums and out-of-pocket costs in order to access the prescription drugs they need.... Comments are due by April 8, 2019."
Sheppard Mullin

District Court: Employee Not Entitled to Disability Benefits for 'Disability' Requiring Workplace Accommodation

"[N]otable for employers ... is Defendant's underlying argument that the fact that Plaintiff could perform his job with a reasonable accommodation meant that Plaintiff was not eligible for STD benefits under the Plan, because it demonstrated that (while requiring accommodation) he was not incapable of performing the essential functions of his occupation." [Cannon v. Charter Communications Short Term Disability Plan, No. 18-041 (W.D.N.C. Jan. 16, 2019)]
Seyfarth Shaw LLP

Millennial and Gen Z Consumers Pave the Way for Non-Traditional Care Models

"When considering traditional in-person care, millennials (ages 22 to 38 in 2019) were two to three times more likely than baby boomers (ages 55 to [73] to be dissatisfied with: the convenience of appointment times (16 percent vs. 6 percent); the location/channel of care (13 percent vs. 4 percent); the effectiveness of the care (12 percent vs. 4 percent); and whether the doctor prescribed the medication they expected (10 percent vs. 5 percent).... [Y]ounger generations are more likely to choose medical providers with strong digital capabilities[.]"
Accenture

House Ways & Means Committee Hearing: The Cost of Rising Prescription Drug Prices

Feb. 12, 2019, hearing; includes link to video along with statement by Chairman Richard Neal, (D-MA) and witness testimony from: [1] Mark E. Miller, Ph.D., Arnold Ventures; [2] Rachel Sachs, Washington University in St. Louis, MO; [3] Alan Reuther, UAW Retiree Medical Benefits Trust; [4] Ola Ojewumi, Patient; [5] Joseph R. Antos, Ph.D., American Enterprise Institute.
Committee on Ways and Means, U.S. House of Representatives

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Why Aren't More Employers Implementing Reference-Based Pricing Benefit Design?

"The major barriers to [reference-based pricing (RBP)] adoption were the complexity of RBP benefit design, concern that employees could face catastrophic out-of-pocket costs, lack of a business case for implementation, and concern that RBP could hurt the employer's competitiveness in the labor market. The few employers that have adopted RBP have implemented extensive, year-round employee education campaigns and invested in multipronged and proactive decision support to help employees navigate their choices."
American Journal of Managed Care

This Valentine's Day, 'Know Your Numbers' by Heart

"Heart disease is the nation's leading cause of death, in both men and women. According to the American Heart Association, nearly 80 percent of cardiac events can be prevented, yet most people don't know the important personal health data that is critical to determining your risk.... Having your personal information is key to understanding your current risk."
Grooms Benefit Solutions

Benefits in General

Themes in Recent Employee Benefits Litigation

"Good fiduciary process continues to win ... Who must prove a fiduciary breach caused losses? It depends.... Administrative staff can create fiduciary liability ... Harder for fiduciaries to win on statute of limitations grounds ... Pension lawsuits challenge benefit calculation ... Fiduciaries win life insurance conversion suit ... Benefit interference claim proceeds."
CapTrust

Selected Discussions
on the BenefitsLink Message Boards

Plan Administrator Can Authorize a Claim Denied by Claims Administrator?

Plan is self-insured. I've been told a plan administrator can override a denial and authorize payment be made for claim previously rejected. Is that accurate?
BenefitsLink Message Boards

Press Releases

DOL Obtains Temporary Restraining Order to Protect Participants and Beneficiaries of Failing MEWA
Employee Benefits Security Administration [EBSA], U.S. Department of Labor

Most Popular Items in the Previous Issue

Text of IRS FAQs on the Premium Tax Credit
Internal Revenue Service [IRS]

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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 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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