Health & Welfare Plans Newsletter

February 18, 2019

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[Guidance Overview]

Not Offering Health Coverage? Reporting May Still Be Required

"[T]he requirement to report about coverage offered (or not offered) is independent of the ACA employer mandate. This means that any ALE that decides it's less expensive to simply pay the employer mandate penalty for all full-time workers must still file its IRS Forms 1095-C."
HUB International

Another Loss for Retirees: Sixth Circuit Holds No Lifetime Healthcare Coverage

"The Sixth Circuit reversed the district court's (N.D. Ohio) determination that the CBAs at issue vested the Hoover Company retirees with unalterable lifetime healthcare benefits. The majority found that the CBA's general durational clauses that state when the agreements end also control when healthcare benefits end." [Zino v. Whirlpool Corp., No. 17-3851/3860 (6th Cir. Feb. 15, 2019; unpub.)]
Kantor & Kantor

Is a Health Insurance Captive Right for You?

"What is a group captive and how does it work? ... What provider network is used in a captive arrangement? ... What is the cost to the employer? What about the employee? ... What are the protections for the employer from severe high claimants? ... Is the Captive Premium expensive? ... How do I go about joining a captive and is there a capital contribution? ... How are wellbeing programs worked into this type of insurance? ... What are the benefits to participating in a captive as opposed to traditional health insurance?"
CBIZ

FitBit Devices from Your Employer Can Be Used in Workplace Wellness Programs -- But How Much Information Is Too Much?

"On his 21st day back at work after a heart attack and triple bypass surgery, Chris Zubko received a call from the main office. Through an app on his phone, his boss was literally monitoring every step of Zubko's recovery.... Welcome to a rapidly growing phenomenon in the workplace: constant health surveillance."
The Washington Post; subscription may be required

Express Scripts Reports Record Low Drug Trend Across Commercial Plans in 2018

"The PBM cited 'an unprecedented 0.3% decline' in per-beneficiary drug spending across Medicare plans. Overall, there was a 1.4% decrease in unit cost trend, which allowed clients to absorb a 1.1% increase in utilization, the PBM said. Oncology replaced diabetes as Medicare's top therapy class by per member per year spend. Express Scripts also reported falling unit drug costs for employer, Medicare and [ACA] exchange plans."
AISHealth

More Insurers Win Lawsuits Seeking Cost-Sharing Reduction Payments

"On February 14 and 15, two judges at the Court of Federal Claims held that insurers are entitled to unpaid cost-sharing reduction (CSR) payments. One of these lawsuits ... is a class action for unpaid CSRs, meaning the decision applies to the 91 insurers who are part of that class.... In some cases, these insurers are entitled to unpaid CSRs from both 2017 and 2018, even though many insurers opted to use 'silver loading' to make up for unpaid CSRs."
Katie Keith, in Health Affairs

Health Assessments and Biometrics 101

"Besides providing a baseline for a population's health, screenings also: Help detect disease in its early and most treatable stages -- even before symptoms are recognized -- and provide a summary of a participant's health; Improve both health and financial outcomes by significant margins (37% of employers reported greater health risk improvement and 34% reported a lower healthcare claims trend).... Health screening at a primary care provider may cost between 2.1 and 3.2 times more than an on-site health screening."
Healthstat

Benefits in General

Public School Teachers Strike for Higher Pay Amid Growing Retirement, Benefit Costs

"While average inflation-adjusted teacher salaries have been relatively stagnant since 1990, benefits costs have risen from 16.8 percent of expenditures in 1990 to 23 percent of today's much larger expenditure base.... Almost every state increased teachers' retirement benefits in the booming 1990s. But the additional promises were not accompanied by responsible funding plans. Overfunded at the turn of the millennium, by 2003, teacher pension plans were collectively short by $235 billion. By 2009, pension debt had more than doubled, to $584 billion."
USA TODAY

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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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