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February 19, 2019 logo logo
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in Phoenix AZ

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DWC - The 401K Experts

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[Official Guidance]

Text of CMS Health Insurance Exchange Guidelines: Auditor Operational Readiness Reviews for the Enhanced Direct Enrollment Pathway and Oversight Requirements (PDF)

42 pages. "[CMS] is continuing to implement Enhanced Direct Enrollment (EDE), an optional program allowing EDE Entities (i.e., Qualified Health Plan [QHP] issuers and web-brokers seeking to participate in EDE) registered with the Federally-facilitated Exchange [FFE] and State-based Exchanges on the Federal Platform (SBE-FPs) to host an application for Marketplace coverage on their own websites.... This set of guidelines outlines EDE program and audit requirements for PY 2019 ... and PY 2020.... The primary audit submission window for prospective EDE Entities interested in implementing EDE in calendar year 2019 is from April 1, 2019 to June 30, 2019."
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]


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.

Anyone Eligible for Part D Prescription Drug Coverage? CMS Report Required

"This filing requirement applies to all group health plans that cover anyone eligible for the Medicare Part D prescription drug program, whether as an active employee, spouse, dependent or retiree. This disclosure is in addition to the Notice of Creditable (or Non-creditable) Coverage that you provide annually to Medicare-eligible participants in the fall."
Kushner & Company

Ohio's New Cybersecurity Requirements on Insurers and Other Licensees Set to Take Effect in March

"Ohio joins South Carolina and Michigan in recent adoptions of the model law.... [Ohio's law] establishes broad data security requirements and imposes standards for investigating and reporting data security incidents. Licensees have one year to comply with most of the new cybersecurity requirements."

What Is an Onsite Health and Wellness Clinic?

"When done right, an onsite clinic will help wrangle out-of-control healthcare costs and make them more predictable. And it does that not by cutting back on services, but by enhancing access to the kind of services that lead to better health outcomes ... Healthier people can be more productive, taking less time off for illness and medical care, and performing on the job with less distraction and anxiety."

Retroactively Denying FMLA Leave and Firing Employee Soon Thereafter Supports Retaliation Claim

"Denying cross-motions for summary judgment with respect to FMLA claims by an employee who was first approved for FMLA leave and then, after she took it, determined ineligible and fired for excessive absences, a federal district court in Texas found triable issues on whether she reasonably relied on an FMLA coordinator's misrepresentation that she was eligible, considering a handbook policy that detailed FMLA requirements. There were also triable issues on whether the reason for her termination (excessive unexcused absences months before her leave) was pretextual." [Byrd v. City of Houston, No. H-18-778 (S.D. Tex. Jan. 29, 2019)]
Wolters Kluwer; free registration required

Benefits in General

Feasibility and Reliability of Automated Coding of Occupation in the Health and Retirement Study

"[The NIOSH Industry and Occupation Computerized Coding System (NIOCCS)] does reasonably well compared to coding results from a highly-trained, professional occupation and industry coder, with ... agreement rates on broader codes of around 80 percent. The main weakness of NIOCCS appears to be its failure to produce codes in many cases. Code rates for NIOCCS for the datasets tested ranged from 60 to 72 percent, as compared to a professional coder's ability to code those same datasets that ranged from 95 to 100 percent."
Michigan Retirement and Disability Research Center, Univ. of Michigan

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David Rhett Baker, J.D., Editor and Publisher
Holly Horton, Business Manager

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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