Health & Welfare Plans Newsletter

February 25, 2019

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Sr. Defined Benefit Plan Administrator
Nyhart
in Indianapolis IN

Client Service Center Associate
Alerus Financial
in Arden Hills MN

Compliance (Defined Benefit) QA Software Tester
ftwilliam.com, Wolters Kluwer
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[Guidance Overview]

New Jersey Expands Family and SAFE Leave Protections and Benefits

"For leave commencing on or after July 1, 2020, changes include ... Benefits are extended from six to twelve weeks during any 12-month period. Weekly benefits will increase from two-thirds (or 66 2/3 percent) of employee's average weekly wage to 85 percent; this change, too, applies to Temporary Disability Insurance benefits (TDB). Maximum weekly benefits increase from $650 to approximately $860. This applies to TBD also. Intermittent leave allotment increases from 42 days to 56 days."
Fisher Phillips

[Advert.]

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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.


First Circuit: Substantial Compliance Doctrine Does Not Save Participant's Untimely ERISA Administrative Appeal

"The First Circuit rejected Plaintiff's argument that the 180-day period should run from the date of the termination of benefits and not from the date of notice.... The court also found that Hartford followed the terms of the Plan, which were consistent with ERISA's requirements, when it provided her notice of the benefit determination and her right to appeal within 180 days. Although the doctrine of 'substantial compliance' has been applied to excuse an insurer's failure to comply with ERISA's notice requirements, it does not apply to late appeals by claimants." [Fortier v. Hartford Life & Accident Ins. Co., No. 18-1752 (1st Cir. Feb. 20, 2019)]
Kantor & Kantor

New Jersey Family Leave: What You Need to Know

"Effective immediately, the definition of who is covered under the act has expanded [to include] siblings, grandparents, grandchildren, in-laws or anyone else related by blood or 'equivalent' family.... [Previously, any] employee of a company with 50 or more employees was guaranteed to have a job waiting for them when they returned from family leave. [Effective June 30, 2019, the] threshold will be lowered to companies with 30 employees or more."
EisnerAmper

State Approaches to Mitigating Surprise Out-of-Network Billing (PDF)

42 pages. "A key first step is removing the patient from the middle of disputes over surprise out-of-network billing and requiring insurers, providers, and/or regulators to resolve problems.... Protections ... should apply comprehensively across settings ... and not merely in emergency situations.... Minimize reliance on notice and consent exceptions ... Include means of enforcement ... [By] focusing regulation on health care providers, the policy approaches detailed in [this paper] are able to largely or entirely protect enrollees in self-insured health plans as well as those in fully-insured plans, while likely surviving any ERISA challenges."
The Brookings Institution

Congress Mulls Cap on What Medicare Enrollees Pay for Drugs

"The effort to cap out-of-pocket costs in Medicare's prescription plan is being considered as part of broader legislation to restrain drug prices. Limits on high medical and drug bills are already part of most employer-based and private insurance. They're called 'out-of-pocket maximums' and are required under the Obama-era health law for in-network services. But Medicare has remained an outlier even as prices have soared for potent new brand-name drugs, as well as older mainstays such as insulin."
Associated Press

Premium Subsidies, Incentives and Interconnectivity of ACA Policies

"While the banner of 'pre-existing condition protections' recently has ascended to the perceived status of being the ACA's crown jewel, premium subsidies are the real lifeblood of ACA markets.... While other ACA issues may be interconnected, the impact of premium subsidies (and resulting net premiums) is the primary indication of consumer response to market changes."
The Actuary Magazine

'Pathways to Success' MSSP Final Rule: Financial Benchmark

"On December 31, 2018, [CMS] published a final rule that ... includes changes to the financial benchmark methodology that measures the gross savings or losses of an accountable care organization (ACO) under the [Medicare Shared Savings Program]. Four key elements of the financial benchmark methodology changed: agreement period length, regional fee-for-service (FFS) adjustment, risk adjustment, and trend."
Milliman

Benefits in General

Student Loans: Some Employers Help Workers Pay Them Down

"Such benefits are relatively new and unusual; only 4 percent of employers surveyed by the Society for Human Resource Management offer it. But its popularity is increasing, because it helps solve a growing concern for workers about their mounting debt. And it helps employers find and retain people when available workers are scarce."
National Public Radio [NPR]

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David Rhett Baker, J.D., Editor and Publisher  davebaker@benefitslink.com
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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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