Health & Welfare Plans Newsletter

March 18, 2019

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Senior Benefits Attorney
The Air Line Pilots Association, International
in Herndon VA

Retirement Plan Administrator
Liden, Nestle, Soled & Associates
in Westlake Village CA

Defined Contribution Plan Administrator
Rudd and Wisdom, Inc.
in Austin TX

Sr. Business Systems Analyst
LT Trust Company
in Denver CO / Telecommute

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DOL Opinion Letter Clarifies Designation and Use of FMLA Leave

"[DOL Opinion Letter FMLA2019-1-A] means FMLA qualifying leave must be designated as such and be deducted from the employee's FMLA allotment ... The opinion letter explicitly states the WHD's disagreement with the Escriba decision, which held that employees may decline FMLA leave to preserve it for future use and instead use vacation time before using FMLA leave. Additionally, the letter prohibits an employer from designating more than 12 weeks of leave (or 26 weeks of leave for military caregiver leave) in a year as FMLA leave."
Ogletree Deakins

Federal vs. New York Family and Medical Leave Laws -- Part 3

"The comparison chart [in this article details] federal vs. New York family and medical leave laws regarding an intermittent leave, reinstatement rights and the maintenance of health benefits during leave."
Strategic Benefit Services

District Court Finds Collective Bargaining Agreement Provides Vested Lifetime Benefits

"[T]he court found that '[t]he agreement does not provide for the right to terminate the benefits. The provision of lifetime benefits without provision for their termination constitutes vested benefits.' Defendants' contended that the language ... is condition[ed] by the phrase 'except as the Company and the Union may agree otherwise,' which incorporates Section 7's provision for termination of the agreement. The court rejected this argument, finding that the termination of the agreement provision says nothing about the termination of benefits." [Stone v. Signode Industrial Group, LLC, No. 17-5360 (N.D. Ill. Mar. 13, 2019)]
Kantor & Kantor

Prices for and Spending on Specialty Drugs in Medicare Part D and Medicaid: An In-Depth Analysis (PDF)

62 pages. "In 2015, the weighted average net price for 50 top-selling brand-name specialty drugs in Medicare Part D was $3,600 per 'standardized' prescription -- a measure that roughly corresponds to a 30-day supply of medication -- whereas the weighted average net price for the same set of drugs in Medicaid was $1,920. In Medicare Part D, net spending on specialty drugs rose from $8.7 billion in 2010 to $32.8 billion in 2015. In Medicaid, net spending on specialty drugs roughly doubled over the same period, reaching $ 9.9 billion in 2015. For beneficiaries in the Medicare Part D program who took brand-name specialty drugs, average annual net spending on such drugs per beneficiary (in 2015 dollars) increased from $11,330 in 2010 to $33,460 in 2015." [Also available: 10-page Summary Report]
Congressional Budget Office [CBO]

New York (Again) Seeks to Regulate Pharmacy Benefit Managers

"On January 15, 2019, Governor Cuomo released the 2019-2020 Executive Budget, which ... would require PBMs to be licensed and places limitations on how they can be compensated. This week, the State Senate released its own Budget that, while joining the Governor's efforts to regulate PBMs, purports to create additional safeguards around PBM business activities, including increased financial penalties on PBMs that violate the law."
Mintz

Feasibility of HSAs for Retirement Savings

"Health savings accounts (HSAs) are now being touted as a way for saving for health care expenses in retirement, but is this feasible? A recent report found employees spend 90% of their HSA assets on current medical expenses, leaving little to save/invest for the long term."
PLANSPONSOR; free registration may be required

Editor's Pick Death by a Thousand Clicks: Where Electronic Health Records Went Wrong

"Electronic health records were supposed to do a lot: make medicine safer, bring higher-quality care, empower patients, and yes, even save money.... Rather than an electronic ecosystem of information, the nation's thousands of EHRs largely remain a sprawling, disconnected patchwork. Moreover, the effort has handcuffed health providers to technology they mostly can't stand and has enriched and empowered the $13-billion-a-year industry that sells it."
Kaiser Health News and Fortune Magazine

Public's Experiences with Electronic Health Records

"Among those whose physician uses an electronic health record (88 percent of the public), large shares say that their physician's use of an EHR has made the quality of care they receive and their interactions with their physician 'better' ... Over half of those with EHRs (54 percent) report feeling 'very concerned' or 'somewhat concerned' that an unauthorized person might get access to their confidential medical records and information."
Henry J. Kaiser Family Foundation

The Health Care Priorities and Experiences of California Residents

"Making sure people with mental health problems can get the treatment they need was identified by 88 percent of Californians as an 'extremely' or 'very' important priority (including 49 percent 'extremely' important). At least three-quarters also see other health priorities as at least 'very important,' including making sure Californians have access to health insurance coverage ... lowering the amount people pay for health care ... lowering the price of prescription drugs ... making sure there are enough health care providers across California ... and making information about medical prices more available[.]"
Henry J. Kaiser Family Foundation

Benefits in General

Summary Plan Descriptions: You Gotta Provide Them, So Make the Most of Them

"If your participants don't understand the information contained in their SPDs, they may make unsound, and potentially costly, benefits decisions. To determine whether your SPDs have readability issues, you should re-read the SPDs from a participant's viewpoint ... Providing updated SPDs every five or 10 years to former retirement plan participants with vested benefits, retirees receiving benefits, and beneficiaries receiving benefits may seem like an unnecessary cost, given that those individuals won't be affected by most plan changes. To lessen the burden on plan administrators, the ERISA rules include an alternative distribution method for such situations."
Foley & Lardner LLP

Selected Discussions
on the BenefitsLink Message Boards

PTO Charge-Back and PTO Buy-Up

We are looking to implement PTO charge back and PTO buy up but we're looking for numbers to present to the board for approval. Anyone know where I can find any sort of statistics with numbers -- something we can define? We're a manufacturing and technology group. It would help to know what level of employees use this kind of benefit.
BenefitsLink Message Boards

Press Releases

Most Popular Items in the Previous Issue

What Does the Future Hold for Employer-Sponsored Health Plans?
Employee Benefit Research Institute [EBRI]

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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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