Health & Welfare Plans Newsletter

April 10, 2019

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Jobs

Retirement Plan Administrator
PlanTech, LLP
in Birmingham AL / Telecommute

Compensation and Workforce Planning Manager
George Mason University
in Fairfax VA

Client Service Associate
Beneco Systems, LLC
in Scottsdale AZ

Retirement Plan Administrator
ERISA Services, Inc.
in Knoxville TN / Telecommute

Retirement Plan Relationship Manager
ERISA Services, Inc.
in Knoxville TN / Telecommute

Retirement Plan Compliance Officer
ERISA Services, Inc.
in Knoxville TN / Telecommute

Defined Benefit Plan Administrator
Northeast Professional Planning Group, Inc
in Red Bank NJ / Tarrytown NY

401k Plan Administrator
National TPA
in CT / MA / NY / RI

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[Guidance Overview]

CMS Finalizes Rate Review Timeline, Issues Guidance on CSR Reconciliation

"The final 2020 payment rule is currently under review at [OMB] ... Given the short timeframe between when the rule [will be] finalized and when QHPs must be submitted and approved, the final 2020 payment rule is not expected to include major changes that deviate from the proposed version. In the meantime, CMS is issuing guidance to help insurers plan for 2020.... CMS did not change its rate filing timeline for 2020."
Katie Keith, in Health Affairs

[Advert.]

Wellness Programs: EEOC Enforcement Actions and Complying with Federal and State Laws

Sponsored by Lorman and BenefitsLink

Apr. 11 webinar. Review design and taxation of incentives, laws that prohibit discrimination based on health factors, and exceptions for certain wellness and supplemental plans. BenefitsLink discount.


Court Requires Successor Employer to Continue Retiree Health Benefits Provided by Prior Collective Bargaining Agreement

"The court noted that 'unlike pension benefits under ERISA, insurance benefits, such as the benefits at issue in this case, do not automatically vest' and an employer 'may create vested welfare benefits by contract.' The defendants argued that Section 6 of the CBA limited lifetime health benefits because the phrase 'except as the Company and the Union may agree otherwise' incorporated Section 7's language permitting unilateral termination. The court disagreed, noting that Section 7 referred only to termination of the CBA, and did not apply to health benefits under Section 6." [Stone v. Signode Industrial Group, LLC, No. 17-5360 (N.D. Ill. Mar, 13, 2019)]
Polsinelli PC

The Fight Over Association Health Plans: Round One of The States vs. DOL Goes to the States

"The Court ultimately found that standing existed based on a 'fairly direct link' between the Final Regulation's intended expansion of self-insured AHPs and the decrease in specific tax revenues. Specifically, the Court determined that state tax revenues will decrease due to the failure to collect premium taxes 'when individuals select coverage through a self-insured AHP.' ... The States claimed that the Final Regulation's bona fide association and working owner provisions conflict with the text and purpose of both the ACA and ERISA and exceed DOL's statutory authority. The Court agreed." [Medical Society of the State of New York v. UnitedHealth Group, No. 16-5265 (S.D.N.Y. Mar. 28, 2019)]
Mintz

What Amazon Alexa Health Tech Update Means for Employers

"Amazon's Alexa is now able to answer employees' healthcare questions -- a move that has the potential to lower the cost of care by improving employee education and compliance, experts say. And that may only be the beginning. Top company executives and benefits experts say Alexa's evolving capabilities could lead to more tailored benefit guidance for employees and even greater efficiencies for HSA and FSA accounts down the road."
Employee Benefit Adviser

Editor's Pick Employer Worksite Clinics: An Evolving Employer-Based Healthcare Delivery System (PDF)

36 presentation slides. "Most employers with a worksite clinic have over 1,000 eligible employees at their largest clinic location, two-thirds rely on external parties to run the clinic, and 59% have 3-10+ healthcare providers ... Half of employers prioritize a core set of services across all of their clinics; Clinic service variation is due to specific location needs and/or use of community health clinic provider ... 95% of employers are satisfied with their clinic outcomes, with 39% being very satisfied."
Gallagher and National Association of Worksite Health Centers [NAWHC]

[Advert.]

2019 Onsite Employee Health Clinics Forum (June 27-28, 2019; Chicago, IL)

Sponsored by World Conference Forum

The largest attended conference on Onsite Health & Wellness Clinics! Leading strategies to build & expand worksite clinics: ensure a competitive benefits strategy and achieve a high performing & healthy workforce! Register now at 2019onsitehealth.com


Senate Finance Committee Hearing: Drug Pricing in America -- A Prescription for Change, Part III

Includes video of April 9 hearing, statement from Ranking Member Ron Wyden (D-OR), and testimony from witnesses: [1] Steve Miller, MD, Cigna Corporation; [2] Derica Rice, CVS Health and CVS Caremark; [3] William Fleming, Pharm.D., Humana Inc.; [4] John Prince, OptumRx; [5] Mike Kolar, JD, Prime Therapeutics LLC.
Committee on Finance, U.S. Senate

Senate Hearing on Drug Pricing Provides a Lesson in What PBMs Do

"In the third of a series of hearings on rising drug prices, the senators seemed focused on getting an answer to one central question: What the heck is a pharmacy benefit manager? ... Representatives from Cigna, CVS Caremark, UnitedHealthcare's OptumRx, Humana and Prime Therapeutics, all PBMs, testified on the ins and outs of their little-understood industry, disputing the idea that they are simply 'middlemen' taking their cut, but rather pharmacy experts looking for the most effective and cheapest drugs for their clients."
Kaiser Health News

Maryland at the Forefront of Groundbreaking Legislation to Lower Drug Prices

"On Monday, the Maryland Legislature voted to create a Prescription Drug Affordability Board with the authority to review drug costs and set reasonable payment rates for drugs -- similar to a state's approach to regulate utilities. The Maryland Prescription Drug Affordability Board would be the first of its kind, acting as an independent body to set limits on how much state and local governments pay for expensive drugs. The goal, according to state officials, is to lower prescription drug spending in the state."
Arnold Ventures

DOL Clarifies Obligation of Employers to Designate FMLA Leave (PDF)

"An eligible employee's absence for an FMLA-qualifying reason must be designated as FMLA leave. An employer may not delay this designation, even if an employee does not request FMLA leave because he or she is using paid leave for the absence. The absence must count against the employee's annual FMLA leave entitlement."
Cowden Associates, Inc.

What Are the Medicare Secondary Payer Rules? (PDF)

"[An] arrangement that pays for or reimburses the Medicare premiums of current employees violates the MSP rules -- whether or not it's offered on a tax-free basis. Similarly, an employer that offers money to Medicare-entitled employees in exchange for those employees waiving coverage under the group plan also violates the rules.... [I]nformal guidance indicates that no violation of the MSP rules occurs where employees entitled to Medicare have the same rights as employees not entitled to Medicare under a bona fide cash-out or cash-in-lieu arrangement offered under a cafeteria plan."
Cowden Associates, Inc.

Benefits in General

Estimates of the Financial Effects on the Social Security (OASDI) Program Assuming Enactment of the 'New Parents Act of 2019' (PDF)

"[If] enacted, this Bill would have a negligible effect on the long-range OASDI actuarial balance (that is, less than 0.005 percent of taxable payroll). In early years (through 2032), when parental leave benefits would be paid but few eligible parents would have experienced the effects of a delayed [Normal Retirement Age/Earliest Eligibility Age] or reductions to their OASDI benefits, this provision would result in more cost to the OASI Trust Fund. In years after 2032, when we project that no parental leave benefits would be paid, the OASI and DI Trust Funds would see a reduction in benefit cost compared to current law[.]"
Office of the Chief Actuary, U.S. Social Security Administration [SSA]

Press Releases

Most Popular Items in the Previous Issue

Tax Treatment of Welfare Benefits for Employees and Beneficiaries (PDF)
Employee Benefits Committee [EBC], American Bar Association

Regulation of Employee Health Care Benefit Plans (PDF)
Employee Benefits Committee [EBC], American Bar Association

Liability Issues Unique to Welfare Plans (PDF)
Employee Benefits Committee [EBC], American Bar Association

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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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