Health & Welfare Plans Newsletter

April 23, 2019

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DB / DC Administrator
Primark Benefits
in Burlingame CA / Telecommute

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Primark Benefits
in Burlingame CA / Telecommute

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Ascensus
in Miami FL

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Alerus Financial
in Arden Hills MN

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Alerus Financial
in East Lansing MI

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[Guidance Overview]

Massachusetts Paid Family and Medical Leave Effective Date Approaches

"While Massachusetts workers will not be eligible to take paid family and medical leave through the state program until 2021, employers of Massachusetts workers will be required to provide notice of the benefits to covered workers in advance of the effective date, to begin making PFML contributions as of July 1, 2019, and to file their first mandatory quarterly reports in October 2019."
Foley & Lardner LLP

[Advert.]

Separate Fact from Fiction Regarding Prescription Drugs

Sponsored by International Foundation of Employee Benefit Plans [IFEBP]

Prescription drugs are a major expense of health plans. Attend this program to learn the broad forces at work and strategies to mitigate costs. Research-based data will be presented by Harvard Medical School Faculty and other industry innovators.


Editor's Pick Coverage of Wilderness Therapy Programs

"Employer-sponsored health plans have generally excluded or limited coverage for these programs. In recent years, however, there has been an uptick in employee demand for coverage of wilderness therapy -- followed by a wave of lawsuits alleging that failure to cover it violates ERISA and/or the MHPAEA.... Plan documents may have exclusions that lump camp-like and wilderness therapy programs into the same category. It's important for plan sponsors to understand the differences and it may be necessary for a plan to distinguish these different types of programs, or more specifically and consistently define permissible versus impermissible coverage."
Buck

New Jersey Posts Update on Health-Coverage Reports Due in 2020

"Starting next year, New Jersey will require employers to report 2019 health-coverage information for covered employees and their dependents residing in the state.... Employers will file health-coverage forms through New Jersey's Form W-2 filing system.... The same filing requirements apply to all employers -- in-state and out-of-state -- that withhold and remit New Jersey income taxes for its residents. Regulators anticipate posting filing instructions in mid-2019."
Mercer

Washington State Set to Pass Nation's First Long-Term Care Benefit

"Washington is poised to become the first state to establish an employee-paid program creating an insurance benefit to help offset the costs of long-term care ... The measure creates a benefit for those who pay into the program, with a lifetime maximum of $36,500 per person, indexed to inflation, paid for by an employee payroll premium."
InsuranceNewsNet.com

Employers Consider Mental Health Important to Management Strategy

"Nearly all (99%) purchasers/employers agree that the mental health of their employees is directly linked to the overall performance of the organization.... Only one in eight respondents have data that directly connects mental health with overall health and performance ... When asked about network access standards for behavioral health compared to medical, 64% of employers responded that health plans administer the same standards for behavioral health but less than half (43%) believe that out-of-network usage for behavioral health is comparable to that for medical/surgical conditions; only about a quarter of employers are aware of health plan strategies to address barriers to network access."
National Alliance of Healthcare Purchaser Coalitions

CMS Launches Value-Based Primary Care Initiative With Downside Risk

"HHS anticipates that 25% of traditional Medicare beneficiaries will opt into the initiative, which will launch in January. The models incentivize providers to reduce hospitalizations and cost of care by rewarding them through performance-based payments. There is downside risk of 10%, about the equivalent of revenue cycle costs. There is an upside potential of 50% that will be based on risk-adjusted hospitalizations."
HealthLeaders Media

Are States Trending Toward Prescription Drug Affordability Boards?

"While Maryland became the first state in the nation to pass legislation creating a Prescription Drug Affordability Board, it may not be the last. Seven other states are exploring similar legislation ... Building 'on the precedent of healthcare rate setting and state regulation of public utilities,' the [National Academy for State Health Policy (NASHP)] has developed model legislation to be used by state lawmakers for establishing drug cost review commissions in their states. A [chart compares] the provisions of current affordability review proposals[.]"
Morgan Lewis

[Opinion]

So We're Charging Doctors for Their Role in the Opioid Crisis -- What About Employers?

"The majority of employers have been unknowingly contributing to the opioid crisis. They spend nearly $20,000 for family healthcare coverage per employee ... [E]mployers keep forking over billions of dollars for the expensive, low-quality care that floods our system with deadly, addictive opioids ... and face a growing legal risk from wrongful death lawsuits by surviving family members who have lost a loved one to an overdose."
FierceHealthcare

Benefits in General

Editor's Pick 2019 American Bar Association Midwinter Meeting Report on ERISA Preemption and Effect on Other Laws (PDF)

34-page report summarizes 2018 litigation, including [1] Scope of ERISA Section 514; [2] Definition of employee benefit plan; [3] Level of employer involvement necessary for the establishment or maintenance of a plan; [4] Arrangements excluded by statute or regulation; [5] Circuit Court attempts to define the boundaries of preemption; [6] Lack of ERISA standing; [7] Removal issues; and [8] Application of preemption to particular claims.
Employee Benefits Committee [EBC], American Bar Association

Editor's Pick 2019 American Bar Association Midwinter Meeting Report on Reporting and Disclosure (PDF)

25-page report of 2018 plan regulatory and litigation developments.
Employee Benefits Committee [EBC], American Bar Association

Editor's Pick 2019 American Bar Association Midwinter Meeting Report on Benefit Claims and Individual Rights (PDF)

72-page report summarizes cases decided during 2018.
Employee Benefits Committee [EBC], American Bar Association

Most Popular Items in the Previous Issue

Health Insurance Oversight System Plan Finder Module: Issuer User Manual (PDF)
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

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Lois Baker, J.D., President  loisbaker@benefitslink.com
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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