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May 10, 2019 logo logo
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HSA Account Administrator
Alerus Financial
in Albert Lea MN

Retirement Relationship Manager
Alerus Financial
in East Lansing MI

Pension Plan Administrator
SD Cooper Company
in Huntington Beach CA

Senior Benefits Advisor
Employee Benefits Security Administration, U.S. Department of Labor
in Atlanta GA / Telecommute

Senior Benefits Advisor
Employee Benefits Security Administration, U.S. Department of Labor
in Plantation FL / Telecommute

Health Insurance Specialist
Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services
in Bethesda MD / Telecommute

Director of Technical Education and Communications
in Dresher PA / Brainerd MN / Tucson AZ / Madison WI

General Attorney-EXC
Pension Benefit Guaranty Corporation
in Washington DC / Telecommute

Health Insurance Specialist (Program Integrity)
Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services
in Woodlawn MD / Telecommute

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[Guidance Overview]

2020 ACA Cost-Sharing Caps Set, Play-or-Pay Penalties Projected

"The final 2020 annual out-of-pocket (OOP) maximums for nongrandfathered group health plans are: Self-only coverage: $8,150. Coverage other than self-only: $16,300. These figures represent an increase of 3.16% from the 2019 final cost-sharing limits of $7,900 (self) and $15,800 (other).... [T]he 2020 play-or-pay assessments for employers are projected to increase to these amounts: Not offering coverage: $2,570 per full-time employee, up from $2,500 in 2019. Offering coverage that is unaffordable or lacks minimum value: $3,860 per full-time employee who receives subsidized coverage through a public exchange, up from $3,750 in 2019."


Join Us This June in San Diego and Earn Your Certificate

Sponsored by International Foundation of Employee Benefit Plans [IFEBP]

The Certificate in Health and Welfare Plans program provides the history, philosophies and objectives of the employment-based health care system and an overview of the latest reform initiatives.

Hospital Prices Paid by Private Health Plans Average More Than Twice What Medicare Would Pay

"An examination of U.S. hospital prices covering 25 states shows that in 2017, the prices paid to hospitals for privately insured patients averaged 241% of what Medicare would have paid, with wide variation in prices among states ... Some states (Kentucky, Michigan, New York, and Pennsylvania) had average relative prices that were 150% to 200% of what Medicare paid, while other states (Colorado, Indiana, Maine, Montana, Wisconsin, and Wyoming) had average relative prices that were 250% to 300% of what Medicare would have paid."
RAND Corporation

Fixing Out-of-Network Bills Means Someone Must Pay

"Insurers and health care providers each oppose the other side's preferred solution to end surprise bills. That conflict makes it almost impossible for lawmakers to come up with a fix that won't leave one of the influential groups unhappy."
Kaiser Health News

White House Announces Principles to Address Surprise Billing in Healthcare

"In emergency situations, balance billing for amounts above the in-network allowed amount should be prohibited.... Before scheduling their care, patients should be given information about whether the care providers are out of their network and what related costs that may bring."
The White House

Current Association Health Plan Contracts Safe

"For current contracts DOL will not pursue enforcement actions against parties for potential violations stemming from actions taken before the district court's decision, as long as parties meet their responsibilities to pay health benefit claims as promised. Moreover, the DOL will not take action against existing AHPs for continuing to provide benefits to members who enrolled in good faith reliance on the AHP regulation's validity prior to the district court's order."
The Wagner Law Group


New ERISA Regulations for Disability Claims and Appeals

Sponsored by Lorman and BenefitsLink

May 23 webinar will explain what new practices to follow, how to change past practices to become compliant with the new regulations, and the risks of non-compliance.BenefitsLink discount.

Despite Increased Awareness and Employee Training, Ransomware Is Still the Healthcare Industry's No. 1 Threat

"Training employees to be highly suspicious of attachments and unknown hyperlinks is key to preventing these phishing attacks. Employers should educate employees on how to spot emails that attempt to masquerade as legitimate emails from co-workers and business contacts but often contain a number of [specific tells.]"
Holland & Hart LLP

Can You Afford Not to Investigate a Security Incident?

"HIPAA's administrative safeguards require covered entities to identify and respond to suspected or known security incidents, mitigate harmful effects of security incidents that are known to the covered entity, and document security incidents and their outcomes. If the security incident rises to the level of a breach the covered entity also has notification requirements. Failure to satisfy these requirements can have very real consequences to your business."

Creating a Bereavement Leave Policy for Your Company

"What type of bereavement leave should you offer and how much? Who will be eligible for leave? How should employees notify you of their need for leave? Answering those types of questions in a comprehensive bereavement leave policy helps you manage employees' expectations and respond to leave requests when the time arises. So, what should you include in your bereavement leave policy?"
HR Daily Advisor


A Doctor Tells Pharmacy Benefit Managers: Stop 'Treating' My Cancer Patients

"Pharmacy benefit managers were supposed to help bring down the cost of drugs by negotiating with competing drug companies and by 'encouraging consumers to use the most cost-effective drugs.' But they have done the opposite, fueling higher drug prices through manufacturer rebates and by extorting fees from pharmacy providers."

Press Releases

Most Popular Items in the Previous Issue

Independent Contractor vs. Employee -- The Tug of War Continues
The Modern Workplace, by Gray Plant Moody

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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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