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[Guidance Overview]

DOL Issues Additional Guidance on AHPs

"The guidance confirms that AHPs operating under the new rule cannot market to or enroll new members and that existing AHPs (that predated the latest rule) can continue to operate. In the meantime, the Trump administration has appealed the court's decision to the Court of Appeals for the District of Columbia."
Katie Keith, in Health Affairs

[Guidance Overview]

Massachusetts Paid Leave Update: Approved Private Plan Exemption Need Not Provide Benefits Until January 2021

"The deadline to file a private plan exemption has been moved from June 30 to September 20, 2019, to allow additional time for employers to examine available insurance options. Employers that receive an approval of their private plan will not be required to remit quarterly contributions to the state trust fund. Now, with the Department's additional clarification, employers need not consider the cost of immediately implementing a generous private plan when deciding the benefits of a private plan exemption."

[Guidance Overview]

Updated Employer Deadlines Under the Massachusetts Paid Family Leave Law

"Employers must provide notice to their current workforces about the PFML on or before June 30, 2019.... Employers wishing to obtain [an] exemption in time for first quarter contributions must submit an approved plan application by September 20, 2019 ... October 31, 2019: Employers must file their first quarterly report and remit required contributions for the previous calendar quarter ... January 1, 2021: Paid family leave benefits will be available to covered individuals ... July 1, 2021: ... [P]aid family leave benefits will be available to covered individuals to care for a family member with a serious health condition."
Winston & Strawn LLP

A Plan to Lower Prescription Drug Prices

"The average annual cost of a brand-name drug has more than tripled in the past decade.... Giving Medicare the ability to negotiate with drugmakers is the best way to attack high drug prices.... Substituting generics for brand-name drugs can cut costs dramatically.... But drug companies do all they can to retain their monopolies.... [T]ransactions among parties in the drug supply chain are rarely made public -- it can be difficult to tell whether any of them are contributing to higher drug prices or being incentivized not to keep them under control."

Telehealth: Two Steps Forward for Payment, Three Steps Back for Fraud?

"In the first four months of [2019], the industry has seen confirmation of payment advances for Medicare Advantage beneficiaries and expansion of coverage under state legislative efforts, tempered by a substantial federal fraud initiative and prosecutions and new state licensure mandates."

Washington Becomes First State to Create Public Option Health Insurance

"Washington's law creates a hybrid system ... in which private insurance carriers will offer three levels of state-defined plans.... [T]he state will define the plans' terms but will not provide the plans itself; rather, it will hire private insurance carriers to administer the plans, including enrolling patients and paying out claims."
Pepper Hamilton LLP

Defeating Motions to Compel Discovery Related to Medical Review Experts

"Disability claimants often attack the ERISA plan's expert medical reviewer as biased, sometimes seeking discovery in an attempt to show bias. Here's a new case that highlights what can happen in a de novo review case: No discovery about a medical expert allowed." [Shaikh v. Aetna Life Ins. Co., No. 18-4394 (N.D. Cal. April 11, 2019)]
Lane Powell PC

Elder Care Benefits: A Growing Need for the U.S. Workforce

"Many employers currently offer an employee assistance program (EAP) which provides employees and household members with educational and referral services for elder care.... Dependent Care Assistance Plans (DCAP) ... allow employees to set aside tax-free dollars for qualified elder care.... Backup elder care benefits ... can also be incredibly useful to employees.... New vendors are also entering the marketplace[.]"

Deductible Relief Day: How Rising Deductibles Are Affecting People with Employer Coverage

"Over time, as deductibles have increased, Deductible Relief Day has fallen later in the year, meaning enrollees have to wait longer to receive the financial protection of their coverage. Ten years ago, Deductible Relief Day fell two months earlier in the year, on March 18, 2009. Back in 2009, the average deductible was $533 for a single person, but has since risen by over 150% to $1,350 in 2018."
The Peterson-Kaiser Health System Tracker

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Wilkins Finston Friedman Law Group LLP

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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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