Health & Welfare Plans Newsletter

May 21, 2019

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Defined Contributions Administrator
Primark Benefits
in Burlingame CA / Telecommute

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NRECA
in Arlington VA / DC / MD

NQ Implementation Project Mgr
Newport Group
in Lake Mary FL / Charlotte NC

Client Service Manager
Newport Group
in Folsom CA

Plan Consultant
Retirement Solution Group
in IL / NH

Program Analyst (Office of the Inspector General)
Pension Benefit Guaranty Corporation
in Washington DC / Telecommute

Senior Plan Document / Compliance Specialist
Professional Capital Services, LLC (PCS)
in Philadelphia PA

Senior Retirement Plan Administrator
Professional Capital Services, LLC
in New York NY / PA

Plan Account Manager I
Benefit Consultants Group
in Cherry Hill NJ

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[Guidance Overview]

Non-Minneapolis Employers Must Comply with Minneapolis Paid Sick Leave Law

"This significant ruling stretches Minneapolis-imposed requirements to non-Minneapolis employers, including -- in some instances -- requiring them to provide paid time off to their employees.... Employees may use the leave for their own, or a family member's, needs related to health, domestic abuse, sexual assault, stalking, and school, daycare, and workplace closings. The ordinance also requires employers to track the accrual and use of leave time." [Minn. Chamber of Commerce v. City of Minneapolis, No. A18-0771 (Minn. Ct. App. Apr. 29, 2019)]
Jackson Lewis P.C.

[Advert.]

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.


How Efficient Is Your Benefits Administration Process?

"On average, employee benefits account for 31.7% of total compensation costs ... Preparing docs, confirming changes, making corrections -- depending on your company's size, even the more clerical tasks associated with benefits could take the whole year to prepare. So how do you know for sure that all this work ensures your administration process is future-proofed and ready?"
Hodges-Mace

Talk to My Cousin -- or My Patient Advocate: Filing ERISA Plan Claims

"More and more participants may be willing to hire a commercial entity to act as their authorized representative in the hope that they will save money on their out-of-pocket medical costs by finding supposed errors in the way their health insurance claims are billed. The DOL has indicated it sees no problem with that practice from an ERISA perspective."
HR Daily Advisor

District Court Issues Permanent Injunction and Bars ACA Employer Mandate Penalties

"The court declared that the plaintiffs may comply with the ACA by offering health plans that exclude coverage for abortion-causing drugs, devices, and procedures (and related education and counseling) but that are otherwise compliant. The court also barred the Departments from imposing penalties against the plaintiffs under the ACA's employer mandate and numerous other group health plan compliance requirements regarding coverage of abortifacients." [Christian Employers Alliance v. Azar, No. 16-309 (D.N.D. May 15, 2019)]
Thomson Reuters Practical Law

Employees' Overall View of Well-Being Wanes, But Employer Support Makes a Positive Impact

"[M]ost people (61 percent) say they are doing everything they can to promote and maintain their health, up nine percentage points since 2014. However, 62 percent of employees have a less-than-positive perception of the current state of their well-being ... Just over half (55 percent) of employees feel in control of their health, which is down seven percentage points from 2018; and only 40 percent feel in control of their financial future, down six points from 2017."
National Business Group on Health [NBGH]

[Advert.]

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Health Insurance Inflation Hits Highest Point in Five Years

"The Consumer Price Index for health insurance in April spiked 10.7% over the previous 12 months--the largest increase since at least April 2014 ... In contrast, the other categories that make up the medical care services index -- professional services and hospital and related services -- rose 0.4% and 1.4% in April, respectively. The CPI for medical care services in April rose 2.3%, while overall inflation increased 2% year over year."
Modern Healthcare Online; free registration required

Private Insurance Payments to California Hospitals Average More Than Double Medicare Payments (PDF)

"For the 10 percent of California hospitals with the highest ratio of private to Medicare payments, private insurance payments average 364 percent of Medicare and 255 percent of cost; for the 10 percent with the lowest ratio, the average is 89 percent of Medicare and 89 percent of cost."
WestHealth Policy Center

Some Dayton, Ohio Hospitals Charge Triple What Medicare Pays

"Miami Valley Hospital ... charged private health plans 295 percent of what Medicare paid for the same outpatient services. Kettering Medical Center ... charged private insurers 287 percent of what Medicare paid for outpatient services."
Dayton Daily News

Bipartisan Support for New Attempts to Control Prescription Drug Costs

"Lawmakers on both sides of the aisle are applauding two recent developments in the ever-raging battle to contain the cost of American healthcare. On May 8, 2019, [HHS] announced a final rule ... that will soon begin requiring pharmaceutical manufacturers to disclose the list price of prescription drugs in television advertisements.... In an unrelated move just a few days later, 43 states and Puerto Rico filed a lawsuit in federal court in Connecticut, alleging that at least 20 drug manufacturers conspired to artificially inflate and manipulate prices for more than 100 different generic medications."
ERISAPros

Curbing FMLA Abuse in the Summertime

"If you do find social media pictures or other evidence of behavior that seems inconsistent with the leave, gather the photos and any other evidence you can of the suspected fraud. Then, bring the employee in for questioning, offering the employee an opportunity to provide a formal statement regarding his or her time on leave. Oftentimes, an employee ... will make false statements about what s/he has been up to. You can then terminate the employee for dishonesty rather than FMLA fraud, which is generally a better legal position to take."
Warner Norcross & Judd LLP

Editor's Pick A Medicare Primer (PDF)

40 pages. "This report provides a general overview of the Medicare program including descriptions of the program's history, eligibility criteria, covered services, provider payment systems, and program administration and financing. A list of commonly used acronyms, as well as information on beneficiary cost sharing, may be found in the appendices." [Report no. R40425, updated May 20, 2019]
Congressional Research Service [CRS]

Federal Subsidies for Health Insurance Coverage for People Under Age 65: 2019 to 2029

12 presentation slides. "In an average month for each year during that period, between 240 million and 242 million such people are projected to have health insurance, mostly from employment-based plans.... Net federal subsidies for insured people will total $737 billion in 2019 ... That annual sum is projected to reach $1.3 trillion in 2029.... Medicaid and the Children's Health Insurance Program account for between 40 percent and 45 percent of the federal subsidies, as do subsidies in the form of tax benefits for work-related insurance."
Congressional Budget Office [CBO]

Total U.S. Voluntary Market Grows 3% in 2018

"New annualized premium for voluntary insurance products totaled $7.2 billion in 2018, a 3% increase from 2017 sales results ... In the fourth quarter 2018, new voluntary life insurance premium jumped 8%, compared with prior year. For the year, voluntary life insurance products rose 3%, with substantial increases in accidental death & dismemberment and whole life product sales offsetting declines in voluntary term, UL and VUL sales."
LIMRA

[Opinion]

End Surprise Billing in Healthcare, But Do It Carefully

"An appropriate solution should reflect the geographic differences in the cost of services, consider the rates established by the private market for these services, and increase predictability for employer plan sponsors.... The U.S. Chamber's recommended solution is to create a benchmark that allows issuers to reimburse facility-based [Emergency room physicians, Radiologists, Anesthesiologists, and Pathologists (ERAP) doctors] for out-of-network services based on the median in-network reimbursement for that same service."
U.S. Chamber of Commerce

Press Releases

Supovitz Named to ERISA Advisory Council
American Retirement Association

Most Popular Items in the Previous Issue

House Passes Legislation to Strengthen the ACA
Katie Keith, in Health Affairs

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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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