Health & Welfare Plans Newsletter

June 6, 2019

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Jobs

Retirement Plan Specialist
InvesTrust
in Oklahoma City OK

Sr. Retirement Plan Benefit Administrator
Compass Retirement Consulting Group
in Stratham NH / MA / ME / Telecommute

Retirement Plan Consultant
Northwest Plan Services, Inc.
in Seattle WA

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Webcasts, Conferences

COBRA Continuation Coverage: The Top Five Issues for Employers
June 26, 2019 WEBCAST
ABD Insurance & Financial Services

HSA Retirement Superhero in Disguise
June 27, 2019 in IL
Worldwide Employee Benefits Network [WEB] - Chicagoland Chapter

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[Guidance Overview]

HHS Proposes to Scale Back ACA Nondiscrimination Rules

"The proposed rules adopt a statutory reading that is much more limited than that reflected in the existing regulations, both in terms of the entities subject to the nondiscrimination requirements and in the breadth of those requirements."
Ballard Spahr LLP

[Advert.]

ECFC 32nd Annual Symposium - Cincinnati - August 6-8 - Sign up now

Sponsored by ECFC [Employers Council on Flexible Compensation]

ECFC Symposium is THE premier networking and professional development event for employers, plan sponsors, TPAs and other service providers in the consumer-directed benefits industry. Join us in Cincinnati.


Sixth Circuit Rejects HIV/Genvoya Claim Under ACA Section 1557

"In class action litigation, the US Court of Appeals for the Sixth Circuit rejected a health plan participant's claim that an insurer's coverage policy regarding HIV medication violated the nondiscrimination rules of [ACA] (ACA) Section 1557. In analyzing the participant's claim, the Sixth Circuit resolved an open question by holding that Section 504 of the Rehabilitation Act of 1973 does not prohibit disparate-impact discrimination." [Doe v. BlueCross BlueShield of Tenn., Inc., No. 18-5987 (6th Cir. June 4, 2019)]
Thomson Reuters Practical Law

Considerations for the Self-Insured Health Plan Sponsor When Negotiating a Trend Guarantee in Your Next TPA Selection

"Provider discount analyses are generally thought to do a reasonable job of estimating the expected change in discount upon switching TPAs, but there are several caveats to consider when interpreting the results ... Though employers may intuitively expect that the use of [medical] trend guarantees will make the analysis simpler (i.e., take the bidding TPA that guarantees the lowest trend), there are many issues to consider for the self-funded employer ... TPAs offering trend guarantees will also attempt to control their exposure via reference to [certain listed] issues[.]"
Milliman

Why Is Active Open Enrollment Becoming the Popular Choice?

"Some employers have adopted a hybrid active-passive enrollment approach, which can provide the best of both worlds -- higher visibility into the benefits being offered while still giving employees the ease of defaulting to the previous year's benefits. The hybrid approach also helps avoid the conflict many benefit teams face with active enrollments when employees 'forget' to elect their benefits and lose their coverage."
Benefitfocus

How External Reference Pricing Could Address Price Disparities Between Drugs in the U.S. and Other Nations

"American taxpayers pay three times as much for prescription drugs as citizens in other wealthy nations, many of which use external reference pricing, a mechanism that benchmarks drug prices to those paid in other countries. The U.S. has yet to embrace this practice to keep prices affordable for consumers -- perhaps because we are often the first adopter of drugs."
Arnold Ventures

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Can the World's Biggest Companies Save Health Care?

"Can the frictionless consumer experience we now have in banking, retail, and entertainment be achieved in health care? Can the data generated by our digital devices -- combined with greater penetration of electronic health records (EHRs) -- lead to better patient outcomes and improved efficiencies? ... Aligning incentives could improve clinical trials ... Consumers could become more closely connected to their health data ... Web searches could lead to patient-specific insight."
Deloitte

HIPAA Breach Settles for $1M in First Settlement Involving State Attorneys General

"Indiana-based Medical Informatics Engineering, Inc. (MIE) agreed to pay $100,000 to the [HHS] Office for Civil Rights (OCR). MIE provides electronic health record and related services to healthcare entities. MIE also committed to a two-year corrective action plan to resolve potential violations of the [HIPAA] Privacy and Security Rules. Separately, MIE agreed to pay $900,000 to 16 states whose attorneys general had sued the company over a related data breach. The suit was the first of its kind premised on a HIPAA violation."
Poyner Spruill LLP

Agencies Invite Comments on Colorado State Innovation Waiver Application

"On May 20, 2019, Colorado submitted a State Innovation Waiver application. The Departments deemed the application complete on June 5, 2019. The Departments are requesting comments on Colorado's Section 1332 State Innovation Waiver as part of the federal public comment period. Comments can be submitted from June 5, 2019 through July 5, 2019."
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

Fifth Circuit Provides Guidance on 'Regular Occupation' Definition

"Is 'regular occupation' defined as the duties the claimant is actually doing in his or her specific job? NO. Each claim should be assessed from the perspective of duties of the job generally in the national economy and not how the job is 'performed for a specific employer or in a specific locale.' " [Nichols v. Reliance Standard Life Ins. Co. (5th Cir. May 23, 2019)]
Lane Powell PC

[Opinion]

Employer Coalition Comments on Senate HELP Health Costs Draft Legislation (PDF)

"We support the draft proposal to prohibit balance billing for all emergency services.... We support requiring providers to give patients receiving scheduled care written and oral notice at the time of scheduling about the provider's network status and any potential charges for out-of-network care ... We believe the best option for resolving surprise medical bills is through a benchmark payment system.... We support the proposition that all providers in an in-network facility must accept the in-network rate.... We oppose the utilization of an arbitration system to settle payment disputes."
Partnership for Employer-Sponsored Coverage [PESC]

Press Releases

Intelligent Capitalworks is Certified for Fiduciary Excellence
Centre for Fiduciary Excellence [CEFEX]

Most Popular Items in the Previous Issue

DOL Updates Model SAR for Welfare Plans
Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]

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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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