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June 25, 2019 logo logo
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Retirement Plan Manager
Benefit Consultants Group
in Cherry Hill NJ

Sr. Pension Administrator
in San Luis Obispo CA / Encinitas CA / Roseville CA / Telecommute

Senior Plan Consultant
Cherry Bekaert LLP
in Virginia Beach VA / Rockville MD / Telecommute

Claims Processor / Call Center Liaison
in Los Angeles CA

Lead Regulatory Support Consultant
in NY

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Webcasts, Conferences

First Look at the New (Final!) HRA Regulations
July 9, 2019 WEBCAST
American Bar Association Joint Committee on Employee Benefits [JCEB]

Health Meets Wealth: What Role Do Health Savings Accounts (HSAs) Play in Retirement Investing?
July 11, 2019 WEBCAST

Leave of Absence Solutions for a Changing Landscape
August 15, 2019 in MA
New England Employee Benefits Council [NEEBC]

►See 134 Upcoming Webcasts and Conferences

►See 1555 Recorded Webcasts


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[Official Guidance]

Text of Filing Instructions for the 2018 CMS MLR Reporting Form (PDF)

56 pages. "These are the filing instructions for the report to the Secretary required by section 2718 of the Public Health Service Act (PHSA), which includes elements that make up the medical loss ratio (MLR) and the calculation and provision of rebates to enrollees. The data included in the MLR Annual Reporting Form are the exact data that will be used to calculate an issuer's MLR and rebates, if any[.]" [Also available: MLR 2018 Annual Reporting Form (XLSX), MLR 2018 Calculator and Formula Tool (XLSM), and MLR 2018 System Validations (PDF)]
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]


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.

[Guidance Overview]

Final Rule Permits Employers to Offer Individual Coverage HRAs

"[An] applicable large employer who is subject to the employer mandate will be able to satisfy its offer of coverage to full-time employees with an individual coverage HRA.... Moreover, if the individual coverage HRA is 'affordable,' an employee who receives the offer of coverage will not be eligible for a premium tax credit even if the employee declines the coverage. This will allow the employer to avoid application of penalties related to the employer mandate."
Ice Miller LLP

[Guidance Overview]

Editor's Pick New Rules Regarding Account-Based Group Health Plans Could Have Some Employers Cheering

"[T]he Final Regulations clarify that the employee classes are to be applied using a common law employer standard and not on a controlled group basis.... [E]mployers will need to analyze whether practices that are acceptable in some spheres (such as providing for enhanced HRA contributions as a wellness incentive for individuals with a health factor under HIPAA) are permissible when offered in connection with an ICHRA.... [E]mployers interested in using an ICHRA to avoid all employer mandate penalties will likely need to contribute larger amounts to ensure that the individual coverage is otherwise 'affordable' for the participants (although a minimal contribution would shield against the big penalty associated with not offering coverage)."
Groom Law Group

[Guidance Overview]

ACA Round-Up: Risk Adjustment, Exchange Blueprint, and More

"On June 17, 2019, CMS released proposed updates to part of the risk adjustment methodology and an updated exchange blueprint application for states interested in operating their own state-based exchange. CMS separately approved 'vertical choice' for the small business exchanges operated by the federal government in all but one state."
Katie Keith, in Health Affairs

[Guidance Overview]

Editor's Pick Massachusetts Paid Family and Medical Leave Final Regs: The Private Plan Exemption

"[E]mployers with a compliant Private Plan do not need to make the required employer medical leave contribution (currently, 0.37% of eligible payroll for employers with 25 or more covered individuals).... [T]he approved plan must meet all the minimum requirements listed [in this article] and must not cost employees any more than they would be required to contribute to the state plan under MAPFML. In addition, the Private Plan exemption does not relieve businesses of the PFML notice obligations and worker protections."


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What Are the New Health Reimbursement Account Rules?

"When HIPAA was enacted in 1996, a key objective was to facilitate portability of health insurance and end 'job lock'.... [W]ith individually-purchased health insurance, portability is achieved.... Although health care cost trends have moderated somewhat in recent years, they are still accelerating at three times inflation. Any opportunity to budget health benefit expenses on the same basis as wage and salary increases is very important to all businesses."

Administration Seeks More Health Care Cost Details for Consumers

"[The Executive Order] directs agencies to develop rules to require hospitals and insurers to provide information 'based on negotiated rates' to the public.... In January, new rules took effect ... that require hospitals to post online their 'list prices,' which hospitals set themselves and have little relation to actual costs or what insurers actually pay. What resulted are often confusing spreadsheets that contain thousands of a la carte charges ... that patients have to piece together ... to estimate their total bill."
Kaiser Health News

Out-of-Pocket Costs Rose 12% in 2018

"Overall out-of-pocket costs rose 12% year-over-year, with inpatient costs jumping more than $600, outpatient costs increasing nearly $200, and emergency department costs rising $40 compared to 2017. Nearly 60% of patients reported having an average out-of-pocket expense between $500 and $1,000 in 2018, a 39% increase year-over-year."
HealthLeaders Media

Out of Pocket Costs: The Only Health Care Prices That Matter to Consumers

"Just 17 percent of people with typical deductibles shop today, and 21% with high deductible plans. More price transparency will drive these numbers up, but how much is unknown. On the other hand, there is some evidence that people want to shop when they can: 47%, for example, asked for a generic drug to save money in the past year; and 36% checked with a provider or health plan on the cost of an office visit. But just 23% used an online tool to compare provider costs. All told, 70% reported some shopping-like behavior in the survey."
Drew Altman, via Axios

California Legislature OKs Health Insurance Mandate

"The California Legislature voted Monday to tax people who refuse to buy health insurance, bringing back a key part of former President Barack Obama's health care law in the country's most populous state after it was eliminated by Republicans in Congress.... The penalty won't apply to everyone, including people living in the country illegally. Lawmakers on Monday also approved a bill that would expand government-funded health insurance to low-income young adults living in the U.S. illegally."
Associated Press

HISIM2: CBO's New Health Insurance Simulation Model

"CBO analysts use the agency's revised health insurance simulation model, HISIM2, to generate estimates of health insurance coverage and premiums for the population under age 65. The model is used in conjunction with other models to develop baseline budget projections ... It is also used to estimate the effects of proposed changes in policies that affect health insurance coverage. This presentation provides an overview of the current model's specifications, calibration estimates, and the results highlighted in CBO's recent report, Federal Subsidies for Health Insurance Coverage for People Under Age 65: 2019 to 2029."
Congressional Budget Office [CBO]


President Trump Issues Executive Order on Healthcare Price Transparency

"During the signing ceremony, Trump yielded the podium briefly to R. Lawrence Van Horn, PhD, MBA, MPH ... who said the executive order's freemarket approach will reduce costs and benefit the economy overall.... Not everyone agrees with that assessment. To the contrary, America's Health Insurance Plans (AHIP) President and CEO Matt Eyles said in a statement that requiring the public disclosure of negotiated rates 'will reduce competition and push prices higher' for consumers and taxpayers alike."
HealthLeaders Media

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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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