Health & Welfare Plans Newsletter

June 26, 2019

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Manager, Retirement Plan Compliance
Guideline, Inc.
in San Mateo CA

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Guideline, Inc.
in San Mateo CA

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Ascensus
in Roseville CA

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BB&T
in Greensboro NC

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Webcasts, Conferences

Drug Pricing Transparency Rule: What You Need to Know
RECORDED
Manatt

Real Cost of Delayed Access to Healthcare
July 10, 2019 in TX
Worldwide Employee Benefits Network [WEB] - Houston Chapter

Protecting Employee Privacy and Identity in the Digital Age
July 25, 2019 WEBCAST
Worldwide Employee Benefits Network [WEB] - Atlanta Chapter

►See 132 Upcoming Webcasts and Conferences

►See 1561 Recorded Webcasts


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[Guidance Overview]

Executive Order Encourages HSA Changes and Promotes Transparency

"A new rule in line with the order could allow first-dollar coverage for conditions that commonly require maintenance drugs or therapies, such as diabetes, hypertension or arthritis, without running afoul of the HSA rules.... Other provisions of the order provide for additional transparency that may not directly impact employer plan sponsors but could still disrupt the current system."
Lockton

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Health Reimbursement Arrangement Plans Update

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July 23 webinar will review the benefits of establishing an individual coverage HRA or an excepted benefit HRA and provide you with what you need to know to establish one or both of them. BenefitsLink discount.


[Guidance Overview]

Editor's Pick Executive Order on Health Care Prescribes Change Ahead for Providers and Insurers

"[This article provides] a list of the EO requirements and the prior administrative action or authority that lays the foundation for the actions."
Faegre Baker Daniels

[Guidance Overview]

Executive Order Calls for Increased FSA Carryovers and Other Benefits Guidance

"The order ... directs the Departments to provide guidance on topics that include high-deductible health plans (HDHPs), health savings accounts (HSAs) ... and health flexible savings arrangements (health FSAs).... The order also directs the Departments to issue regulations and request comments on a proposal to require health providers, health insurers, and self-funded group health plans to provide or facilitate access to information about expected out-of-pocket costs for items or services to individuals before they receive care."
Thomson Reuters Practical Law

[Guidance Overview]

Dallas Enacts Paid Sick Leave Law

"Employees eligible for paid sick leave are those who perform at least 80 hours of work for pay in a year within the City of Dallas ... For employers with more than five employees, the ordinance is effective August 1, 2019. For employers with five or fewer employees (at any time in the preceding 12 months), the ordinance is effective August 1, 2021."
Fox Rothschild LLP

[Guidance Overview]

Proposed Changes Would Ease ACA Nondiscrimination Rule Issues

"[HHS] Office for Civil Rights (OCR) recently issued a proposed rule amending provisions of its 2016 rule prohibiting certain forms of discrimination under Section 1557 of the [ACA].... [1] Modifying the applicability of the Section 1557 regulations ... [2] Increasing flexibility through 'individual assessment of entity compliance with language access' ... [3] Revising video interpretation standards ... [4] Simplifying requirements for health insurers and employers ... [5] Repealing grievance requirements and compliance coordinator requirements."
McGuireWoods

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Unpacking the Executive Order on Health Care Price Transparency and Quality

"The insurance and hospital industries raised immediate concerns about the executive order and what it could mean for health care costs and the disclosure of proprietary information (such as the rates negotiated by insurers and providers). This post discusses the executive order but does not delve into the potential legal challenges associated with its implementation."
Katie Keith, in Health Affairs

Editor's Pick When Government Sets Hospital Prices: Maryland's Experience (PDF)

24 pages. "Rather than reducing health-care costs in any significant way, Maryland's payment-regulation experiment has, as this report explains, been captured by the hospitals that it was intended to regulate.... [T]he system allows the state to claim higher reimbursements from the federal government for Medicare patients.... The adoption of all-payer rate-setting on a national level would establish additional barriers to price competition, thereby making it harder to reduce America's health-care costs."
Manhattan Institute

The High Price of Hospital Care

"Commercial insurers are estimated to pay about twice what Medicare does for hospital care. Across all payers, hospitals receive reimbursement averaging about 134 percent of what Medicare pays ... High prices do not always indicate better quality; in fact, they often mask inefficiencies in the hospital business. The first portion of this report examines trends in hospital profits and pricing variation across geographic areas and payers. The second portion describes policy options to rein in the high cost of hospital care."
Center for American Progress

The ACA, Nearly a Decade Later (PDF)

34 presentation slides. Topics: [1] Background; [2] Legislative changes; [3] Regulatory hurdles; [4] Litigation; [5] Future challenges?
American Academy of Actuaries

[Opinion]

Blue Cross Blue Shield Association Statement on the Executive Order on Price Transparency

"We strongly support providing consumers with better access to care that keeps people healthy and addresses chronic conditions. We're pleased the executive order also advances this goal by giving health insurers more flexibility to cover high-value services on a pre-deductible basis for consumers enrolled in high deductible health plans."
Blue Cross Blue Shield Association

[Opinion]

How Congress Should Deal with Surprise Medical Bills for Patients (PDF)

"Leading congressional proposals to address these concerns fall short. None reduces medical costs, and instead will induce insurers and providers to shift the costs of the new mandates back to patients in opaque ways.... Instead of choosing among competing 'patient protections' proffered by representatives of industries that benefit from surprise bills, Congress should pursue reforms that promote choice and competition, minimize government interference and regulation, and allow patients to take more control of their medical care."
The Heritage Foundation

Benefits in General

How Are Generational Trends Reshaping the Employee Benefits Landscape?

"Employers are finding themselves in an 'arms race' to design a benefits package that optimally improves employee satisfaction and wellness -- physical, emotional and financial -- within a given budget. Understanding the needs of your unique employee populations may enable you to get more value out of your benefits offering today and in the future."
Voya

District Court Opinion: ERISA Does Not Apply to Benefit Claims by Foreign Nationals Working Outside U.S. (PDF)

"The foreign plan exemption is only one of five provisions that state when a plan will be exempted under ERISA ... It is mere speculation to conclude that this exemption means that foreign nationals working in a foreign country are within the scope of ERISA.... Without an affirmative intention of Congress that clearly expresses that ERISA applies extraterritorially, the Court must therefore presume that ERISA 'is primarily concerned with domestic conditions,' and Plaintiffs' motion to remand will be granted due to a lack of subject matter jurisdiction." [In re Reliance Standard Life Ins. Co., Nos. 19‑331, 19‑332, 19‑333, 19‑334, 19‑335, 19‑336, 19‑338, 19‑339, 19‑340, 19‑341, 19‑342, 19‑343 (E.D. Penn. Jun. 24, 2019)]
U.S. District Court for the Eastern District of Pennsylvania

Seventh Circuit Holds That 'Substantial Compliance' Does Not Apply to Missed Deadlines

"[S]ome circuits allow plan administrators to claim 'substantial compliance' when not meeting their deadlines to decide claims or appeals and invoke little or no penalty for these transgressions. The Seventh Circuit has made it clear to plan administrators: substantial compliance does not apply to ERISA's regulatory deadlines. Make a decision on time or be subject to de novo review." [Fessenden v. Reliance Standard Life Ins. Co., No. 18-1346 (7th Cir. Jun. 25, 2019)]
Kantor & Kantor

[Opinion]

Testimony of AICPA to the ERISA Advisory Council: Improving the Financial Statement Audit Process (PDF)

10 pages. "While the primary objective of the auditor is to express an opinion on whether the plan's financial statements are fairly presented, the audit process can also help the plan administrator keep apprised of matters that may need to be addressed to fulfill their responsibilities."
American Institute of Certified Public Accountants [AICPA]

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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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