Health & Welfare Plans Newsletter

July 8, 2019

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Defined Benefits Analyst
Retirement Planning Services
Telecommute

Counsel - ERISA & CIT Matters
M&T Bank
in New York NY / Buffalo NY / Wilmington DE

Senior Plan Administrator
My Benefits, LLC
in Atlanta GA

Retirement Plan Services Sales Representative
F&M Trust
in Chambersburg PA

Supervisory Actuary -DH
Pension Benefit Guaranty Corporation
in Washington DC / Telecommute

Benefits Attorney
Air Line Pilots Association
in Herndon VA

Actuary (Pathways Recent Graduate)
Pension Benefit Guaranty Corporation
in Washington DC / Telecommute

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Save Money on Self-Funded Health Plans with Billing Reviews

"Conducting provider billing reviews can be an especially beneficial method to uncover payment errors and can potentially save employers money. Issues can arise within medical benefit plans frequently, yet it's common for organizations to only perform a claim audit or billing review once every three years."
Moss Adams LLP

Surprise Billing Hits Roadblock En Route to Reform

"The effort to protect patients from surprise bills ... inched forward ... as the Senate Health, Education, Labor and Pensions Committee marked up legislation that would prohibit providers from billing a patient for the difference between what the provider charges and what the insurer reimburses, as well as require insurers to pay out-of-network doctors at the median in-network fee for treatments. But the path forward is riddled with resistance."
Morning Consult

Parties File Briefs on Standing in Challenge to ACA

"In its July 3 letter, the Department of Justice asserts that there remains a live case or controversy between the plaintiffs and the federal government. Because there is a live case or controversy, it does not matter whether the intervenors have standing.... [T]he plaintiffs agree that the Fifth Circuit has jurisdiction and ask the court to affirm Judge O'Connor's decision on the merits.... The plaintiffs agree that the intervenor states have standing, but they assert that the House does not." [Texas v. Azar, No. 19-10011 (5th Cir. oral arg. sched. Jul. 9, 2019)]
Katie Keith, in Health Affairs

ACA Round-Up: Texas v. U.S., Montana Waiver, Risk Adjustment Report, and More

"Ahead of oral arguments this week, recent days have brought a flurry of activity in Texas v. United States, the lawsuit challenging the validity of the [ACA]. States have also been active on the ACA front: Montana's reinsurance waiver was deemed complete, and New Jersey and Pennsylvania passed legislation to transition to state-based marketplaces. Finally, the [CMS] released its summary risk adjustment report for 2018 detailing about $10.4 billion in transfers."
Katie Keith, in Health Affairs

[Opinion]

ObamaCare's Failed Cost Controls

"What explains the law's poor performance? To start, its signature cost-control provisions simply have not panned out.... ObamaCare's most promising cost-control provision is the one that both Republicans and Democrats are determined to jettison.... [T]he Cadillac tax is poorly designed, because it would hit low-salaried workers as hard as CEOs."
The Wall Street Journal; subscription may be required

[Opinion]

Maryland's Path to a Prescription Drug Affordability Board

"[T]his year Maryland became the first state in the nation to create a Prescription Drug Affordability Board. The law's July 1st enactment marked the culmination of a multi-year, grassroots effort based on the recognition of a simple truth that pharmaceutical manufacturers have long ignored: drugs don't work if people can't afford them."
Families USA

Press Releases

Most Popular Items in the Previous Issue

Tips and Strategies for Successful IRS and DOL Plan Audits (PDF)
McDermott Will & Emery, for Plan Sponsor Council of America [PSCA]

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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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