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Health & Welfare Plans Newsletter July 30, 2019 |
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Webcasts, Conferences COBRA Basics Part 8: COBRA in the M&A Context
COBRA Basics Part 9: COBRA Rules for Nontraditional Health Programs
What the New DOL Association Retirement Plan and Open MEP Rules Mean for PEOs
Health Benefits Laws Compliance Assistance Seminar
Best Practices for Navigating Employee Benefits After Termination
Certificate in Employee Benefits Law Seminar
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Discussions |
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This Newsletter:
BenefitsLink Retirement Plans Newsletter:
Message Boards Digest:
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[Official Guidance]
819 pages. "[These regs include CMS] proposals related to: [1] a definition of 'hospital'; [2] different reporting requirements that would apply to certain hospitals; [3] definitions for two types of 'standard charges' ... that hospitals would be required to make public, and a request for public comment on other types of standard charges that hospitals should be required to make public; [4] a definition of hospital 'items and services' ... [5] requirements for making public a machine-readable file that contains a hospital's gross charges and payer-specific negotiated charges for all items and services provided by the hospital; [6] requirements for making public payer-specific negotiated charges for select hospital-provided items and services that are 'shoppable' and that are displayed in a consumer-friendly manner[.]"
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[Advert.]
ECFC 32nd Annual Symposium - Cincinnati - August 6-8 - Sign up now
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. |
![Sponsored by ECFC [Employers Council on Flexible Compensation]](https://benefitslink.com/bnrs/2019/ECFC_Symposium19_top.jpg "Sponsored by ECFC [Employers Council on Flexible Compensation]")
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[Guidance Overview]
IRS Expands Coverage for Preventive Care of Chronic Conditions for HSA Eligible Individuals "The services identified in [Notice 2019-45] constitute preventive care solely for purposes of the HDHP/HSA rules ... and do not affect the ACA rule mandating coverage of preventive care without cost sharing. Employer-sponsored HDHPs ... may cover these new services without application of the required minimum HDHP deductible.... Expanding pre-deductible HDHP coverage for items related to chronic conditions may bolster HDHP enrollment."
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CMS Unveils Sweeping Proposed Mandates on Hospital Pricing Transparency "Under the proposed rule, hospitals would make public their 'standard charges' for both gross charges and payer-specific negotiated charges for all items and services. The pricing would have to be available on the Internet in a machine-readable file, and would include information such as common billing or accounting codes used by the hospital, and a description of the item or service. The pricing information would have to be 'consumer friendly,' with payer-specific negotiated charges for common shoppable services, such as imaging, outpatient visits, and lab tests."
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CMS Proposes Hospitals Post Online Their Rates Negotiated with Payers "[CMS] proposed that every U.S. hospital participating in Medicare must publish the prices they negotiate with payers for standard services and items in a bid to boost transparency.... The rule goes further than a rule that went into effect this year that requires hospitals to post list prices on their websites."
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Administration Proposal Would Require Hospitals to Disclose Discounted Prices They Give Insurers "The Trump administration on Monday said it would begin forcing hospitals to publicly disclose the discounted prices they negotiate with insurance companies, a requirement intended to help patients shop for better deals on a range of medical services, from hip replacements to CT scans. The plan, issued as a proposed federal rule, would take effect in January, but would likely be challenged in court by an industry that has long held such rates secret."
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[Advert.]
A Practical Approach to Developing a Wellness Program
August 6 webinar. Learn the best strategies for designing your program implement and deploy your program, and how to keep it fresh and effective. BenefitsLink discount. |
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Healthcare Costs Increase Again in 2019 "In 2019, healthcare costs for our hypothetical family of four have reached $28,386, an increase of 3.8% from the year prior. Healthcare costs for the average American adult are at $6,348.... This year, employees saw a 3.6% increase, compared to a 4.0% increase for employers." [An interactive tool which allows the user to understand how costs are expected to vary for different types of families with respect to size, age/gender mix, and different cost levels representative of variation by area.]
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Interactive Map: What Is Your State Doing to Affect Access to Adequate Health Insurance? "Select a state on the map and an action [from the dropdown box] to learn what the individual insurance market stabilization strategies states may be pursuing."
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Oregon Latest to Enact Paid Family Leave Law "The Oregon program will be funded by contributions from employers with 25 or more employees and also by employee payroll deductions. The law will take effect in January 2023, covering employees who earned at least $1,000 in wages the previous year regardless of hours worked."
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[Opinion]
Drug Rebates Will Remain, But So Will Pressure to Reduce Drug Prices and Demonstrate Value "While the rebate issue is now off the table, pressure to reduce prescription drug costs is not. But rather than waiting for the next round of regulations, ... the pharmaceutical industry should consider developing its own business models that address drug prices and demonstrate value."
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Benefits in General |
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Making Sense of the New Auditing Standard for ERISA Plans "SAS 136 replaces a modified opinion ... used with ERISA Section 103(a)(3)(C) audits with a two-pronged opinion.... The auditor must obtain plan sponsor acknowledgements that the sponsor is responsible for determining [1] whether a 103(a)(3)(C) audit is permissible and whether the certification meets ERISA requirements, [2] maintaining and providing a current plan document, [3] preparing and fairly presenting financial statements, and [4] providing a substantially completed (draft) Form 5500."
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Does Employee's Signed Release Include ERISA Claims? "The Southern District of Iowa dismissed the plaintiff's claim after finding that ... the plaintiff's release covered ERISA claims against the plan's trustee ... The court considered that [the plaintiff] had not taken any steps to act as a representative of the ESOP ... had not satisfied other procedural requirements to represent the ESOP, and had not recruited any other plaintiffs.... [T]he court dismissed the case because, as the only plaintiff, [the plaintiff's] claim had been released." [Innis v. Bankers Trust Co. of South Dakota, No. 16-650, (S.D. Ia. Apr. 30, 2019)]
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Employers Beware: South Carolina Abolishes Common-Law Marriage "[T]his ruling reaches beyond state lines ... After July 24, 2019, it no longer is enough for employees claiming an employee is a 'spouse' for employee benefit plan purposes simply to establish they were married under the common law of South Carolina.... This Court decision will also have implications for employees in South Carolina seeking to take [FMLA leave] to care for a spouse with a serious health condition." [Stone v. Thompson, 17-000227 (S.C. Jul. 24, 2019)]
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Social Security and Paid Leave: Views of Voters Age 50+ "Although nearly eight in 10 voters ages 50+ (78%) strongly or somewhat support the concept that more workers should have access to paid leave, just over half strongly or somewhat support funding paid leave with higher taxes or delays in getting Social Security ... [If] older voters were required to pay higher federal payroll taxes, the overwhelming majority would rather the money raised be used to shore up Social Security for the long term (82%) than to fund paid leave (17%)."
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Fourth Circuit Allows Beneficiary to Pursue Fiduciary Breach Claims Against Employer "The Fourth Circuit concluded that a plaintiff need not allege that an ERISA plan administrator and named fiduciary also satisfies the functional fiduciary test to state a plausible ERISA fiduciary breach claim. The Fourth Circuit faulted the district court for overlooking the employer's roles as joint plan administrator and named fiduciary, and instead focusing on cases involving functional ERISA fiduciary status." [Dawson-Murdock v. National Counseling Group, Inc., No. 18-1989 (4th Cir. Jul. 24, 2019)]
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Selected Discussions |
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Building Trades Participation of Non-Building Trades Employees in Health Care Plan In the case of a multiemployer health plan maintained by one of the building and construction trades, an issue has arisen as to whether employees of some of the employers who do not perform work traditionally in the trade, e.g. clerical, could be permitted to join the plan. The concept would be not to include them as non-bargaining unit employees, but to actually have them join the union and participate as bargaining unit employees. Any knowledge as to whether this is permissible or not?
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Press Releases |
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Most Popular Items in the Previous Issue |
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Prescription Drug Rebates, Explained
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Key Highlights of Final HRA Regs
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David Rhett Baker, J.D., Editor and Publisher
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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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