Health & Welfare Plans Newsletter

August 15, 2019

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[Guidance Overview]

Prepare for Paid Sick Time in Pittsburgh: Paid Sick Days Act Upheld by Pennsylvania's Supreme Court

"While the Act’s effective date remains unclear, Pittsburgh’s mayor is expected to provide guidance on this question, so employers should monitor the City’s website for information.... The Act covers all full-time and part-time employees of all employers within the City of Pittsburgh, regardless of the size of the employer[.]"

Epstein Becker Green

[Advert.]

Attend the Employee Benefits Symposium on September 8-11, 2019

Sponsored by International Foundation of Employee Benefit Plans [IFEBP]

The Employee Benefits Symposium is led by established benefit experts and attended by experienced professionals across the country. You'll find edgy topics and actionable takeaways including solution-orientated sessions and relatable case studies.


[Guidance Overview]

IRS Expands List of Preventive Care Benefits for HSA-Compatible Plans

"[Notice 2019-45] makes clear that only the items and services in the appendix are to be considered preventive services for chronic conditions ... Furthermore, they are only considered to be preventive services when they are prescribed for the purpose of preventing the exacerbation of the chronic condition or the development of a secondary condition. Thus, this is a limited expansion of the preventive care exception."

Ice Miller LLP

[Guidance Overview]

CMS Floats Plan for Hospital Disclosure of Payer-Specific Prices

"[CMS] has published its proposed Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) rates and policies for calendar year 2020.... CMS includes a controversial proposal to require all hospitals to disclose payer-specific pricing, including 'consumer-friendly' information for hundreds of 'shoppable' services.... [This article provides] highlights of the proposed rule."

Reed Smith

IRS Decreases ACA Affordability Percentage for 2020

"[E]mployers with a low-paid workforce may have to lower their employee contributions/premiums for the lowest cost self-only health coverage option for 2020 to meet the adjusted percentage. ... [E]mployers may instead increase employee compensation for these low-paid workers."

Winston & Strawn LLP

New York Large Group Insurers Must Cover Medically Necessary Mammograms for Women Aged 35 to 39

"Currently, many insurance companies are only required to cover annual mammogram screenings for women over the age of 40, but over 12,000 cases of breast cancer are detected annually are in women under the age of 40 and are oftentimes in later stages and more aggressive forms of cancer. Shannon's Law will require large group insurance companies to cover annual mammogram screenings for women aged 35 to 39 when medically necessary."

Wolters Kluwer; free registration required

Tracking the Rise in Premium Contributions and Cost-Sharing for Families with Large Employer Coverage

"[T]he average family spent $4,706 on premiums and $3,020 on cost-sharing, for a combined cost of $7,726 in 2018. This represents an 18% increase in the health costs borne by employees and their families from five years earlier ($6,571 in 2013), outpacing the 8% increase in inflation and a 12% increase in workers' wages over the same period.... On average, employer plans cover 85% of enrollees’ in-network expenses in 2017, leaving plan enrollees to cover the remainder in cost-sharing. Since 2003, employer plans have covered between 85% and 86% of enrollee costs."

The Peterson-Kaiser Health System Tracker

Amazon Mail-Order Pharmacy Faces Pushback

"Surescripts LLC, a provider of the technology widely used to route electronic prescriptions, accused Amazon’s mail-order pharmacy subsidiary PillPack of receiving patient data that it had fraudulently obtained through a third party. ... The dispute with Surescripts is an example of the challenges that PillPack faces in disrupting the $424 billion U.S. prescription drug market: In many cases, PillPack's competitors are also gatekeepers that control access to patient data and payment rates from insurers."

The Wall Street Journal; subscription may be required

[Opinion]

Employers Shouldn't Fear Expansion of Medicare

"A new survey of 147 large employers from the National Business Group on Health found that 55% of them support a Medicare expansion that’s limited to older Americans. Only 23% think eligibility should drop to age 50, however, and 45% don’t think it should expand at all. A majority believe that a broader 'Medicare for All' plan would increase health costs."

The Washington Post; subscription may be required

Benefits in General

Third Circuit Joins Majority in Rejecting 'De Facto Administrator' ERISA Theory

"The Third Circuit ... concluded that it 'must restrict application of the title "administrator" to those who fit the statutory definition and not stretch the term to authorize penalties against others whom a disappointed participant might like to reach.' Although most circuits align with the Third, the de facto administrator theory remains jurisdictionally sensitive, as the First and Eleventh Circuits have accepted the theory in some capacity." [Bergamatto v. Bd. of Trustees of the NYSA-ILA Pension Fund, No. 18-2811 (3d Cir. Aug. 6, 2019)]

Jackson Lewis

Fourth Circuit Vacates Dismissal of Spouse's Fiduciary Breach Claims Against Employer

"The Fourth Circuit [held] that a participant or beneficiary is generally not required to allege that the plan administrator and named fiduciary also satisfies a functional fiduciary test to state a plausible fiduciary breach claim. Nevertheless, the court also concluded that, even if named fiduciary status was not enough to subject the employer to fiduciary responsibilities, the employer’s alleged conduct satisfied the functional definition of a fiduciary." [Dawson-Murdock v. National Counseling Group, Inc., No. 18-1989 (4th Cir. Jul. 24, 2019)]

Thomson Reuters / EBIA

Press Releases

CalPERS Offers New Program to Help Public Employers Offset Future Pension Costs
CalPERS [California Public Employees' Retirement System]

NIPA announces new EPCRS Certificate Course
NIPA [National Institute of Pension Administrators]

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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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