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Consulting Actuary
Pension Review Services
in Farmingdale NY

Employee Benefit Plan Assistant (Pathways Recent Graduate Program)
Employee Benefits Security Administration, U.S. Department of Labor
in Seattle WA / Telecommute

Employee Benefits Investigator (Pathways Recent Graduate Program)
Employee Benefits Security Administration, U.S. Department of Labor
in Boston MA / Telecommute

Retirement Plan Administrator
Bates & Company
in Winter Park FL / Clearwater FL

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Webcasts, Conferences

Health Care Update: The Affordable Care Act. It's Still Here!
September 10, 2019 WEBCAST
American Bar Association Joint Committee on Employee Benefits [JCEB]

Annual Meeting
October 27, 2019 in TX
Conference of Consulting Actuaries

►See 157 Upcoming Webcasts and Conferences

►See 1547 Recorded Webcasts


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[Official Guidance]

CMS Announces Upcoming Enhancement of Overall Hospital Quality Star Ratings

"Today's announcement means CMS plans to next update the Star Ratings in early 2020 according to the current methodology. CMS plans proposed rulemaking in 2020 to enhance the methodology and aims to finalize these rules prior to the release of the Star Ratings in calendar year 2021.... CMS has posted a summary of the more than 800 comments received on potential technical changes to the Hospital Compare Overall Star Ratings received during a public comment period that ended March 29, 2019."

Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

[Guidance Overview]

DOL Gives Working Parents FMLA Pass to Attend Children's Special Education Meetings

"The DOL's approach should not be read as blanket FMLA protection for parent attendance at IEP meetings. As a threshold matter, a child must have a 'serious health condition' to implicate the FMLA. Some, but not all, children with IEPs qualify under the FMLA definition, which requires an impairment or physical or mental condition that necessitates continuing treatment from a healthcare provider."

Franczek Radelet P.C.

[Guidance Overview]

DOL Gives Working Parents FMLA Pass to Attend Children's Special Education Meetings

"Employers can and should require that the requesting employee provide certification from their child's health care provider confirming that the child has a serious health condition.... [E]mployers can request that employees give 30 days' notice of those care meetings, or as soon as practicable if the need for leave is not foreseeable.... Illinois employers who are covered by both the FMLA and ISVRA should confirm that their FMLA policies provide for the concurrent running of FMLA leave with other available paid or unpaid leave to prevent employees from stacking the two types of statutory leave."

Franczek Radelet P.C.

Married Attorneys Sue Law Firm Over Parental Leave Policy

"[T]hey allege that Jones Day discriminates by giving biological mothers 'eight more weeks' of parental leave. The couple claims that although Jones Day 'labels' the additional eight weeks 'disability leave,' biological mothers are not actually required to establish a disability to obtain the leave. According to their complaint, there is 'no legitimate basis' for 'giving sex-based disability leave to employees who are not disabled.' " [Savignac and Sheketoff v. Jones Day, No. 19-2443 (D.D.C., complaint filed Aug. 13, 2019)]

Zuckerman Spaeder LLP

District Court: Requirements for Requesting FMLA Leave Cannot Be More Onerous than for Requesting Non-FMLA Leave

"[T]he employer argued that while the employee had repeatedly contacted her manager and district manager to request leave, she failed to contact Human Resources, as was required by the employer's FMLA policy.... [T]he district court held that the requirement that employees must follow 'usual and customary notice and procedural requirements' to obtain FMLA leave does not permit employers to deny leave based on a failure to comply with more stringent notice requirements applicable only to FMLA requests." [Moore v. GPS Hospitality Partners IV, LLC, No. 17-500 (S.D. Ala. Jun. 3, 2019)]

The Wagner Law Group

District Court Denies Motion to Dismiss Mental Health Parity Act Putative Class Action

"[A] federal district court in California denied United Healthcare's [UHC's] motion to dismiss a putative class action challenging the reimbursement rates for out-of-network mental health services.... [T]he plaintiffs alleged that UHC reduced reimbursement rates for out-of-network services by 25% for services provided by a psychologist and by 35% for services provided by a masters level counselor in violation of the [MHPAEA]." [Smith v. United Healthcare Ins. Co., No. 18-6336 (N.D. Cal. Jul. 18, 2019)]

Proskauer Rose LLP

Is This Gross Misconduct That Excuses COBRA?

"On a motion for summary judgment, the court observes that '"gross misconduct" amounts to more than a single event of negligence.'  Because there is no evidence that Nurse N had been similarly derelict in the past, her actions do not rise to the level of gross misconduct." [New v. Family Health Care P.C., No. 17-2379 (D. Md. Jul. 1, 2019)]

Miles & Stockbridge

New Employer Health Coverage Reporting Required in Certain States

"Effective January 1, 2019, taxpayers in both the District of Columbia and New Jersey are required to maintain minimum essential health coverage or potentially pay a penalty. In both cases, employer reporting of health coverage information ... is required to assist the state in enforcing the individual health coverage mandates... California, Rhode Island and Vermont have all enacted similar laws ... effective January 1, 2020.... [T]he California and Rhode Island laws include employer reporting[.]"


Do the DOL's FMLA Forms Work for You? Now Is Your Chance to Speak Up

"On August 5, 2019, the [DOL] published proposed revisions to the Wage and Hour Division's [FMLA] forms ... Many revisions are stylistic or organizational.... Some revisions give additional cues to both employees and employers about the legal nuances of the FMLA.... New formatting is intended to eliminate the current duplicative questions, and streamline the process for health care providers.... The proposed forms also provide additional instruction and definitions."

Jackson Lewis P.C.

Reports Conflict About Whether Self-Funding Health Benefits Is Increasing

"Data from the Medical Expenditure Panel Survey -- Insurance Component (MEPS-IC) shows, in 2016, 40.7% of private-sector employers reported that they self-insured at least one of their health plans, but by 2018, 38.7% reported the same.... Mercer's most recent National Survey of Employer-Sponsored Health Plans found, among employers with 10 to 49 employees, 17% offered a self-insured plan in 2018, up from 10% in 2014."

PLANSPONSOR; free registration may be required

The Impact of the ACA on Insurance Coverage Disparities After Four Years

"[The authors] find that the fully implemented ACA eliminated 44 percent of the coverage gap across income groups, with the Medicaid expansion accounting for this entire reduction. The ACA also reduced coverage disparities across racial groups by 26.7 percent, across marital status by 45 percent, and across age groups by 44 percent, with these changes being partly attributable to both the Medicaid expansion and nationwide components of the law."

National Bureau of Economic Research [NBER]; purchase required for full document

Benefits in General

Total Rewards Statements: Tips to Help Employees Maximize Benefits Value

"Total rewards statements should not be a shortened version of your benefits guide. Use your total rewards statement as an opportunity to tell your organization's total rewards story. This communication should be compelling and convey your company's culture and overall total rewards strategy."


Press Releases

Most Popular Items in the Previous Issue

What Is a 'Functional' Fiduciary?
Compliance Dashboard

CMS Is Bringing Health Plan Quality Ratings to All Exchanges for the First Time
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS], Inc.
1298 Minnesota Avenue, Suite H
Winter Park, Florida 32789
(407) 644-4146

Lois Baker, J.D., President
David Rhett Baker, J.D., Editor and Publisher
Holly Horton, Business Manager

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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