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DC Plan Administrator
Northeast Professional Planning Group, Inc.
in Red Bank NJ / NY

Benefits Financial Analyst
Leading Edge Benefit Advisors, LLC
in Fort Myers FL

Defined Contribution Administrator
Sunwest Pensions
in Tempe AZ

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Webcasts, Conferences

Perspective on the Future Healthcare Landscape
September 11, 2019 in TX
Worldwide Employee Benefits Network [WEB] - Houston Chapter

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[Official Guidance]

Text of Agency FAQs About ACA Implementation, Part 40: Limitations on Cost Sharing Under PPACA (PDF)

"[T]he Departments understand that the policy advanced by the 2020 NBPP and prior IRS guidance related to HDHPs may conflict, and therefore the Departments' interpretation of how drug manufacturers' coupons apply with respect to the annual limitation on cost sharing is ambiguous.... HHS, in consultation with the Departments of Labor and the Treasury, intends to undertake rulemaking in the forthcoming HHS Notice of Benefit and Payment Parameters for 2021. Until the 2021 NBPP is issued and effective, the Departments will not initiate an enforcement action if an issuer of group or individual health insurance coverage or a group health plan excludes the value of drug manufacturers' coupons from the annual limitation on cost sharing, including in circumstances in which there is no medically appropriate generic equivalent available."

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

[Guidance Overview]

It's Back to School Time -- Expect California Parents to Seek Leave for School Activities

"Employers who employ 25 or more individuals in one location are required to provide this leave to their employees.... Parents are entitled to job-protected leave for up to 40 hours each year for the following reasons: [1] To find, enroll, or re-enroll their child in a school or with a licensed child care provider, or participate in activities of the school or licensed child care provider of their child. [2] To address a child care provider or school emergency."

Jackson Lewis

Apps and Technology Make Shopping for Benefits Easier

"Emerging tech platforms should provide employees with more options for insurance--and a better understanding of those options--and make it easier to manage wellness, healthcare and any insurance coverages. Apps will put more information in front of the average employee/consumer, giving them more freedom to make choices about their care. The idea is these emerging platforms and apps tie together payroll and HRIS with wellness and healthcare navigator apps to help employees live healthier lives."

Corporate Synergies

Majority of Consumers Open to Telehealth, Adoption Continues to Grow

"66 percent of Americans are willing to use telehealth, and 8 percent have had a telehealth visit with a doctor. While consumers value and recognize telehealth for its convenience, fast service and cost savings, 17 percent of consumers willing to try virtual care are not sure if their insurance plans cover the service, reaffirming the industry need for increased consumer education and awareness around telehealth’s availability and value."

American Well

Families with Large-Employer Health Plans Spend Almost $8,000 a Year on Healthcare

"[F]rom 2008 to 2018, average premiums for a family on a large-employer health plan increased 55 percent, while average cost-sharing increased 70 percent. During that time, average wages rose only 26 percent.... [A]verage annual healthcare spending by families covered by large employers has increased by two-thirds, from $4,617 to $7,726. For lower-wage employees of large firms, that amounts to a significant share of their annual income."

Treasury & Risk; free registration required


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Inside North Carolina's Big Effort to Transform Health Care

"North Carolina is in the early stages of turning away from the traditional fee-for-service model... Instead, providers will often be paid based on health outcomes ... The better the providers do, the more they can earn. If they perform poorly, money could eventually come out of their pocket. The goal is to keep people healthy and out of the hospital and to save money on health care spending."

The New York Times; subscription may be required

Individual Insurance Market Looking More Like Group Market

"One way ... to see how well these market reforms have worked is to observe whether financial conditions among these market segments have converged. To do so, [the authors] assembled financial performance data for each market segment over six years, with information coming from insurers’ financial reports to the federal government. This view provides only a rough, yet instructive, gauge of how the ACA’s market reforms have worked."

The Commonwealth Fund

CMS Approves Reinsurance Waivers in Delaware, Rhode Island

"Delaware and Rhode Island were the final two states awaiting approval of a Section 1332 waiver for the 2020 plan year. In addition to summarizing the programs in Delaware and Rhode Island, this post highlights some of the variation among the now 12 states with an approved state-based reinsurance program."

Katie Keith, in Health Affairs


Clamoring Companies Complaining About Climbing Claims; Clarification of Covered Care Can Clip Costs

"By focusing on payment integrity and accuracy of medical claims, as well as helping guide members to the 'efficient' (the intersection of the highest quality and lowest cost) providers, employers can avoid wasteful spending on care delivery.... Avoid reckless plan document language that costs millions.... Have specific plans for uncommon and costly claims.... Deploy evidence-based musculoskeletal management programs.... Insist on value-based primary care....  Protect employees by sending them to providers with first-rate medical quality records.... Proactively manage pharmacy benefits."


Benefits in General

Preparing for the New EBP Audit Standard

"SAS 136 is effective for audits of ERISA plan financial statements for periods ending on or after December 15, 2020 ... The standard addresses requirements specific to: Engagement acceptance ... Audit risk assessment ... Communication of reportable findings ... The form and content of the auditor's report for ERISA plans have changed[.]"

WithumSmith+Brown, PC

Press Releases

Most Popular Items in the Previous Issue, 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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