Health & Welfare Plans Newsletter

August 30, 2019

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Jobs

Senior Pension Administrator - Combo DB / DC Plans
Primark Benefits
in Burlingame CA / Telecommute

Employee Benefits Compliance Associate
Slevin & Hart, P.C.
in DC

Retirement Plan Associate / Financial Advisor
Garcia Wealth Management Group
in Templeton CA

Manager, Actuarial Services Group
University of California Office of the President
in Oakland CA

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[Guidance Overview]

Oregon Adopts New Broad Paid Family Medical Leave Law

"Employers with 25 or more employees in Oregon, and their employees, must generally contribute to the fund: Employers will make 40% of the required contributions to the plan; employees will pay 60%.... Required contributions to the plan must begin by January 1, 2022. All notices to employees required by the new law, its enforcement provisions, prohibitions on discrimination or retaliation, and recordkeeping requirements will also go into effect in January 2022. Eligible employees can receive paid leave benefits starting on January 1, 2023."

Littler

[Advert.]

Best Practices for Navigating Employee Benefits After Termination

Sponsored by Lorman and BenefitsLink

Sept. 30 webinar covers different arrangements available after employment terminates related both to retirement and health, including COBRA, life and disability insurance, and various retirement plan arrangements. BenefitsLink discount.


Employers Should be Prepared for the Challenges of the 2019 Hurricane Season

"Although the FMLA regulations do not specifically address natural disasters, the regulations state that if, for some reason, the employer's business activity has temporarily ceased and employees generally are not expected to report for work for one or more weeks ... the days the employer's activities have ceased do not count against the employee's FMLA leave entitlement.... If the business is closed for less than a week, the FMLA's regulation pertaining to holidays likely would apply. "

FordHarrison

Editor's Pick Reducing Wasteful Spending in Employers' Pharmacy Benefit Plans

"Formularies developed on their behalf by intermediaries like pharmacy benefit managers (PBMs) and health plans can ensure drug safety and support negotiating with manufacturers. But intermediaries can profit from these negotiations, creating financial incentives to include high-price drugs even if they offer little clinical value.... Plan sponsors could lower drug spending and out-of-pocket costs for enrollees by reducing the use of high-cost, low-value drugs on formularies. Savings could be achieved by improving pharmacy benefit design and management."

The Commonwealth Fund

Star Trek Medicine in the Age of a Flintstones Reimbursement System: Can Value-Based Contracting Pull All Stakeholders Into the Same Era?

"In today’s environment, negotiating, implementing, and monitoring VBCs can take a tremendous amount of time and effort. There should be a more systematic approach to all aspects of these arrangements, which will likely require organizations to come together and establish a common framework and set of standards that can be used across the industry. Here’s a look at some of the areas ... [that] need to be modernized to realize the full potential of value-based contracts[.]"

Deloitte

Health Plan Strategic Implications of MACRA (PDF)

61 pages. "The primary intention of this white paper is to provide insight and considerations for the actuarial profession in assessing the potential risk and opportunities of MACRA to both provider and payer organizations.... Health plan administrators will also gain a better understanding of ... [1] Potential friction between provider and health plan relations either caused or amplified by MACRA; [2] Potential for cascading impact on non-Medicare businesses ... [3] Potential for commercial cost shifting and the relationship to each market's unique characteristics and region; [4] Likely implications to a health plan's narrow network strategy ... [5] Potential impact on Medicare Advantage profitability[.]"

Society of Actuaries

Court Allows Challenge to Insurer's PTSD Payment Limitation to Proceed

"Mental health parity cases become more expensive for insurers to defend as courts allow them to proceed. Because the allegations in this case involve ... a quantitative limitation, the plan's terms and operation should be scrutinized under a complex mathematical test that analyzes whether the financial requirements or treatment limitations on mental health or substance use disorder benefits are more restrictive than those that apply to 'substantially all' of the plan's medical and surgical benefits in the same classification." [Smith v. UnitedHealthcare Ins. Co., No. 18-6336 (N.D. Cal. Jul. 18, 2019)]

Thomson Reuters / EBIA

They Got Estimates Before Surgery -- and a Bill After That Was 50% More

"It is a good idea to get an estimate in advance for health care if your condition is not an emergency. But it is important to know that an estimate can be way off -- and your provider probably is not legally required to honor it."

Kaiser Health News

American Workers Want Life Insurance as an Employee Benefit

"Although 28 percent of employed Americans have voluntary group life insurance through their employer, 59% of workers who say they don't because their employer doesn't offer it say they would be likely to purchase it if it was an option.... Those who have it say it increasingly gives them 'peace of mind' that they are after (44% in 2018 vs 53% in 2019) to survive should a tragedy happen."

OneAmerica

Benefits in General

[Official Guidance]

Text of EBSA Meeting Notice for Advisory Council on Employee Welfare and Pension Benefit Plans

"[T]he 198th meeting of the [ERISA Advisory Council] will be held as a teleconference on September 25, 2019.... The purpose of the open meeting is to discuss reports/recommendations for the Secretary of Labor on the issues of: [1] Beyond Plan Audit Compliance: Improving the Financial Statement Audit Process and [2] Permissive Transfers of Uncashed Checks from ERISA Plans to State Unclaimed Property Funds. Descriptions of these topics are available on the [Advisory Council page of the EBSA web site]."

Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]

[Guidance Overview]

Editor's Pick Comprehensive FAQs on Benefits and Other Issues Relating to Hurricanes and Other Workplace Disasters

"This article addresses many employment-related issues facing employers in the wake of hurricane-related disasters; ... in addition to federal laws, [it focuses] on certain state laws, especially those in the areas most impacted by the storms.... [T]he information here is of more widespread applicability than just the current hurricane season, and may be helpful following any unexpected natural catastrophe."

Fisher Phillips

U.S. Supreme Court Will Hear Three ERISA Cases This Fall

"After more than two years without one, three ERISA cases will come before the US Supreme Court in 2019-2020.... [Each case] presents issues of practical consequence for plan sponsors, fiduciaries, and participants in ERISA plans across the country."

Morgan Lewis

Court Awards $41,000 in ERISA Penalties for Failure to Provide Plan Documents

"The litigation arose after the plan administrator misappropriated participant contributions for corporate purposes and mishandled a beneficiary's claim involving a major surgery." [Kinsinger v. SmartCore, LLC, No. 17-643 (W.D.N.C. Aug. 27, 2019)]

Thomson Reuters Practical Law

Selected Discussions
on the BenefitsLink Message Boards

Can Self-Insured Health Plan Cap Payments for Air Ambulances?

Self-insured plan wants to cap payments made for air ambulances to some arbitrary number, $20,000 for example. Does it matter that this is for emergency care, and is this a essential health benefit under the ACA?

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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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