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
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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
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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
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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
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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
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Benefits in General
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[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]
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[Guidance Overview]
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
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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
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Selected Discussions on the BenefitsLink Message Boards
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Most Popular Items in the Previous Issue
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