Health & Welfare Plans Newsletter

September 5, 2019

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Manager, Benefits & Wellness
Barnes Group Inc.
in Bristol CT

Compliance Associate
Guideline, Inc.
in San Mateo CA

Paralegal ERISA - ACA
Western Growers
in Irvine CA

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North Carolina Expands Access to Association Health Plans While Federal Rule Is Litigated

"North Carolina's Small Business Health Care Act allows association health care plans that are cheaper than [ACA] [small group market] plans. While the bill does not remove health care coverage from people with pre-existing conditions, insurers aren't required to offer association health plans with a full range of services for people with pre-existing conditions."

Society for Human Resource Management [SHRM]; membership may be required to view article

Eighth Circuit Distinguishes Supreme Court's Amara Ruling; Holds SPD Can Be a Plan

"Arguably, a combined plan document/SPD is unacceptable because it is not possible for a document to summarize itself. Nevertheless, many plans, particularly welfare plans, use a combined document and will appreciate the confirmation that this approach is acceptable -- so long as the document meets ERISA's stated criteria for both written instruments and SPDs." [MBI Energy Services v. Hoch, No. 18-1539 (8th Cir. Jul. 3, 2019)]

Thomson Reuters / EBIA

OCR Recognizes Insider Threats to HIPAA PHI, You Should Too

"Threats from insiders ... can cause substantial, sometimes crippling harm to an organization by intentionally modifying, leaking, selling, or destroying sensitive information.... Malicious insiders already have access to patient information on the expectation that they need access to perform their jobs.... Identifying potential malicious activity as soon as possible is critical ... and there are some things that organizations can be doing."

Jackson Lewis

Insurers Welcome Changes to Addiction Treatment Privacy Rules

"A recent federal proposal -- which would loosen privacy rules surrounding substance use disorder (SUD) treatment -- is being applauded by health insurer trade groups. But some advocates are worried about potential harms to patients."

AISHealth

CVS-Aetna Deal Secures Final Judicial Sign-Off

"After an extended and atypical review, the federal judge tasked with signing off on CVS Health's nearly $70 billion Aetna acquisition has done so, granting final judgment in favor of a deal the merging companies struck with five states and the U.S. Department of Justice." [U.S. v. CVS Health Corp. and Aetna Inc., No. 18-2340 (D.D.C. Sept. 4, 2019)]

HealthLeaders Media

How to Comply with Conflicting Certification Requirements Under FMLA and CFRA

"California employers must comply with the federal Family and Medical Leave Act (FMLA) and the California Family Rights Act (CFRA) and, if there is a conflict, follow the law that is most beneficial to employees. This article provides tips on how to satisfy your medical certification obligations under those statutes."

HR Daily Advisor

Cigna Rolls Out New Plan to Fully Cover Multi-Million Dollar Gene Therapies

"The first two gene therapies to be included in Cigna’s program are blindness therapy, Luxturna, and the most expensive drug in the world Novartis’ $2.1 million spinal muscular atrophy treatment, Zolgensma, the insurer said....  Additional therapies may be added to the program, and it will be able to leverage the expertise of its pharmacy benefits manager Express Scripts, which it bought for $54 billion last year, Cigna said."

Reuters

[Opinion]

That Beloved Hospital? It's Driving Up Health Care Costs

"Data shows that hospitals are by far the biggest cost in our $3.5 trillion health care system ... Spending on hospitals represents 44 percent of personal expenses for the privately insured ... [H]ospital prices increased a whopping 42 percent from 2007 to 2014 for inpatient care and 25 percent for outpatient care, compared with 18 percent and 6 percent for physicians."

Elisabeth Rosenthal, via The New York Times; subscription may be required

[Opinion]

Congressional Proposals to Increase Federal Health Care Spending: A Flawed Approach, Building on Failure

"Legislative proposals are pending in Congress to vastly expand federal financing and government control of medical care.... This overlooks substantial evidence that existing federal spending on health care is misallocated. Increasing federal spending would certainly not remedy this problem.... [S]tates should be encouraged to develop and pursue alternative means of making health care more affordable by increasing consumer choices and reducing costs."

The Heritage Foundation

[Opinion]

Relatively Modest Health Reform May Create More Value Than 'Medicare for All'

"The ACA brought the percentage of uninsured Americans down into the high single digits for the first time in our political lifetimes and got us far closer to 'universal' coverage than most people realize.... It might be helpful for health policy advocates to ask: Are we right in assuming that Americans' health is best improved by getting from 90 percent to 100 percent of the population covered?"

Jeff C. Goldsmith, in Health Affairs

Benefits in General

Perfecting Your Benefits Communication Strategy

"[1] Set expectations at all levels of the organization.... [2] Keep it simple.... [3] Be clear and concise.... [4] Communicate regularly.... [5] Be transparent.... [6] One size does not fit all."

bswift

Press Releases

Most Popular Items in the Previous Issue

DOL Will Restructure EBSA
National Center for Employee Ownership [NCEO]

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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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