Health & Welfare Plans Newsletter

September 6, 2019

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Self-Funded Health Plan Operations Senior Director
University of California Office of the President
in Oakland CA

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Nova 401(k) Associates
in Houston TX / Telecommute

Manager, Pension Administration
Ascensus
in Charlotte NC

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Ascensus
in Charlotte NC

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BlueStar
in Jacksonville FL / Telecommute

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[Official Guidance]

Text of Agency Final FAQs, Part 39: Mental Health and Substance Use Disorder Parity Implementation and the 21st Century Cures Act (PDF)

21 pages; 11 Q&As, revising Proposed FAQs published in April of 2018. "[T]hese FAQs are designed to help people understand the law and benefit from it as intended through examples that illustrate the requirements of MHPAEA and its implementing regulations.... These FAQs do not contain any new interpretations of MHPAEA, but instead provide additional examples of how the MHPAEA final regulations apply to different fact patterns to promote compliance." [Also released: Final MHPAEA Disclosure Template ("Form to Request Documentation from an Employer-Sponsored Health Plan or a Group or Individual Market Insurer Concerning Treatment Limitations")]

Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]; U.S. Department of Health and Human Services [HHS}; and U.S. Department of the Treasury

[Official Guidance]

EBSA Report on MHPAEA Investigations for Fiscal Year 2018 (PDF)

"[EBSA] is issuing its report on investigations regarding the Mental Health Parity and Addiction Equity Act (MHPAEA) for Fiscal Year (FY) 2018.... In addition to providing its FY2018 enforcement data, EBSA is sharing information regarding its FY2018 MHPAEA enforcement strategy. Informed by investigations conducted in prior years, and in light of the Agency's limited resources, EBSA's enforcement approach has shifted in the following two ways. [1] Investigations targeted to achieve high impact ... [2] Complex investigations conducted by specialized, interdisciplinary teams."

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

[Guidance Overview]

2019 Developments in Leave and Accommodation Law

"The states (and US territory) that passed new laws, expanded or otherwise amended existing leave and accommodation laws, or had new laws go into effect this year include: California, Colorado, Connecticut, District of Columbia, Kentucky, Illinois, Maine, Maryland, Massachusetts, Michigan, Nevada, New Jersey, New Mexico, New York, North Carolina, Oregon, Puerto Rico, Utah and Washington. A few notable trends are emerging."

Jackson Lewis P.C.

[Guidance Overview]

Editor's Pick Zombie Benefits: HRAs Are Back from the Dead

"ICHRAs and EBHRAs may be offered for plan years beginning on or after January 1, 2020. The final regulations are long, incredibly complex, and in some cases require advance notice to employees. Accordingly, employers wanting to offer one of these new HRAs as of January 1, 2020 need to move quickly, prepare plan documents and summaries, and timely distribute applicable notices. In addition, employees who want to take advantage of an ICHRA with a January 1, 2020 effective date will need to enroll in individual medical coverage during the open enrollment period at the end of 2019 (running from November 1, 2019 to December 15, 2019) unless they have Medicare."

Snell & Wilmer

Employer Trends in Self-Insured Health Plan Coverage (PDF)

"Since 2013, the percentage of establishments offering self-insured health plans has declined for large firms while increasing for smaller firms. Those trends reversed in 2018.... Self-insurance coverage varied substantially by state. Overall, the percentage of establishments offering at least one self-insured plan ranged from a high of 53 percent in North Carolina to a low of 24 percent in Massachusetts."

Employee Benefit Research Institute [EBRI]

Eliminating Pharmacy Waste -- It's Not Easy

"An August 2019 study by the Commonwealth Fund looks at the use of low-value high-cost drugs and has concluded that correcting misaligned incentives can result in a potential 3% to 24% in savings.... Pharmacy Benefit Manager (PBM) contracts are part of the reason."

Frenkel Benefits

Groupons for Medical Treatment? Welcome to Today's U.S. Health Care

"The concept of patients using Groupons to get discounted medical care elicited the typical stages of Twitter grief: anger, bargaining and acceptance that this is the medical system today in the United States. But, ultimately, the use of Groupon and other pricing tools is symptomatic of a health care market where patients desperately want a deal -- or at least tools that better nail down their costs before they get care."

Kaiser Health News

What Can the National Weather Service Teach Us About Disseminating Health Care Price Information?

"NOAA runs the National Weather Service, which gathers huge amounts of weather data, provides real-time analytics (such as forecasts), and displays those data on its website. Although the site is in many ways excellent, relatively few Americans use it. Instead, most get their weather forecasts from a variety of third-party distributors.... Thus, although the National Weather Service has 'failed' to capture much of its own viewing audience, it has been very successful in getting its data widely disseminated and used. Can health care successfully follow this National Weather Service model?"

Health Affairs

Two-Thirds of Wage and Salary Workers Could Take Paid Leave in 2017-18, Up from 2011

"Sixty-six percent of wage and salary workers were able to take paid leave from their jobs in 2017-18, up from 60 percent in 2011. The percentage of women with access to paid leave increased from 58 percent in 2011 to 65 percent in 2017-18. The percentage of men with access to paid leave increased from 62 percent to 67 percent over the same period."

U.S. Bureau of Labor Statistics [BLS]

Benefits in General

Federal Court Certifies Class in Multiple-Plan ERISA Challenge to Health Plan and Retirement Plan Fees

"The court held that for purposes of class certification, the plaintiffs only needed to establish that they had standing to bring each claim asserted on behalf of the class; the plaintiffs did not have to actually be participants in every plan involved." [Chavez v. Plan Benefits Services, Inc., No. 17-659 (W.D. Tex. Aug. 30, 2019).]

McDermott Will & Emery

How Does a Plan Sponsor Know When a Participant Makes a Claim for Benefits?

"If you’re uncertain whether the communication received qualifies as a claim for benefits, it’s generally good to first assume that all communications from plan participants, beneficiaries, and third-party designees deserve a response. This may be as simple as providing the requested documents along with a letter stating that they did not seem to make a claim. This puts the recipient on notice that the plan sponsor did not see a claim."

Hall Benefits Law

[Opinion]

How Your Employer Uses Perks to Control Your Life

"Like government welfare, offering any benefits that people come to rely on is also a convenient vehicle to mold their behavior. And just as Henry Ford sought to transform auto workers through a generous though invasive profit-sharing program, today’s employers also use perks to influence our behavior in subtle and not-so-subtle ways."

Elizabeth Tippett and Jesse Paul, for The Colorado Sun

Press Releases

Jake Spiegel Joins Employee Benefit Research Institute
EBRI [Employee Benefit Research Institute]

NAPA Announces the Retirement Industry's Top 100 DC Wholesalers
National Association of Plan Advisors [NAPA]

Most Popular Items in the Previous Issue

North Carolina Expands Access to Association Health Plans While Federal Rule Is Litigated
Society for Human Resource Management [SHRM]; membership may be required to view article

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Lois Baker, J.D., President  loisbaker@benefitslink.com
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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