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September 12, 2019

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[Official Guidance]

FAQs Regarding Requirements for Non-Issuer Users of a Primary EDE Entity (PDF)

"These FAQs clarify the requirements for prospective upstream non-issuer users of an [enhanced direct enrollment (EDE)] environment  ... Any prospective hybrid, non-issuer upstream EDE Entity ... planning to participate in EDE for PYs 2019 and 2020 must notify CMS as soon as possible of its intent to submit an audit consistent with the processes detailed in this document."

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

[Advert.]

2020 Onsite Employee Health Clinics Forum (January 23-24; Phoenix, AZ)

Sponsored by World Conference Forum

The leading forum on building & expanding on-site health clinics -- incorporating strategies that reduce costs, ensure employee satisfaction and positively impact patient behavior.


[Guidance Overview]

IRS Notice Expands Preventive Care Available under HDHPs

"[IRS Notice 2019-45] recognizes that certain medical care services and items for an individual with a chronic condition can prevent exacerbation of the condition, and classifies those services and items as preventive care to attempt to limit the risk of more serious conditions and costly treatment."

Drinker Biddle

[Guidance Overview]

Two Interesting New Rules Regarding Prescription Drugs -- What Is Really Going On?

"[T]hrough the PBM controlled formularies, the costs of many prescription drugs were ... hidden from participants because they were categorized as 'preventive care' and provided at no cost to participants. IRS Notice 2019-45 will change that practice.... [ACA FAQ Part 40 indicates] the Departments will not initiate an enforcement action if a [group health plan] excludes the value of drug manufacturers' coupons from the [out-of-pocket maximum] ... [T]his would not overrule any similar State Insurance law that has already passed."

Trucker Huss

COBRA Notices Potentially Subject to Class Action Litigation If Not Complete

"[T]he spouse of a former employee of a technology company alleged that the COBRA notice they received failed to identify a termination date for the health care coverage, location of where payments should be sent, and name of the plan administrator.... [S]he sought to certify a class of the company’s Group Benefits Plan participants and requested statutory penalties of $110 to each participant or beneficiary per day ... While this case and another case in Florida have settled, a third case with similar allegations remains pending."

Jackson Lewis

OCR Cybersecurity Newsletter Focuses on Threats From Malicious Insiders

"OCR highlights steps to identify suspicious activity, including: [1] Understanding the operating environment.... [2] Monitoring activity.... [3] Adapting to change.... Covered entities and business associates may wish to ... assess the adequacy of their corresponding policies and procedures. OCR's selection of this topic for the newsletter may presage increased enforcement activity in this area. "

Thomson Reuters / EBIA

2020 Global Medical Trend Rates Report

38 pages. "Medical Trend is expected to remain stable in the US. This is driven mainly by moderate price and minimal utilization increases. Prices continue to drive trend while utilization of services remains relatively flat or decreasing.... [P]harmacy trends continue to have significant volatility[.]"

Aon

In 2020, Employer Health Costs to Double Inflation Yet Again

"Employer healthcare costs in the U.S. are rising 6.5% in 2020 or nearly double the rate of general inflation for yet another year amid the rising costs of specialty pharmaceuticals and ongoing chronic conditions ... The rise in employer medical plan costs will outpace general inflation rising 2.4% this year and projected at 2.7% in 2020[.]"

Forbes

Majority of Public OK with Hospitals, Docs Being Paid Less Due to Surprise Billing Change

"78% of respondents supported legislation that protects patients from having to pay surprise out-of-network medical bills. However, that number shrinks to 57% after respondents hear opponents’ arguments that such legislation would lead to doctors and hospitals getting paid less for the services they provide."

FierceHealthcare

As the Need for Family Caregivers Explodes, How Can Employers Address a Growing Workplace Crisis?

"[T]he overwhelming majority of caregivers (90%) feel they lack support from their company in some area.... It is estimated that 22% of American workers spend an average of 32 hours a week assisting with caregiving tasks.... [which adds] up to more than $50 billion annually in lost revenue nationwide for American companies -- or an estimated $3,200 per employee."

Voya

2019 Midyear Devenir HSA Research Report

"There are now over 26 million health savings accounts, holding $61.7 billion in assets, a year-over-year increase of 12% for accounts and 20% for HSA assets for the period ending June 30th, 2019."

Devenir

Factors to Consider When Deciding on Stop-Loss Insurance

"Stop-loss insurance is increasingly critical to smaller plans due to an increase in frequency and costs of catastrophic claims, as well as the ACA elimination of annual and lifetime limits on claims for essential health benefits.... Volatile timing and level of claims put pressure on cash flow and reserves. Stop-loss insurance can smooth out the amounts that need to be added to reserves on a regular basis."

International Foundation of Employee Benefit Plans [IFEBP]

[Opinion]

Be Grateful for Your Health Insurance Company

"Insurers are unpopular because their job is to say 'no.' They police medical claims for waste and encourage patients to seek care from cost-effective providers. Yet they deliver a real benefit to consumers. The clearest way to observe this is to compare traditional Medicare, where government manages seniors' claims, with Medicare Advantage, where private insurers do."

Chris Pope, via The Wall Street Journal; subscription may be required

Benefits in General

[Opinion]

Retirement, Financial Wellness, and the Power of Simplicity

"Some plan sponsors are trying to assist employees with almost everything financial ... and are even attempting the daunting task of integrating financial wellness into their medical wellness programs.... [M]any employees are simply looking for their needs to be met, rather than complicated holistic programs.... [M]any individuals already lead financially complex lives that can greatly benefit from simplification."

Cammack Retirement Group

Press Releases

Announcing the 2019 Top 10 DC Wholesalers - DCIO and RK
National Association of Plan Advisors [NAPA]

Most Popular Items in the Previous Issue

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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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