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[Guidance Overview]

Massachusetts Updates Guidance on PFML

"As the Massachusetts Paid Family and Medical Leave (PFML) law enters the first quarter of PFML contributions, the Department of Paid Family and Medical Leave (DFML) has released additional guidance on the next steps for employers that have applied for a private plan exemption.... [T]he DFML also has provided additional information on the bond process for self-insured plans, including changes to the bond coverage formulae and required form."
Seyfarth Shaw LLP

New York Paid Family Leave Program: 2020 Updates

"[1] Eligible employees are entitled to take up to 10 weeks of paid leave. [2] The contribution amount will increase to 0.270% of an employee's gross wages each pay period, with a maximum annual contribution cap of $196.72. [3] Employees earning less than the current statewide average weekly wage of $1,401.17 will contribute less than the annual cap, consistent with their actual wages."

Late Decision on Court-Ordered Remand of Disability Claim Results in De Novo Review

"[T]he court held that the de novo standard of review applied in this case because Liberty Life failed to comply with ERISA deadlines which applied on remand and did not render a decision until 16 months after the remand order. Next, the court gave substantial weight to Liberty's inherent conflict of interest, noting that Liberty continued to violate the ERISA claims procedure regulations upon remand, committed the same errors that the court identified in the remand order, and violated portions of the remand order that expressly required Liberty to take certain actions." [Spears v. Liberty Life Assurance Company of Boston, No. 11-1807 (D. Conn. Sept. 30, 2019)]
Kantor & Kantor

Disclosure of Patients' PHI on Yelp Leads to $10,000 HIPAA Settlement

"In addressing the practice's release of PHI on social media/public platforms, HHS cited a provision of the HIPAA rules that generally governs a CE's implementation of HIPAA policies and procedures. Although this provision does not expressly mention social media -- the regulations were finalized before social media was as much a part of our lives as it is today -- HHS apparently interprets the regulation as applying to social media and public platforms[.]"
Thomson Reuters Practical Law

Proposed Regs Clarify Application of Employer Shared Responsibility and Nondiscrimination Rules to ICHRAs

"Comments are due by December 29, 2019, and have been requested on various topics, including issues raised when employers allow [individual coverage HRA (ICHRA)] participants to pay the portion of their premiums not covered by the ICHRA with cafeteria plan salary reductions."
Thomson Reuters / EBIA

Mental Health Parity Rules: DOL Updated Guidance and Enforcement

"These FAQs [issued Sept. 5, 2019] provide clarifications relating to: [1] Exclusions for treatment that are considered experimental or investigative; [2] Prescription drug coverage; [3] Step therapy protocols or fail-first policies as they apply to in-patient and out-patient treatment; [4] Comparable provider reimbursement rates and network provider participation standards; and [5] Coverage for eating disorders."

Checklist for Employees: Open Enrollment Considerations

"[1] Take more than five minutes to look at your open enrollment materials and see what is new for 2020.... [2] Really do the math.... [3] Take advantage of incentives.... [4] Contribute to your Health Savings Account (H.S.A.) ... [5] Review supplemental health coverage options.... [6] Consider new plans with smaller networks.... [7] Sign up for Telemedicine ... [8] If you have a chronic condition ... see if there is a program offered through the medical plan to help you.... [9] If you, or a family member, get a scary diagnosis. Reach out for help.... [10] Check out dental and vision plan options to be sure you are in the right plan for you/your family."

Amazon, Walmart and Healthcare -- Oh My!

"As many employers struggle to control health cost growth while ensuring that employees have access to affordable care, it's important to remain open to what these nontraditional players can bring to the fight.... As new opportunities emerge, consider everything you know about your population and what would have the greatest impact on how they currently access health care (or not) and how they take care of themselves (or not). Healthcare is very personal, so some of these offerings will be a better fit than others."

Statistics You Need to Know About Healthcare and Telemedicine

"Healthcare costs are increasing, burdening both employers and employees. At the same time, accessing care has also become more difficult for a variety of reasons. Statistics demonstrate the scale of these problems, and how telemedicine can address them."
First Stop Health

Trump Executive Order Bolsters Medicare, Medicare Advantage

"The EO directs the secretary of HHS to propose regulation that allows Medicare to provide 'more diverse and affordable plan choices.' Some of the actions included in the EO were to reduce barriers to obtaining Medicare Medical Savings Accounts, promote innovations in supplemental benefits and telehealth services, and create a payment model that allows beneficiaries to share directly in savings from supplemental MA benefits."
American Journal of Managed Care


The Right Way to Fix Health Insurance: Addressing the Type 2 Diabetes Crisis

"The disease that’s busting the health care piggy bank in America is type 2 diabetes. Diabetes costs shot up from $21 billion to $90 billion in the last 20 years. Heart disease still costs more, but diabetes will soon overtake it. Unless Americans change their behavior."
New York Post


Importing Lower-Cost Prescription Drugs to Support Public Health Services

"Biologic products, which include vaccines and insulins, cannot be imported, nor can narcotics, including suboxone and methadone for substance use disorder. From a public health spending perspective, these exclusions limit savings. The law also allows importation of drugs only from Canada. These constraints represent a serious limitation on the ability to import drugs."
The Commonwealth Fund

Benefits in General

When ERISA Preempts State Laws for Employee Benefits

"A recent appellate ruling ... addressed whether two Hawaii anti-subrogation statutes are pre-empted by ERISA.... Although the insurer's lien would have been preserved had a portion of the settlement been denominated as reimbursement for medical 'special damages,' that did not occur and the health insurer was left without a means of enforcing its claimed lien to recoup the money it had paid." [Rudel v. Hawai'i Management Alliance Association, No. 17-17395 (9th Cir. Sept. 11, 2019)]
DeBofsky, Sherman & Casciari, P.C.

Press Releases

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ACA Numbers and Limits 2014-2020 (PDF)
Kaufman & Canoles, P.C., Inc.
1298 Minnesota Avenue, Suite H
Winter Park, Florida 32789
(407) 644-4146

Lois Baker, J.D., President
David Rhett Baker, J.D., Editor and Publisher
Holly Horton, Business Manager

BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2019, 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, 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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