Health & Welfare Plans Newsletter

October 22, 2019

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Webcasts, Conferences

HRSouthwest Conference
October 27, 2019 in TX
SHRM - Dallas [DallasHR]

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November 21, 2019 in NC
Worldwide Employee Benefits Network [WEB] - Greater Carolinas Chapter

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[Guidance Overview]

California Imposes New Flexible Spending Account Notice Requirement on Employers

"The imprecisely worded three-sentence law appears to mandate notification of FSA participants before they will lose FSA coverage of reimbursement claims upon a mid-year termination of employment or because of a mid-year termination of the FSA plan, which could occur because of a mid-year sale or acquisition of the employer sponsor. It also seems to require giving notice of any mid-year deadline to submit claims for reimbursement of expenses where the time by which the expenses must have been incurred was some earlier date. But the statute gives no mandatory notice language or model form, nor any specific required notice timing or specific penalty for violation."
Jackson Lewis P.C.

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[Guidance Overview]

Premiums for Healthcare.gov Plans Are Down 4 percent But Remain Unaffordable to Non-Subsidized Consumers

"[Today, CMS] announced that the average premium for the second lowest cost silver plan on HealthCare.gov for a 27 year-old will drop by 4 percent for the 2020 coverage year. Additionally, 20 more issuers will participate in states that use the Federal Health Insurance Exchange platform in 2020 bringing the total to 175 issuers compared to 132 in 2018[.]"  [Also available: 2020 Health Insurance Exchange Premium Landscape Issue Brief; 2020 Plan Landscape Data; and 2020 Health Insurance Exchange Public Use Files.]
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

Report to Congress: Prescription Drug Pricing

"The sections on prescription drug spending provide comparative gross prescription drug spending and prices as well as the top 10 highest-cost drugs and the top 10 most frequently prescribed drugs ... The section on public funding for biomedical research provides the list of drugs that have been approved for sale by the [FDA] in the past five years that have benefited significantly from government grants or research subsidies in either the pre-clinical or clinical stages of development, as well as spending in Medicare and Medicaid for each of those drugs."
Assistant Secretary for Planning and Evaluation [ASPE], U.S. Department of Health and Human Services [HHS]

Report to Congress: Prescription Drugs: Innovation, Spending, and Patient Access

"This Report responded to a request from the House and Senate Committees on Appropriations. Published estimates of the cost of new drug development range from $1.2 billion to $2.6 billion ... Patterns of increases in overall prescription drug spending growth varied across government programs, but spending on specialty drugs and biologics increased rapidly in all programs. Access to prescription drugs improved between 2011 and 2014 as the percentage of adults not taking drugs as prescribed because of cost decline."
Assistant Secretary for Planning and Evaluation [ASPE], U.S. Department of Health and Human Services [HHS]

Editor's Pick Employer Health Benefits: 2019 Annual Survey

238 pages. "Annual premiums for employer­ sponsored family health coverage reached $20,576 this year, up 5% from last year, with workers on average paying $6,015 toward the cost of their coverage. The average deductible ... is $1,655 for single coverage. Fifty­-six percent of small firms and 99% of large firms offer health benefits to at least some of their workers, with an overall offer rate of 57%."
Kaiser Health Foundation

Yes, We Can Reduce Waste in Healthcare Spending

"[D]evelop a network strategy that, as much as possible, seeks to directly influence the delivery system to provide more cost-efficient care.... Centers of Excellence can be deployed to address pricing failure ... The largest category of waste ... is administrative complexity."
Mercer

Editor's Pick How Employers Can Address Plan Selection Bias with Risk Adjustment (PDF)

"Because selection bias does not change the overall morbidity of the group, it is important to set the premium contributions without consideration for how healthy the subpopulation is within any one option. Otherwise, the option with the sicker subgroup will become more and more costly."
Milliman

Drugstore Drones: UPS Will Fly CVS Prescriptions to U.S. Customers

"Flight Forward and partner Matternet also announced a deal to deliver biological samples and other cargo on University of Utah Health hospital campuses. That will be similar to the service at North Carolina's WakeMed Hospital, where Flight Forward operates about 10 flights per day[.]"
Reuters

Is There Potential for Public Plans to Reduce Premiums of Competing Insurers?

"A public option could catalyze competition in less competitive markets, leading other marketplace insurers to lower their premiums. [The authors] analyze commercial insurers’ experiences competing in marketplaces with managed-care organizations, which, prior to ACA implementation, only offered coverage within public programs ... [and find] an association between the presence of a Medicaid insurer in a rating region and competing insurers offering lower premiums."
Urban Institute

Benefits in General

Supreme Court to Decide Three Cases on Ability to Sue Under ERISA

"The Intel case deals with the statute of limitations for bringing a breach of fiduciary duty claim under ERISA. The Thole case involves whether participants in a fully funded defined benefit plan can sue for breach of fiduciary duty when there was no apparent effect on their benefits. And the Jander case will expand upon the Dudenhoeffer ruling as to what plaintiffs need to plead in a stock drop case to avoid the case being dismissed."
Murphy Austin

Press Releases

Most Popular Items in the Previous Issue

Remembering a True Public Servant: Alan Lebowitz
U.S. Department of Labor [DOL] Blog

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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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