Health & Welfare Plans Newsletter

November 1, 2019

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[Official Guidance]

Text of CMS Basic Health Program Final Regs: Federal Funding Methodology for Program Years 2019 and 2020

"This document provides the methodology and data sources necessary to determine federal payment amounts for program years 2019 and 2020 to states that elect to establish a Basic Health Program under the [ACA] to offer health benefits coverage to low-income individuals otherwise eligible to purchase coverage through Affordable Insurance Exchanges."
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

[Guidance Overview]

IRS Outlines How Individual-Coverage HRAs Can Meet ACA Employer Mandate

"[I]ndividual-coverage -- but not excepted-benefit -- HRAs count as an offer of MEC that can help employers avoid the 4980H(a) assessment. Whether offering individual-coverage HRAs can help avoid the 4980H(b) assessment depends on complex affordability determinations, but the proposed IRS rules provide certain safe harbors to simplify those calculations."
Mercer

[Guidance Overview]

Telehealth Is Here to Stay

"The Creating Opportunities Now for Necessary and Effective Care Technologies for Health Act of 2019 (CONNECT Act) [introduced in both houses of Congress on Oct. 30] may eliminate significant barriers Medicare beneficiaries currently face in accessing and utilizing telemedicine.... CONNECT relies on the discretion of HHS, instead of full removal of the current statutory barriers to telehealth coverage in Medicare.... CONNECT would lift telehealth restrictions during times of national emergency, permit the use of telehealth for recertification of care, and expand the types of health professionals able to provide telehealth services."
Morgan Lewis

[Guidance Overview]

Westchester County, NY Publishes Paid Safe Leave Guidance as Law Takes Effect

"The Commission's FAQs ... clarify the rate of pay employees must receive when taking leave. Specifically, employers must pay employees the hourly rate they normally earn during hours worked. However, the FAQs do not address pay calculations for employees not paid solely on an hourly basis, e.g., piece-rate workers or commission-only employees."
Littler

[Guidance Overview]

Amendments to San Antonio's Paid Sick Leave Ordinance -- and Related Developments Affecting the Lone Star State

"[This article summarizes] significant amendments to the ordinance, and notable changes made to the 'frequently asked questions' (FAQs) published by the enforcement agency. [It also provides] a brief update regarding litigation over similar ordinances in Austin and Dallas."
Littler

[Guidance Overview]

Bernalillo County, New Mexico Amends Mandatory PTO Ordinance Before the Ink Dries

"[T]he ordinance will require certain employers with a physical premise in the county's unincorporated limits to provide PTO that employees can use for any reason ... The enacted amendments generally change the law's effective date from July 1, 2020 to January 1, 2020. However, this change did not revise the law's operative date, i.e., when employers must provide, or allow employees to accrue, leave."
Littler

Controlling Healthcare Costs Through Self-Funding: A Case Study (PDF)

"The organization has had no health plan premium increases in last three years, and deductibles have actually been lowered. Reference-based pricing saves an average of 20% annually on healthcare facility charges, which accounted for 80% of the group's claims costs. Between $100,000 to $150,000 is saved annually in pharmaceutical costs[.]"
HUB International

What's Behind the 2020 Health Insurance Premium Hikes?

"According to the National Business Group on Health, the total cost of worker health benefits is expected to increase 5 percent in 2020, reaching a high of $15,000 per employee.... Although employers do not sponsor short-term plans, the expansion of these plans could affect the premiums you pay for group coverage.... The exodus of younger and healthier individuals from the risk pool can increase premiums for everyone. Also, short-term plans often are favored by employees who have lost their jobs since these plans are an affordable alternative to COBRA coverage."
Employee Benefits Report

An Array of Health Plan Choices: Open Enrollment for Federal Employees Under the FEHBP

"Choosing a health plan is like solving a puzzle. You may find plans with very reasonable premiums, but these tend to have higher deductibles and you may pay a higher percentage of coinsurance. Plans with lower cost-sharing generally have higher premiums."
Government Executive

Benefits in General

Best Practices in Administering Benefit Claims: Full and Fair Review

"What is the timing for an initial claim decision? ... What information must an adverse claim decision include? ... What is the timing for decision on appeal? ... Who decides the appeal and what information must an adverse appeal decision include? ... Special rules for group health plans."
Proskauer

Editor's Pick A Look at Teachers' Job Requirements, Employer Costs, and Benefits

"In March 2018, dental care plans were available to 53 percent of private industry workers in educational services and to 57 percent of state and local government workers. Vision care plans were available to 34 percent of state and local government workers in educational services and to 29 percent of workers in the private industry. ... [Defined benefit] plans were available to 90 percent of state and local government workers in the educational services industry. Defined contribution plans ... were available to 35 percent of state and local government workers in the educational services industry."
U.S. Bureau of Labor Statistics [BLS]

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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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