Health & Welfare Plans Newsletter

November 8, 2019

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[Official Guidance]

CMS Releases SBC Materials and Supporting Documents Authorized for Use for Plan or Policy Years That Begin on or After January 1, 2021

"Plans and issuers will be required to use the 2021 Summary of Benefits and Coverage (SBC), the 2021 SBC Calculator Guide and Narratives, and, should they choose to use the SBC Calculator, the 2021 SBC Calculator beginning on the first day of the first open enrollment period for any plan years (or, in the individual market, policy years) that begin on or after January 1, 2021, with respect to coverage for plan or policy years beginning on or after that date."


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

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[Official Guidance]

Text of CMS Guidance: Evaluation of EDGE Data Submissions for the 2019 Benefit Year (PDF)

18 pages. "[This bulletin describes] the operational processes and metrics for when and how CMS intends to evaluate the sufficiency of data in terms of the 'quantity' and 'quality' of an issuer's EDGE server data submissions for benefit year (BY) 2019. CMS will use this evaluation to [1] determine which States will be included in the BY 2019 interim summary risk adjustment report to be published in March 2020, [2] determine which issuers will receive BY 2019 interim risk adjustment transfer reports, and [3] determine which issuers will be included in the final risk adjustment transfer calculations or be assessed a default risk adjustment charge in a State market risk pool for BY 2019, and which issuers will receive high-cost risk pool (HCRP) payments and charges for BY 2019."
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

Air Ambulances: 10 Year Trends in Costs and Use

"From 2008 to 2017, the use of helicopter ambulances declined from 34.2 to 29.3 trips -- or 14.3% -- per 100,000 people, while the use of plane ambulances remained relatively consistent at 4 trips per 100,000 people. The average price of an air ambulance trip increased substantially over the 10-year period, rising 144% (from $11,414 in 2008 to $27,894 in 2017) for helicopters and 166% (from $15,684 in 2008 to $41,674 in 2017) for planes."
Health Care Cost Institute

Look, Ma, No Deductible! JPMorgan and Amazon Try Out New Health Plans

"[T]he new Haven health plan rolled out by JP Morgan to about 30,000 employees in Ohio and Arizona has no deductible requirement at all -- a notable difference from their existing health plan and from nearly all other health plans in the US.... [T]he decision by this very prominent employer health plan sponsor to forgo a deductible ... may be pointing to a new era of less -- or more thoughtful -- employee cost sharing."
Mercer

There Is No Delay When It Comes to FMLA

"[DOL Opinion Letter FMLA2019-1-A provides] that, once the employer is given notice of the qualifying circumstances relating to the employee's leave request, the FMLA mandates that the employer designate the leave as FMLA leave even if the employee prefers otherwise.... [If] the employer provides for the accrual of seniority under a paid leave policy, then it must permit the accrual of seniority during any portion of FMLA leave that is substituted for paid leave."
Franczek P.C.

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Court Rejects ADA and ERISA Interference Claims of Employee Allegedly Terminated Due to Daughter's Disability

"Proving an ERISA Section 510 interference claim [can be] an uphill battle for an employee who must show that the employer acted with the specific intent to violate ERISA. Although this decision was favorable for the employer, it is a useful reminder of the potential danger in terminating an employee in similar situations. The employer must be prepared to present evidence demonstrating a nondiscriminatory reason for the employee's termination." [Rider v. Bluegrass Oxygen, Inc., No. 18-456 (E.D. Ky. Oct. 7, 2019)]
Thomson Reuters / EBIA

Benefits in General

Best Practices in Administering Benefit Claims: Establishing (and Following) a Good Claims Process

"The claims process ... is not generally viewed by the courts to be an adversarial process ... The fiduciary should give careful consideration to the evaluation of a participant's claims and arguments, particularly since the participant is generally entitled to all documents that are considered by the claims fiduciary in making its decision -- even if the documents are not relied upon in reaching the decision."
Proskauer

What Employee Benefits Professionals Will Be Watching in 2020

"Health and Welfare preventive care services.... Protecting against identity theft in taxes.... Rehabilitation for Multiemployer Pension Act.... SECURE act on multiple employer plans.... Part-timers and 401k plans. "
Morgan Lewis

Press Releases

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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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