Health & Welfare Plans Newsletter

November 12, 2019

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[Guidance Overview]

DOL Updates SBC Templates for Plan Years Beginning on or After January 1, 2021

"The [DOL] has issued updated summary of benefits and coverage (SBC) templates, instructions, and related materials for use in completing SBCs, as required under the [ACA]. The updated materials reflect the Tax Cuts and Jobs Act's (TCJA) reduction to zero of the penalty for violating the ACA's individual mandate. HHS also updated its SBC-related documents, which -- like the DOL's updated SBC documents -- must be used for plan or policy years beginning on or after January 1, 2021."
Thomson Reuters Practical Law

How Benefits Advocacy Programs Could Solve Employers' Health Care Challenges

"Because benefits advocacy programs have a full understanding of an individual’s health care benefits, plan details, and resources available, they’re able to provide the information, guidance, and support that the employee needs. Instead of requiring employees to piece together disparate information given by insurance providers, clinicians, etc., benefits advocacy programs give employees one person to call to receive a complete overview and understanding of their options."
BenefitsPro; free registration required

Patients Equally Satisfied with Telemedicine and In-Person Appointments

"[M]ost parents of pediatric patients were more or equally satisfied with the treatment their children received during telemedicine visits for allergies and asthma.... Of the satisfied patients, 76 percent indicated they were satisfied with telemedicine because of convenience."
Vet Candy

Google Signs Healthcare Data and Cloud Computing Deal with Ascension

"The Wall Street Journal ... reported Google [is] teaming up with Ascension to collect personal health-related information of millions of Americans across 21 states. The partnership will also explore artificial intelligence and machine learning applications to help improve clinical effectiveness as well as patient safety ... [T]he data involved in the project includes lab results, doctor diagnoses and hospitalization records, among other categories, and amounts to a complete health history, complete with patient names and dates of birth."
Reuters

Georgia Unveils Bold ACA Waiver Plan

"The state's waiver proposal has two primary phases: first is a reinsurance program to help insurers pay high-cost claims (and thus lower premiums), set to go into effect in 2021. Then there's the 'Georgia Access Model,' which starting in 2022 would: [1] Direct consumers to buy coverage through private broker or insurer websites, rather than HealthCare.gov; [2] Put the state in control of ACA subsidies; and [3] Allow health plans that don't cover all 10 of the ACA's essential health benefits (EHB) categories to be sold alongside qualified health plans (QHPs)."
AISHealth

[Opinion]

What Can the U.S. Learn from Rx Spending Controls in France?

"France [1] sets maximum prices for new products that reflect the added value of the new drug compared with a comparator product ... [2] prohibits price increases after a new drug's launch and, after five years, lowers prices and obtains additional discounts based on market competition ... [3] requires manufacturers to pay rebates if spending exceeds a national pharmaceutical spending cap set by Parliament. By employing approaches used in France, private and public payers in the U.S. could reduce drug spending without restricting access to new drugs."
The Commonwealth Fund

Selected Discussions
on the BenefitsLink Message Boards

Seeking Retroactive Reinstatement of VEBA's Exemption; IRS Penalties if Reinstatement Limited from Date of Submission?

"A client with a VEBA had its exemption automatically revoked for failure to file 990s for three consecutive years. Seeking retroactive reinstatement of the exemption. According to Rev. Proc. 2014-11, the IRS will not assess failure to file penalties against the organization if IRS grants the organization's request for retroactive reinstatement. What if the IRS does not accept the argument raised in the reasonable cause statement, in which case reinstatement would not become effective until the date the reinstatement submission was mailed? Would the IRS assess failure to file penalties for the period between the revocation date and the mailing date of the reinstatement filing?"
BenefitsLink Message Boards

Press Releases

Applications Now Open for Steven H. Sandell Grant Program
Center for Retirement Research at Boston College

Applications Now Being Accepted for Dissertation Fellowship Program
Center for Retirement Research at Boston College

Most Popular Items in the Previous Issue

CMS Announces 2020 Medicare Parts A and B Premiums and Deductibles
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

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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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