Health & Welfare Plans Newsletter

November 13, 2019

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Class Certification Denied in ERISA Health Coverage Lawsuit

"A federal district court denied class certification to health plan participants who claimed the plan promised them lifetime benefits. The court found too many individualized questions about what the plan told each participant, and the claims could not be resolved on a class-wide basis." [Fitzwater  v. Consol Energy, Inc., Nos. 16-9849 and 17-3861 (S.D. W. Va. Oct. 15, 2019)]

McDermott Will & Emery

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The Importance of Prudent Administrative Procedures and Substantive Decisions in Responding to ERISA Benefit Claims

"Two recent cases illustrate -- in differing ways -- how plan fiduciaries' missteps in dealing with benefit claims led to losses in court, and why implementation [of] best practices are essential to avoid exposure to denial of benefit litigation and the associated costs."

The Wagner Law Group

Editor's Pick Philadelphia's Portable Benefits Plan Could Be Gig Economy Model

"The City Council unanimously passed the Domestic Worker Bill of Rights ... [which] will create a portable benefits system for domestic workers -- such as housecleaners, home health aides, and nannies -- to receive paid time off. It is expected to benefit upwards of 16,000 workers right off the bat, with that number increasing in future years.... ['[W]hat happens here could be a model for millions of American workers without adequate access to benefits because they are subcontractors or juggling multiple part-time jobs or driving for Uber to supplement their income -- so-called nontraditional work arrangements'."

Fisher Phillips

Stemming the Rising Costs of Prescription Drugs: Pharmacy Benefit Managers

"In this position paper, the American College of Physicians expands on its position paper from 2016 by offering additional recommendations to improve transparency in the PBM industry and highlighting the need for reliable, timely, and relevant information on prescription drug pricing for physicians and patients."

Annals of Internal Medicine

Stemming the Rising Costs of Prescription Drugs: Public Health Plans

"The increasing price of prescription drugs is an ongoing concern for Medicare and Medicaid ... Shifts in benefit design, including higher deductibles and a movement away from copayments to coinsurance, have increased patient out-of-pocket costs and put pressure on program budgets. In this paper, the American College of Physicians ... offers additional recommendations to decrease out-of-pocket costs for patients, enhance the government's purchasing power, and address existing policies that add costs to the health care system."

Annals of Internal Medicine

ACA Round-Up: First Enrollment Report, SBC Updates, and More

"CMS reports that 177,082 consumers selected a plan [on Nov. 1 or Nov. 2] in the 38 states that use HealthCare.gov.... The new SBC includes additional information about what qualifies as minimum essential coverage.... More significant changes were made to instructional guides for group and individual plans to comply with the SBC requirement."

Katie Keith, in Health Affairs

Benefits in General

Fighting the Benefits Illiteracy Epidemic

"If employers can begin to empathize with employees' lack of understanding by providing consistent benefits training and education and empowering benefits engagement throughout the year, employees will be able to make more informed benefits decisions for themselves and their families."

HR Daily Advisor

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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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