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Health & Welfare Plans Newsletter December 23, 2019 |
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Webcasts, Conferences Open Enrollment Season is Over, Now What? How to Effectively Communicate and Engage with Employees All Year Long
Global Benefits Management: Tips for Building and Maintaining an Effective Program
Holistic Perspective on Catastrophic Rehab and Recovery
Compensation, Retirement and Benefits Trends Report
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Discussions |
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[Official Guidance] Text of CMS Draft 2021 Actuarial Value Calculator Methodology (PDF) 25 pages. "The first part of this document ... includes an overview of the regulation that allows HHS to make updates to the AV Calculator as well as the updates that are incorporated into the draft 2021 AV Calculator. The second part of the document provides a detailed description of the development of the standard population and the AV Calculator methodology.... The draft 2021 AV Calculator is [available online (XLSM)] ... [T]he 2021 AV Calculator does not affect any 2020 plans, and will only be applicable for 2021 plans." Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS] |
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[Official Guidance] "This bulletin proposes guidance for purposes of establishing the submission deadlines ... for health insurance issuers to submit Rate Filing Justifications for single risk pool coverage in the individual and small group markets effective on or after January 1, 2021. This bulletin also proposes the dates on which CMS will provide public access to information regarding proposed rate changes and final rate changes for single risk pool coverage, as well as the deadline for States with Effective Rate Review Programs to post proposed rate increases subject to review." Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS] |
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[Official Guidance] Text of 2020 CMS Unified Rate Review Instructions (PDF) 48 pages. "The [Unified Rate Review Template (URRT)] has undergone significant changes from prior years; the instructions and the information requested in the Actuarial Memorandum have changed significantly. The URRT Version 5.0 [XLSM] has been updated to more closely follow the build-up from the Index Rate to the Plan Adjusted Index Rate. The URRT Version 5.0 also collects calibration factor information and geographic area rating factors." Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS] |
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[Guidance Overview] "The Cadillac Tax was officially repealed as part of the massive HR 1865 omnibus bill ... signed into law by President Trump [on Dec. 20]." ABD Insurance & Financial Services |
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[Guidance Overview] ACA Provisions In New Budget Bill "[The bill’s] ACA-related provisions ... include full repeal of various ACA taxes, marketplace-related provisions (on silver loading and auto-reenrollment), various appropriations and reporting requirements, funding for the Patient-Centered Outcomes Research Institute (PCORI), delayed cuts to disproportionate share hospital (DSH) allotments, and changes to the biosimilar approval pathway in the Biologics Price Competition and Innovation Act (which was passed as part of the ACA)." Katie Keith, in Health Affairs |
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[Guidance Overview] "The previous regulatory landscape had left employers uncertain about the role that perks and benefits played in the calculation of the regular rate of pay, particularly with respect to newer, modern perks, such as wellness programs and payments for unused paid leave. The new regulations clarify which perks and benefits must be included in the regular rate of pay, as well as which perks and benefits an employer may provide without including them in the regular rate of pay." Ogletree Deakins |
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[Guidance Overview] "[1] FDA issues a Proposed Rule to allow states and other entities to import certain prescription drugs from Canada.... [2] FDA issues draft guidance for industry to explain how drug manufacturers can import their own products intended for marketing in a foreign country. [3] It will be many months before either proposal is finalized and, even then, there are serious questions about the feasibility of implementing these policies. [4] Limited cooperation from Canada and drug manufacturers could hamper the ability of these programs to import drugs." Akin Gump |
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[Guidance Overview] Keeping Up with The Californians: More New Laws Affecting Employee Benefits (PDF) "[1] Individuals will be subject to a penalty if they do not have minimum essential coverage. This will affect employers as there will be reporting requirements and possibly increased demand for group health coverage.... [2] A new notice requirement will apply for flexible spending accounts when flexible spending account funds must be claimed prior to the end of the plan year.... [3] Mandatory arbitration not permitted ... [T]his new California law will affect plans that are not subject to ERISA." Boutwell Fay LLP |
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[Guidance Overview] Pittsburgh Paid Sick Days Act Will (Finally) Take Effect -- Prepare for the Ides of March "[T]he City of Pittsburgh's Paid Sick Days Act will go into effect on March 15, 2020.... On December 16, 2019, the Mayor's Office on Equity released official guidelines on the Ordinance ... The guidelines state that employees employed outside the city who travel to and perform work in Pittsburgh are covered, and the portion of their regular travel time in the city counts as hours worked.... The guidelines address frontloading, but are not a model of clarity ... If displaying a poster is not feasible, e.g., if an employer has remote employees, employers may provide a paper or electronic copy of the poster." Littler |
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Paid Parental Leave for Federal Workers "Employers should not be surprised if, after passing this measure, the federal government passes future legislation mandating that private-sector employers provide similar paid parental leave benefits. ... [A]lthough the focus to date has been on parental leave -- not family or medical -- it is also possible that in the future, the federal government could require employers (including private employers) to provide paid leave in these circumstances as well." Nixon Peabody LLP |
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Fifth Circuit Issues ACA Ruling, But Severability Question Remains "Even if the Supreme Court ultimately invalidated the entire law (an unlikely outcome given the Fifth Circuit's punt on the issue of severability), it would not mean immediate chaos will ensue. All three branches of government have tools at their disposal to deal with the fallout from a wholesale invalidation of the ACA." [Texas v. U.S., No. 19-10011 (5th Cir. Dec. 18, 2019)] McDermott Will & Emery |
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CMS Releases Rule to Require ACA Insurers Send Separate Bill for Abortion Coverage "CMS estimates 18 states have qualified health plan issuers that offer coverage of abortion services that under the Hyde Amendment cannot be reimbursed by federal funds. Under the rule, a qualified health plan issuer must send an entirely separate monthly bill to the customer for only the portion of their premium tied to abortion coverage. The insurer must also tell the consumer that they must pay for any abortion coverage or services." FierceHealthcare |
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Most Popular Items in the Previous Issue |
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Repeal of the Tax on Qualified Transportation Fringe Benefits Provided by Nonprofits
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