Health & Welfare Plans Newsletter

January 8, 2020

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Webcasts, Conferences

The Problem With a One-Size-Fits-All Approach to Health Care Claims: Policy Implications and Solutions
January 29, 2020 WEBCAST
EBRI [Employee Benefit Research Institute]

FMLA - Curbing the Abuse
February 12, 2020 in TX
Worldwide Employee Benefits Network [WEB] - Houston Chapter

►See 113 Upcoming Webcasts and Conferences

►See 1441 Recorded Webcasts


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[Guidance Overview]

Malfunctioning Transit Passes: Timing Is Everything

"[Chief Counsel Memorandum 201949019] clarifies that once an employer has distributed a functioning transit pass or card to employees, the benefit is considered provided ... If a card later malfunctions, even if the malfunction is not caused by the employer or employee ... the card is still treated as readily available to employees.... As a result, any cash reimbursement issued by the employer as a result of such malfunction is a taxable benefit."

Seyfarth

Court Finds Fiduciary Exception to Attorney-Client Privilege Applies to Cigna's Privileged Documents

"[A] district court in Texas held that the fiduciary exception to the attorney-client privilege prohibits Cigna from withholding privileged documents from a medical service provider related to Cigna's alleged wrongful denial of insurance claims under the NFL Player Insurance Plan." [Advanced Physicians, S.C. v. Connecticut General Life Ins. Co., No. 16-2355 (N.D. Tex. Jan. 3, 2020)]

Kantor & Kantor

Health Care Provider v. Payor Disputes: Getting Around ERISA Preemption

"[T]he court emphasized several points: In determining ERISA preemption, courts focus specifically on the rights that a provider is seeking to enforce. Because many potential claims here could be enforced under ERISA (derivatively through patients' assigning benefits), those claims would be completely preempted by ERISA and properly in federal court if Provider were seeking to enforce such claims. Here, Provider was not seeking to enforce such derivative-only ERISA claims." [Crescent City Surgical Centre v. United Healthcare of La., Inc., No. 19-12586 (E.D. La. Nov. 19, 2019)]

K&L Gates

Will the Supreme Court Take Up the Contraceptive Mandate (Again)?

"Little Sisters of the Poor wants the Court to ... determine whether the contraceptive mandate violates the Religious Freedom Restoration Act (RFRA).... The Court denied a similar appeal from Little Sisters of the Poor as recently as June 2019. But they may have done so for procedural reasons since the interim final rules at issue in that appeal were superseded by final rules that are the subject of this appeal." [Little Sisters of the Poor Saints Peter and Paul Home v. Pennsylvania, Nos. 17-3752, 18-1253, 19-1129, 19-1189 (3d Cir. Jul. 12, 2019; cert. pet. filed Oct. 1, 2019)]

Katie Keith, in Health Affairs

HSA Enrollment Rises Even as Full-Replacement Strategies Decline

"Even as some employers backed away from full-replacement strategies, enrollment in high-deductible account-based plans rose from 33% of all covered employees last year to 36% in 2019. These plans are offered by 71% of large and midsize employers, up from 68% in 2018, and by 37% of small employers."

Mercer

High-Deductible Health Plans Spur Maternity Out-of-Pocket Spending

"Between 90 and 100 percent of women with employer sponsored maternity care reported some kind of out-of-pocket healthcare spending for maternity care throughout this study. Over time, that number rose by 4.5 percent.... [T] he cost of maternity care was stable. It hovered between $29,100 and $29,700 from 2008 to 2015. Instead, women were taking on a greater share of the cost, leading to higher out-of-pocket spending."

HealthPayer Intelligence

Health Care Paperwork Cost $812 Billion in 2017

"[H]ealth care bureaucracy cost Americans $812 billion in 2017. This represented more than one-third (34.2%) of total expenditures for doctor visits, hospitals, long-term care and health insurance. The study estimated that cutting U.S. administrative costs to Canadian levels would have saved more than $600 billion in 2017."

InsuranceNewsNet.com

Bundled Payments Lowered Costs for Some Conditions, But Not for Others

"Medicare’s hip and knee replacement bundled payment models didn’t lead to a decrease in quality of care and also saved Medicare money. But bundled payments for other types of clinical episodes like heart attacks haven’t yielded similar results."

FierceHealthcare

Cancer Death Rate Is in Steady Decline Among Americans

"The cancer death rate in the United States has dropped 29 percent since 1991, the American Cancer Society reported ... The decline translates to approximately 2.9 million fewer cancer deaths than would have occurred if the mortality rate had remained constant.... [R]educed smoking rates and to advances in lung cancer treatment ... together spurred an accelerated drop in the cancer death rate of 2.2 percent from 2016 to 2017 -- the largest single-year decline in cancer mortality ever reported."

The New York Times; subscription may be required

States Ring in New Year with Ambitious New Health Laws

"A new law in Colorado protects patients from out-of-network bills, establishing a cap on what out-of-network providers can charge as well as an arbitration process to address payment disputes.... Maryland approved a first-of-its-kind prescription drug affordability board ... California enacted legislation to ban pharmaceutical companies from engaging in practices that seek to block competition by generic manufacturers ... [L]aws effective Jan. 1 in Georgia, Illinois, and Minnesota ... attack [drug prices] from a variety of angles, including forcing PBMs to be more transparent about their operations and pricing strategies and restricting them from preventing pharmacists from disclosing to patients cheaper alternatives."

Arnold Ventures

2019: The Year We Learned to Love Instability

"Here's a look at the major trends ... tracked over the past twelve months in Mercer's Center for Health Innovation, with some thoughts on how they will continue to evolve.... New entrants and partnerships are shaking up healthcare ... Patient or consumer? Healthcare attempts to strike a better balance ... Medicine advances, population health declines -- and both add to cost."

Mercer

Benefits in General

Can Employees Afford Both Retirement and HSA Plan Contributions?

"88% of HSA accountholders maintained or increased their 401(k) contributions after enrolling in an HSA. Workers who participate in both HSAs and defined contribution plans tend to save more than workers who only use one vehicle."

Voya

Selected Discussions
on the BenefitsLink Message Boards

'Opt Out' Benefits for a Small (Non-ALE) Employer

"Say you have an employer with less than 50 employees. They have no intention of ever having 50 employees. Their cafeteria plan offers an opt-out benefit for those who don't elect the employer's group health coverage. As I understand it, there can be three types of opt-out arrangements: unconditional, conditional, or an 'eligible opt-out arrangement' -- which is a conditional arrangement that also meets specific additional criteria. If the employer is a non-ALE, what is the downside, if any, to having an 'unconditional' opt-out arrangement, other than possibly affecting the affordability calculation for purposes of whether an individual is eligible for a subsidy for policies purchased on an exchange? Seems like a conditional opt-out arrangement, for a small employer, may unnecessarily restrict the employee from choosing to buy individual coverage?"

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BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2020 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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