Health & Welfare Plans Newsletter

January 10, 2020

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Self-Funding Can Give Employers More Control Over Health Plans

"The key benefits employers derive from transitioning to a self-funded program are: [1] Enhanced cost benefit transparency into every aspect of the program; [2] Expense reduction; [3] Flexibility around plan design; [4] Access to claims data; [5] Better control of claims payments and investment income on reserves. [This article provides] an overview of the actuarial components of the employer-sponsored program: projecting claims and expenses, and evaluating an employer's budget and risk tolerance."

Milliman's Healthcare Town Hall

Trends in Health Savings Account Balances, Contributions, Distributions, and Investments, 2011-2018

"Between 2011 and 2018, end-of-year account balances increased but remained low -- going from $1,990 in 2011 to $2,803 in 2018.... Average total contributions -- combined individual and employer contributions -- increased from $2,348 to $2,919 between 2011 and 2018.... 59 percent of account holders withdrew funds. The average annual amount distributed was $1,865 in 2018, implying an average rollover of $1,054."

Employee Benefit Research Institute [EBRI]

Texas v. U.S. -- The Fifth Circuit Decides

"Despite the remand to the District Court, both the House of Representatives and California, et. al. filed petitions of certiorari on January 3. Both argue that the Fifth Circuit's refusal to rule on the severability question unnecessarily prolongs the litigation (agreeing with Judge King), creates an 'intolerable situation' and 'uncertainty over the future of the healthcare sector.' Both also argue that the remaining open issue -- severability -- is a strictly legal question and therefore can and should be considered by the Court without waiting for the District Court reconsideration." [U.S. House of Representatives v. Texas, No. 19-481 (cert. pet. and motion to expedite consideration filed Jan. 3, 2020)]

Groom Law Group

Retiree Medical Benefits Vested for Life and Survived CBA Termination

"The employer asserted that the CBA contained a Term Provision which gave it the right to terminate the agreement along with the retiree health care benefits provided thereunder. The Seventh Circuit disagreed, finding that the CBA's Coverage Provision, which established the promised retiree health care coverage, 'would run independently' from the Term Provision and that the 'duration of the [retiree health care] coverage was not limited to the term of the Agreement.' The court explained that the CBA's Term Provision was 'nothing more than a durational limit' that gave the employer the right to terminate the CBA alone, and not the retiree health care benefits." [Stone v. Signode Industrial Group LLC, No. 19-1601 (7th Cir. Nov. 20, 2019)]

The Wagner Law Group

No Magic Words Needed in Employee Requests for Leave That Might Be Protected by FMLA

"The court ... allowed the claim to proceed, finding the complaint raised a plausible inference that the employee provided adequate notice of his intent to take FMLA leave. The court also found the complaint plausibly alleged that the employee's attempt to take FMLA leave and his termination were causally connected." [Waterman v. Paul G. White Interior Solutions, No. 19-032 (D. Me. Nov. 5, 2019)]

Jackson Lewis

Benefits in General

Best Practices in Administering Benefit Claims: The Three C's

"[Be] clear, be consistent, and communicate. The key to effective benefit claim administration ultimately boils down to drafting and maintaining clear plan documents, implementing and enforcing plan terms consistently, and communicating clearly with plan participants and beneficiaries."

Proskauer

Press Releases

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2019 Year in Review (PDF)
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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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